Immunocompromising conditions

Immunocompromising conditions (excluding human immunodeficiency virus [HIV]), medications, radiation13... 

Traveler s diarrhea is identified by multiple names depending on where the disease occurs, but all describes the clinical syndrome manifested by malaise, anorexia, and abdominal cramps followed by the sudden onset of diarrhea that incapacitates many travelers. In particular, an increased risk lies with North Americans and northern Europeans traveling to Latin America, southern Europe, Africa, and Asia. The highest risk is observed with patients with immunocompromised conditions, achlorhydria, or inflammatory bowel disease and people taking diuretics, digoxin, lithium, or insulin (because of the need for appropriate hydration). Overall, an estimated 20% to 50% of people traveling to high-risk areas will develop the illness. 

Vaccination in compromised hosts (e.g., those with chronic disease, such as diabetes, connective tissue disease, or alcoholics or those with cancer or HIV disease) must be individualized based on the disease state and its treatment. The Centers for Disease Control and Prevention (CDC) has classified persons with immunocompromised conditions into three groups " ... 

The folic acid analog trimetrexate is a competitive inhibitor of bacterial and protozoan dihydrofolate reductase. This compound is currently used as a treatment for Pneumocystis carinii pneumonia (PCP) in patients with immunocompromising conditions. 

Perforated peptic ulcer First-generation cephalosporins 1. Antianaerobic cephalosporins3 2. Possibly add aminoglycoside if patient condition is poor 3. Aminoglycoside with clindamycin or metronidazole add ampicillin if patient is immunocompromised or if biliary tract origin of infection... 

Inflammation is the key factor in the development of sepsis. Patients with severe infections, trauma, debilitating conditions, or an immunocompromised status may experience an imbalance between inflammatory mediators that progresses to sepsis. 

Immunocompromised A condition in which the immune system is not functioning normally. This condition is seen in the very young, the very old, human immunodeficiency virus-infected individuals, and in transplant patients. An immunocompromised person is susceptible to opportunistic infections. 

Pneumocystis carinii pneumonia occurs in immunocompromised patients and it hence is a common cause of pneumonia in AIDS. High doses of co-trimoxazole are indicated for treatment of mild-to-moderate pneumocystis pneumonia. This condition should be treated by those experienced in its management as it can be fatal. 

The finely tuned hematopoietic system, however, sometimes breaks down. Neutropenia—decreased blood neutrophil numbers below 1800 cells/mm —is a clinical condition in which neutrophilic leukocytes in the blood fall two standard deviations below normal. Leukopenia and granulocytopenia are terms that are generally used interchangeably with neutropenia. Recurrent infections which typically are inconsequential in healthy subjects, could produce significant consequences in neutropenia, and can be devastating for immunocompromised patients. There are many acquired causes of neutropenia, with... 

Oral candidiasis - besides other predisposing factors - is a common disease in the immunocompromised patient and should remind clinicians of the possibility of HIV infection. It is often associated with esophageal manifestations. Relapsing or chronic persistent vulvovaginal candidiasis has been reported in up to 50% of HIV-infected women, therefore some authors recommend HIV testing in this condition too [58]. Resistance to antifungal drugs is a common problem... 

Propionibacterium acnes, commonly isolated from the skin, is the most frequently found anaerobe. Factors and conditions such as blepharitis, dry eye syndrome, meibomian gland dysfunction, and contact lens use may influence the composition of the normal flora or cause disruption to normal epithelial microbial barriers, either of which can lead to disease in susceptible patients. Although immunocompromised individuals may harbor Candida albicans, fungi are considered opportunistic pathogens. Little evidence supports the existence of any indigenous fungi in the normal conjunctival flora. 

Oral acyclovir is recommended for the treatment of varicella infection (chickenpox) in patients over 13 years of age who are othei vdse healthy, children over 12 months of age wdth a chronic cutaneous or pulmonary condition or receiving long-term salicylate therapy, and in children receiving short or intermittent courses of aerosolized corticosteroids. Intravenous acyclovir should be used for treatment of varicella infection in immunocompromised children, including those receiving high doses of corticosteroids. Acyclovir has been showm to be the most effective agent for the treatment of infections caused by VZV (Snoeck et al., 1999). 

Fungus infections range from inconvenient skin conditions to life-threatening systemic diseases the latter have become more frequent as opportunistic infections in patients immunocompromised by drugs or AIDS, or receiving intensive medical and surgical interventions in ICUs. 

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