Có 40+ tài liệu thuộc chủ đề "Harrisons Internal Medicine"
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Infections in Transplant Recipients. Like prophylaxis, preemptive treatment, which targets patients with polymerase chain reaction (PCR) evidence of CMV entails the unnecessary treatment of many individuals (on the basis of a laboratory test that is not highly predictive of disease) with drugs that have adverse effects. Currently, because of the neutropenia associated with ganciclovir in HSCT recipients, a preemptive approach—that...
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PCR can be used to monitor EBV production after hematopoietic stem cell transplantation. High or increasing viral loads predict an enhanced likelihood of developing EBV-LPD and should prompt rapid reduction of immunosuppression and search for a focus of disease. If reduction of immunosuppression does not have the desired effect, administration of a monoclonal antibody to CD20 (rituximab or others) for...
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Although hemorrhagic cystitis, pneumonia, gastroenteritis, and fatal disseminated infection have been reported, adenovirus infection, which (like CMV infection) usually occurs in the first or second month after transplantation, is often asymptomatic. The polyomavirus BK virus is found at high titers in the urine of patients who are profoundly immunosuppressed. CMV infection is often a problem, particularly in the first 6...
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Infections in Transplant Recipients. Kidney Transplantation. Table 126-4 Common Infections after Kidney Transplantation. Period after Transplantation. Middle (1–4 Months). Urinary tract. associated with. BK virus. BK virus (nephropathy, graft failure, generalized. Toxoplasma gondii. Note: CMV, cytomegalovirus.. Early Infections. Bacteria often cause infections that develop in the period immediately after kidney transplantation. There is a role for perioperative antibiotic prophylaxis, and...
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Infections in Transplant Recipients. Because of continuing immunosuppression, kidney transplant recipients are predisposed to lung infections characteristic of those in patients with T cell deficiency (i.e., infections with intracellular bacteria, mycobacteria, nocardiae, fungi, viruses, and parasites). The high mortality rates associated with Legionella pneumophila infection (Chap. 141) led to the closing of renal transplant units in hospitals with endemic legionellosis.....
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Infections in Transplant Recipients. Kidney transplant recipients are also subject to infections with other intracellular organisms. These patients may develop pulmonary infections with Nocardia, Aspergillus, and Mucor as well as infections with other pathogens in. monocytogenes is a common cause of bacteremia ≥1 month after renal transplantation and should be seriously considered in renal transplant recipients presenting with fever and...
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Infections in Transplant Recipients. gondii infection is important before and in the months after cardiac transplantation.. The overall incidence of toxoplasmosis is so high in the setting of heart transplantation that some prophylaxis is always warranted. monocytogenes meningitis should be considered in heart transplant recipients with fever and headache.. Ganciclovir is efficacious in the treatment of CMV infection. A subset...
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Infections in Transplant Recipients. The incidence of Pneumocystis infection (which may present with a paucity of findings) is high among lung and heart-lung transplant recipients. Some form of prophylaxis for Pneumocystis pneumonia is indicated in all organ transplant situations (Table 126-5). Prophylaxis with TMP-SMX for 12 months after transplantation may be sufficient to prevent Pneumocystis disease in patients whose degree...
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Infections in Transplant Recipients. As in other transplantation settings, reactivation disease with herpes-group viruses is common (Table 126-3). Herpesviruses can be transmitted in donor organs. Although CMV hepatitis occurs in ~4% of liver transplant recipients, it is usually not so severe as to require retransplantation. Without prophylaxis, CMV disease develops in the majority of seronegative recipients of organs from CMV-...
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Infections in Transplant Recipients. In the absence of compelling data as to optimal timing, it is reasonable to administer the pneumococcal and H. influenzae type b conjugate vaccines to both autologous and allogeneic HSCT recipients beginning 12 months after transplantation. A series that includes both the 7-valent pneumococcal conjugate vaccine and the 23-valent Pneumovax is now recommended (following CDC guidelines)....
