Disseminated diseases

Liposomal amphotericin B (AmBisome) may be more appropriate for disseminated disease. 

Adult patients with acquired immune deficiency syndrome (AIDS) demonstrate an acute form of disseminated disease that resembles the syndrome seen in infants and children. 

Patients with mild, self-limited disease, chronic disseminated disease, or chronic pulmonary histoplasmosis who have no underlying immunosuppression can usually be treated with either oral ketoconazole or IV amphotericin B. 

In 0.5% to 3.0% of patients with gonorrhea, the gonococci invade the bloodstream and produce disseminated disease. The usual clinical manifestations of disseminated gonococcal infection are tender necrotic skin lesions, tenosynovitis, and monoarticular arthritis. 

Approximately 10% of patients develop reactivation disease, which arises subsequent to the hematogenous spread of the organism. In the United States, most cases of TB are believed to result from reactivation. Occasionally, a massive inoculum of organisms may be introduced into the bloodstream, causing widely disseminated disease and granuloma formation known as miliary TB. 

Disseminated disease can cause neurologic deficits from CNS metastases, bone pain or pathologic fractures secondary to bone metastases, or liver dysfunction from hepatic involvement. 

Infections Corticosteroids may mask signs of infection, and new infections may appear during their use. There may be decreased resistance and inability of the host defense mechanisms to prevent dissemination of the infection. Restrict use in active tuberculosis to cases of fulminating or disseminated disease in which the corticosteroid is used for disease management with appropriate chemotherapy. Corticosteroids may exacerbate systemic fungal infections and may activate latent amebiasis. 

Stwngyloides stercoralis infection is acquired, like hookworm, from filariform larvae in contaminated soil that penetrate the skin. This parasite maintains itself for many decades in the small intestine asymptomatically. Persons treated with immunosuppressive drugs or who are debilitated by chronic illness may be at risk for widespread tissue invasion or hyperinfection syndrome. Prompt treatment may be life saving in disseminated disease. 

Ciprofloxacin and ofloxacin are effective for gonococcal infection, including disseminated disease, and ofloxacin is effective for chlamydial urethritis or cervicitis. Ciprofloxacin is a second-line agent for legionellosis. Ciprofloxacin or levofloxacin is occasionally used for treatment of tuberculosis and atypical mycobacterial infections. They may be suitable for eradication of meningococci from carriers or for prophylaxis of infection in neutropenic patients. 

The most common initial signs and symptoms inclnde congh, dyspnea, chest pain, spntnm prodnction, and hemoptysis. Many patients also exhibit systemic symptoms snch as anorexia, weight loss, and fatigne. Disseminated disease can canse nenrologic deficits from CNS metastases, bone pain or pathologic fractnres secondary to bone metastases, or liver dysfunction from hepatic involvement. 

Coccidioides immitis is a dimorphic fungus that grows in soil in much of the southwestern United States infection results from inhalation of airborne C. immitis arthroconidia. Coccidioidomycosis is not transmitted from person to person. Approximately 60% of infected persons are asymptomatic the remainder can develop a spectrum of disease from mild influenza-like illness to pneumonia to disseminated disease, including meningitis. Because the incubation period for this infection ranges from 1 to 4 weeks, persons who may... 

Habitat of Paracoccidioides brasiliensis is the soil of semitropical areas along rivers and agricultural areas in Latin America. In children, acute dissemination causes severe illness, often associated with pustules or subcutaneous abscesses. In adults (mainly males) - usually many years after an asymptomatic primary pulmonary infection - chronic disseminated disease leads to mucocutaneous lesions (ulcerating papules and pustules, subcutaneous cold abscesses, sometimes scrofuloderma-like manifestations), especially around nose or mouth in about half of the patients. Itraconazole is the drug of choice. 

The prognosis for an infent with neonatal HSV infection is guarded. Treatment of the conjunctivitis should include topical 1% trifluridine every 2 hours until the infection begins to resolve and then tapered according to the clinical response. Systemic therapy with intravenous acyclovir is indicated in the presence of viremia and disseminated disease. 

Late, disseminated disease and chronic Lyme disease... 

Ghose, T. Norvell, S.T. Guclu, A. Bodurtha, A. Tai, J. MacDonald, A.S. Immunochemotherapy of malignant melanoma with chlorambucil-bound antimelanoma globulins preliminary results in patients with disseminated disease. J. Natl. Cancer Inst. 1977, 58, 845-852. 

Neonatal HSV infection occurs in 1 3500 to 1 5000 deliveries in the United States. It is most commonly acquired by intrapartum contact with infected maternal genital secretions and is usually caused by HSV type 2. In tlie newborn there are three general presentations of the disease skin, eye, and mouth disease accounts for approximately 45% of infections, encephalitis accounts for 35%, and disseminated disease accounts for 20%. As disseminated disease is often associated with neurological disease, CNS disease occurs in about 50% of newborns with neonatal HSV infection. 

Cryptococcal meningitis is the most common form of fnngal CNS infection in the United States and is a major canse of morbidity and mortality in immnnosnppressed patients. In the United States, 85% of cases occur in HIV-infected patients. C. neoformans is a soil fungus acquired by inhalation of spores from the environment leading to a pneumonia, which is nsnaUy asymptomatic. Most patients present initially with disseminated disease, especially meningoencephalitis. The incubation period in AIDS patients may be very short, as opposed to a relatively normal host, in whom it may be very long. 

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