Patients pneumonia

Pneumogstis carini pneumonia (PCP), the most common of the opportunistic infections, occurs in more than 80% of AIDS patients (13). Toxoplasmosis, a proto2oan infection of the central nervous system, is activated in AIDS patients when the 004 count drops and severe impairment of ceU-mediated immunity occurs. Typically, patients have a mass lesion(s) in the brain. These mass lesions usually respond well to therapy and can disappear completely. Fungal infections, such as CTyptococcalmeningitis, are extremely common in AIDS patients, and Histop/asma capsulatum appears when ceU-mediated immunity has been destroyed by the HIV vims, leading to widespread infection of the lungs, Hver, spleen, lymph nodes, and bone marrow. AIDS patients are particularly susceptible to bacteremia caused by nontyphoidal strains of Salmonella. Bacteremia may be cleared by using antibiotic therapy. 

Fluoroquinolones in the treatment of pneumonia in elderly patients 99MI34. 

In patients infected with HIV (human immunodeficiency virus), the helper cell population is weakened to the point where the immune system is no longer able to function properly. The body thus becomes susceptible to otherwise nonlethal diseases such as pneumonia. 

ALS is a disorder of the motor neurons and the cortical neurons that provide their input. The disorder is characterized by rapidly progressive weakness and muscle atrophy. Most affected patients die of respiratory compromise and pneumonia after 2 to 3 years. There is prominent loss of motor neurons in the spinal cord and brainstem although the oculomotor neurons are spared. Large pyramidal motor neurons in layer V of motor cortex, which are the origin of the descending corticospinal tracts, are also lost. 

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. 

This drug is used cautiously in patients with peripheral vascular disease, neuropathy, chronic pancreatitis, or impaired liver function. Didanosine is a Pregnancy Category B drug and is used cautiously during pregnancy and lactation. There may be a decrease in the effectiveness of dapsone in preventing Pneumocystis carinii pneumonia when didanosine is administered with dapsone Use of didanosine with zalcitabine may cause additive neuropathy. Absorption of didanosine is decreased when it is administered with food. 

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... 

Some comatose patients are unconscious for less than 2 hours, do not show signs of severe toxicity, and have few complications. In other patients, coma lasts from 2 to 24 hours, and symptoms are more marked. Patients with severe toxicity, including status epi -lepticus and malignant hyperthermia, may remain in coma for 1 day to 3 weeks. These patients often have respiratory or metabolic acidosis. Comatose patients are susceptible to aspiration pneumonia and rhabdomyolysis. Head injury and intracerebral bleeding should be considered as the cause of the comatose state. 

May be preferred in patients whose risk of hospital-acquired pneumonia (HAP) is greater than upper gastrointestinal bleed. Data suggests a lower incidence of HAP when compared with H2-receptor antagonist... 

Nosocomial bacterial pneumonia developing in patients on mechanical ventilation... 

In general, it is suggested that patients remain up to date on standard immunizations. Patients with HF should be counseled to receive yearly influenza vaccinations. Additionally, a pneumococcal vaccine is recommended. Usually only one pneumonia vaccination is necessary unless a patient is vaccinated before age 65. In that case, a booster vaccination is suggested 5 years after the initial vaccination. 

Airway clearance therapy is a necessary routine for all CF patients to clear secretions and control infection, even at diagnosis prior to becoming symptomatic. Waiting until development of a first pneumonia or until daily symptoms are present delays benefits and may contribute to a faster pulmonary decline. 

Vaccination against hepatitis A and B is recommended in patients with underlying cirrhosis to prevent additional liver damage from an acute viral infection.35 Pneumococcal and influenza vaccination may also be appropriate and can reduce hospitalizations due to influenza or pneumonia. 

In summary, the settings in which fluid replacement is used are hypovolemic patients (e.g., sepsis or pneumonia) hypervolemic patients [e.g., congestive heart failure (CHF), cirrhosis, or renal failure] euvolemic patients who are unable to take oral fluids in proportion to insensible losses (e.g., the perioperative period) and patients with electrolyte abnormalities (see below). 

TO, a 77-year-old male nursing home resident is admitted to the hospital with a 3-day history of altered mental status. The patient was unable to give a history or review of systems. On physical examination the vital signs revealed a blood pressure of 100/60 mm Hg, pulse 110 beats per minute, respirations 14/minutes, and a temperature of 101°F (38.3°C). Rales and dullness to percussion were noted at the posterior right base. The cardiac exam was significant for tachycardia. No edema was present. Laboratory studies included sodium 160 mEq/L (160 mmol/L), potassium 4.6 mEq/L (4.6 mmol/L), chloride 120 mEq/L (120 mmol/L), bicarbonate 30 mEq/L (30 mmol/L), glucose 104 mg/dL (5.77 mmol/L), BUN 34 mg/dL (12.14 mmol/L), and creatinine 2.2 mg/dL (194.5 pmol/L). The CBC was within normal limits. Chest x-ray indicated a right lower lobe pneumonia. 

Influenza and pneumonia are common preventable infectious diseases that increase mortality and morbidity in persons with chronic diseases including DM.5 Yearly influenza vaccinations, commonly called flu shots, are recommended for patients with DM. Pneumococcal vaccination also is recommended for patients with DM as a one-time vaccination for most patients. 

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