Infectious episodes

Clinically, GM-CSF or G-CSF have been used to accelerate recovery after chemotherapy and total body or extended field irradiation, situations that cause neutropenia and decreased platelets, and possibly lead to fatal septic infection or diffuse hemorrhage, respectively. G-CSF and GM-CSF reproducibly decrease the period of granulocytopenia, the number of infectious episodes, and the length of hospitalization in such patients (152), although it is not clear that dose escalation of the cytotoxic agent and increased cure rate can be rehably achieved. One aspect of the effects of G-CSF and GM-CSF is that these agents can activate mature cells to function more efficiently. This may, however, also lead to the production of cytokines, such as TNF- a, that have some toxic side effects. In general, both cytokines are reasonably well tolerated. The side effect profile of G-CSF is more favorable than that of GM-CSF. Medullary bone pain is the only common toxicity. 

Dervieux, T., Medard, Y., Verpillat, P., et al. (2001) Possible implication of thiopurine S-methyltransferase in occurrence of infectious episodes during maintenance therapy for childhood lymphoblastic leukemia with mercaptopurine. Leukemia. 15, 1706-1712. 

Throughout the observational period of the clinical trial, the patients were reported to be in good clinical condition without experiencing any severe infectious episodes [515130],... 

Hematological toxicity was analysed in 199 patients treated with a high-dose intravenous bolus aldesleukin regimen for metastatic melanoma or renal cell carcinoma (60). Anemia requiring transfusions was noted in 14% of all treatment courses and severe thrombocytopenia occurred in 2.2%, with three patients suffering from serious hemorrhages. Severe leukopenia was infrequent and not associated with infectious episodes. Early transient lymphopenia (93% reduction) was followed by rebound lymphocytosis up to 198% above baseline values. Except for severe thrombocytopenia, treatment withdrawal was... 

In patients with renal transplants, the overall incidence of infections during the first three posttransplantation months was significantly higher in one trial of patients treated with prophylactic muromonab or ciclosporin (39), but there was no significant difference in the severity of infections in another similar trial (40). Both studies failed to identify any adverse impact of infectious episodes on patient survival. In a comparison of prophylactic ATG-Fresenius with muromonab there were more common... 

There has been a lot of debate on the optimal timing of VCU relative to the infectious episode. Should examination be performed during acute infection or 1-2 weeks later There is no scientific consideration to sustain one hypothesis or the other. In our opinion, VCU is an important examination in children with a history of infection simply because reflux has been shown to be... 

Total infectious episodes rather than incidence of VAP. 

Infections are the major cause of morbidity and mortality during the first year following kidney transplantation 80% of grafted patients experience at least one infectious episode. The risk of infection is associated, in particular, with the cumulative dose of immunosuppression, nosocomial environmental factors (water, operating room, air conditioning), the presence of foreign materials (central and urinary catheters), and the patient s nutritional and metabolic status (diabetes, renal insufficiency, cardiac insufficiency). 

On the contrary, there are numerous reports of outbreaks of faecal-oral waterborne infectious diseases following heavy rain episodes. 

Polyclonal antibody preparations have been used for several decades to induce passive immunization against infectious diseases and other harmful agents, particularly toxins. The antibody preparations are usually administered by direct i.v. injection. While this affords immediate immunological protection, its effect is transitory, usually persisting for only 2-3 weeks (i.e. until the antibodies are excreted). Passive immunization can be used prophylactically (i.e. to prevent a future medical episode) or therapeutically (i.e. to treat a medical condition that is already established). An example of the former would be prior administration of a specific anti-snake toxin antibody preparation to an individual before they travel to a world region in which these snakes are commonly found. An example of the latter would be administration of the anti-venom antibody immediately after the individual has experienced a snake bite. 

Persons with mutations that partially destroy G6PDH activity may develop an acute, episodic hemolysis. Certain mutations affect the stability of G6PDH, and, because erythrocytes cannot synthesize proteins, the enzyme is gradually lost over time and older red blood cells lyse. This process is accelerated by certain drugs and, in a subset of patients, ingestion of fava beans. In the United States, the most likely cause of a hemolytic episode in these patients is overwhelming infection, often pneumonia (viral and bacterial) or infectious hepatitis. 

Maintenance dose - When the desired response is attained, titrate the dose to maintain the response based on factors such as variations in zidovudine dose and the presence of intercurrent infectious or inflammatory episodes. If hemoglobin exceeds 13 g/dL, stop the dose until hemoglobin drops to 12 g/dL. 

Dual therapy with ciclosporin and prednisone has been compared with triple therapy with ciclosporin, prednisone, and azathioprine in a randomized trial in 250 renal transplant patients (13). Patients in the triple therapy group had less frequent severe episodes of acute rejection and more frequent episodes of leukopenia than the double therapy group (28% versus 4%). There were no other differences in the adverse effects profiles, in particular the incidence of infectious comphcations. 

Isolated and intermittent drug fever with a spiking pattern has been attributed to mycophenolate in a 41-year-old man with a renal transplant (38). The relation to treatment was confirmed by the exclusion of numerous infectious causes, the persistence of fever despite ciclosporin withdrawal, subsidence of fever after mycophenolate withdrawal, and the absence of further episodes of fever during follow-up. 

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