Immunocompromised patient infections

Pseudallescheria boydii is a geophilic fungus causing mycetoma and may be a rare cause of pulmonary infections (especially in immunocompromised patients), infections of the CNS and inner organs as well as ear and eye infections. There has been a recent report on an unusual case of cutaneous pseudallescheriasis with pustules and erythema resistant to azole treatment [69]. 

C. parvum infections are often asymptomatic, but symptoms such as profuse watery diarrhoea, stomach cramps, nausea, vomiting and fever are typical. The symptoms can last from several days to a few weeks in immunocompetent individuals, but in immunocompromised patients infection can become chronic, lasting months or even years. The mean infective dose for immunocompetent people is dependent on the strain of C. parvum but it is considered to be approximately 100 cells, and infants are more vulnerable to infection. Diarrhoea is a major cause of childhood mortality and morbidity as well as malnutrition in developing countries. Cryptosporidium is the third most common cause of infective diarrhoea in children in such countries, and consequently it plays a role in the incidence of childhood malnutrition. 

M. H. Miceli and P. Chandrasekar, Safety and efficacy of liposomal amphotericin B for the empirical therapy of invasive fungal infections in immunocompromised patients. Infect. Drug Resist., 2012, 5, 9 16. 

Cytomegalovirus (CMV) is a herpesvirus, which causes an inapparent infection in immunocompetent persons. Worldwide, approximately 40% of people are infected with CMV. In immunocompromised patients, transplant recipients and neonates, CMV can cause serious and potentially lethal disease manifestations like pneumonia, retinitis and blindness, hepatitis, infections of the digestive tract, deafness or mental retardation. 

CMV, a virus of the herpes family, isa common viral infection. Healthy individuals may beoome infected yet have no symptoms. However, immunocompromised patients (such as those with HIV or cancer) may have the infection. Symptoms include malaise, fever, pneumonia, and super infection. Infants may acquire the virus from the mother while in the uterus, resulting in learning disabilities and mental retardation. CM V can infect the eye, causing retinitis. Symptoms of CMV retinitis are blurred vision and decreased visual acuity. Visual impairment is irreversible and can lead to blindness if untreated. 

RSV infection is highly contagious and infects mostly children, causing bronchiolitis and pneumonia. Infants younger than 6 months are the most severely affected. In adults, RSV causes colds and bronchitis, with fever, cough, and nasal congestion. When RSV affects immunocompromised patients, the consequences can be severe and sometimes fatal. 

Acyclovir (Zovirax) and penciclovir (Denavir) are the only topical antiviral dragp currently available These dragp inhibit viral replication. Acyclovir is used in the treatment of initial episodes of genital herpes, as well as heqies simplex virus infections in immunocompromised patients (patients with an immune system incapable of fighting infection). Penciclovir is used for the treatment of recurrent herpes labialis (cold sores) in adults. 

Antiviral drugp interfere with viral reproduction by altering DNA synthesis. These drug are used in the treatment of herpes simplex infections of the eye, treatment in immunocompromised patients with cytomegalovirus (CMV) retinitis, and for the prevention of CMV retinitis in patients undergoing transplant. 

Ison MG, Gubareva LV, Atmar RL, Treanor J, Hayden EG (2006a) Recovery of drug-resistant influenza virus from immunocompromised patients a case series, J Infect Dis 193 760-764 Ison MG, Mishin VP, Braciale TJ, Hayden EG, Gubareva LV (2006b) Comparative activities of oseltamivir and A-322278 in immunocompetent and immunocompromised murine models of influenza virus infection, J Infect Dis 193 765-772... 

Cytomegalovirus (CMV) Enveloped, icosahedral particles 150nm in diameter CMV is generally acquired in childhood as a subclinical infection. About 50% of adults carry the virus in a dormant state in white blood cells. The virus can cause severe disease (pneumonia, hepatitis, encephalitis) in immunocompromised patients. Primary infections during pregnancy can induce serious congenital abnormalities in the fetus... 

Once infected with M. tuberculosis, a person s lifetime risk of active TB is about 10%, with about half this risk evident during the first 2 years after infection.2,3,6 Young children, the elderly, and immunocompromised patients have greater risks. HIV-infected patients with M. tuberculosis infection are roughly 100 times more likely to develop active TB than normal hosts owing to the lack of normal cellular immunity.3,9... 

Shigella strains invade intestinal epithelial cells with subsequent multiplication, inflammation, and destruction.8 The organism infects the superficial layer of the gut, rarely penetrates beyond the mucosa, and seldom invades the bloodstream. However, bacteremia can occur in malnourished children and I immunocompromised patients. 

Twenty percent of HIV-infected patients develop fluconazole-resistant Candida albicans isolates after repeated exposure to fluconazole.33 To treat fluconazole-resistant oropharyngeal candidiasis, daily itraconazole for 2 to 4 weeks may be used. Oral itraconazole solution exhibits a mycological cure rate of 88% and a clinical cure rate of 97% in immunocompromised patients.34 Fluconazole-resistant esophageal candidiasis should be treated with intravenous amphotericin B or caspofungin. 

Immunocompromised patients on fluconazole with progressive sinus or pulmonary disease by radiography should be evaluated for possible mold infection. 

In some helminth infections, a migration through various body tissues is essential for maturation, as in ascarasis or schistosomiasis, whereas in other infections, the larva leaves the egg and simply matures in the intestinal tract, as in trichuriasis and enterobiasis. Host tissues involved vary depending upon the parasite. In severely immunocompromised patients, sites may be involved that are not involved in normal hosts. 

Pseudomonas aeuruginosa 6.30/5567 (75) Severe opportunistic infections can be lethal in immunocompromised patients and patients with extensive full thickness burns... 

Amphotericin B (AmB) is a broad-spectrum antifungal agent that is the antibiotic of choice for disseminated fungal infections, particularly in immunocompromised patients. AmB is also used for the treatment of Leishmaniasis as a second-line treatment. However, its toxicity toward mammalian cells is often dose limiting, whatever its indication. 

Very severe life-threatening infections, especially in immunocompromised patients ... 

Herpes simplex virus (HSV) /nfecf/ons Treatment of acyclovir-resistant mucocutaneous HSV infections in immunocompromised patients. 

Ganciclovir capsules are indicated only for prevention of CMV disease in patients with advanced HIV infection at risk for CMV disease and for maintenance treatment of CMV retinitis in immunocompromised patients. 

Neonatal herpes simplex virus infection Treatment of neonatal herpes infections. Parenteral Treatment of initial and recurrent mucosal and cutaneous herpes simplex virus (HSV)-I and -2 and varicella-zoster virus (VZV/shingles) infections in immunocompromised patients. 

Chickenpox Although chickenpox in otherwise healthy children is usually a self-limited disease of mild to moderate severity, adolescents and adults tend to have more severe disease. Treatment was initiated within 24 hours of the typical chickenpox rash in the controlled studies, and there is no information regarding the effects of treatment begun later in the disease course. IV acyclovir is indicated for the treatment of varicella-zoster infections in immunocompromised patients. 

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