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Infections in Transplant Recipients. Virus-Associated Malignancies. In addition to malignancy associated with gammaherpesvirus infection (EBV, KSHV) and simple warts (HPV), other tumors that are virus-associated or suspected of being virus-associated are more likely to develop in transplant recipients, particularly those who require long-term immunosuppression, than in the general population. Transplant recipients develop nonmelanoma skin or lip cancers that, in contrast...
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Table 125-3 Controlling Antibiotic Resistance: Approaches to Consider. Conduct surveillance for antibiotic resistance.. For clonal expansion (e.g., single-strain outbreaks): Stress hand hygiene (alcohol hand rub and universal gloving). For polyclonal expansion (e.g., multistrain outbreaks): Stress antibiotic prudence (consider antibiotic rotation for ICUs). see also www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf.. Currently, several antibiotic resistance problems are of particular health care concern. First, the emergence of...
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Clostridium difficile–Associated Disease, Including Pseudomembranous Colitis. Clostridium difficile–. Associated Disease, Including Pseudomembranous Colitis. difficile is an obligately anaerobic, gram-positive, spore-forming bacillus. whose spores are found widely in nature, particularly in the environment of hospitals and chronic-care facilities. CDAD occurs most frequently in hospitals and nursing homes where the level of antimicrobial use is high and the environment is contaminated by...
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Clostridium difficile–Associated Disease, Including Pseudomembranous Colitis. difficile were initially thought to be at high risk for CDAD. However, four prospective studies have shown that colonized patients actually have a decreased risk of subsequent CDAD. At least three events are proposed as essential for the development of CDAD (Fig. Exposure to antimicrobial agents is the first event and establishes susceptibility to...
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Clostridium difficile–Associated Disease, Including Pseudomembranous Colitis. Table 123-1 Relative Sensitivity and Specificity of Diagnostic Tests for Clostridium difficile–Associated Disease (CDAD). Type of Test Relative Sensitivity a. Stool culture for C. difficile isolate tests positive for toxin. with clinical data, is diagnostic. of CDAD. Cell culture cytotoxin test on stool. With clinical data,. is diagnostic of CDAD;. highly specific but not...
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Clostridium difficile–Associated Disease, Including Pseudomembranous Colitis. Although limited prospective randomized clinical trials showed no statistical differences among treatment agents for cessation of diarrhea (the primary outcome endpoint. Table 123-2), later observational studies suggest that response rates to metronidazole may have decreased. The clinical response rate for bacitracin is 10–20% lower than that for vancomycin. therefore, bacitracin use for first-line therapy...
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Clostridium difficile–Associated Disease, Including Pseudomembranous Colitis. Aslam S et al: Treatment of Clostridium difficile–associated disease: Old therapies and new strategies. Johnson S et al: Interruption of recurrent Clostridium difficile–associated diarrhea episodes by serial therapy with vancomycin and rifaximin. Clin Infect Dis PMID: 17304459]. Kyne L et al: Association between antibody response to toxin A and protection against recurrent Clostridium difficile...
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Sexually Transmitted Infections:. Overview and Clinical Approach. Sexually Transmitted Infections: Overview and Clinical Approach. Worldwide, most adults acquire at least one sexually transmitted infection (STI), and many remain at risk for complications. Each year, for example, an estimated 6.2 million persons in the United States acquire a new genital human papillomavirus (HPV) infection, and many of these individuals are at...
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Sexually Transmitted Infections:. STD care and management begin with risk assessment and proceed to clinical assessment, diagnostic testing or screening, treatment, and prevention.. Indeed, the routine care of any patient begins with risk assessment (e.g., for risk of heart disease, cancer). STD/HIV risk assessment is important in primary care, urgent care, and emergency care settings as well as in specialty...
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For certain syndromes, results of rapid tests can narrow the spectrum of this initial therapy (e.g., wet mount of vaginal fluid for women with vaginal discharge, Gram's stain of urethral discharge for men with urethral discharge, rapid plasma reagin test for genital ulcer). After the institution of treatment, STD management proceeds to the. of prevention and control: contact tracing (see...