Prolonged serious infection

Diffusion tests are used to determine the susceptibility of microorganisms but have their limitations when equivocal results are obtained or in the case of prolonged serious infection, e.g., bacterial endocarditis, the elucidation of antibiotic action in relation to the pathogen needs to be more precise. Also the terms susceptible and resistant are open to interpretation. Thus, when in douht, a precise assessment is needed and involves determining the MIC of the antimicrobial compounds to the organisms using the 2-fold serial dilution method, which shown in Figure 11.2 [20,24]. 

Route of administration. Parenteral therapy (which may be i.m. or i.v.) is preferred for therapy of serious infectiorrs because high therapeutic concentrations are achieved reliably and rapidly. Initial parenteral therapy should be switched to the oral route whenever possible once the patient has improved clinically and as long as they are able to absorb the drug i.e. not with vomiting, ileus or diarrhoea. Many antibiotics are, however, well absorbed orally, and the long-held assumption that prolonged parenteral therapy is necessary for adequate therapy of serious infections (such as osteomyelitis) is often not supported by the results of clinical trials. 

Neutrophils are depressed first because they renew their population every day. Neutropenia is defined as an absolute neutrophil count (ANC) 500 cells pi Patients with an ANC of less than 100 cells pi or those with prolonged neutropenia (more than 7 days) are at significantly high risk for serious infection. That risk can be reduced with prophylactic antibiotics... 

Colony-stimulating factors can be safely and effectively used with myelosuppressive chemotherapy for acute leukemias. The benefits can include reduced incidence of serious infections, reduced hospital stays, and fewer treatment delays, but do not include prolonged disease-free survival. 

Secondary immunodeficiencies (9) are much more common than primary ones and frequently occur as a result of immaturity of the immune system in premature infants, immunosuppressive therapy, or surgery and trauma. Illnesses, particularly when prolonged and serious, have been associated with secondary immunodeficiencies, some of which may be reversible. Acquked immune deficiency syndrome (AIDS) (10—12) may be considered a secondary immunodeficiency disease caused by the human immunodeficiency vimses HIV-1 or HIV-2. Hitherto unknown, the disease began to spread in the United States during the latter part of the 1970s. The agent responsible for this infection has been isolated and identified as a retrovims. 

Cryptosporidium Gastroenteritis. The protozoan called Cryptosporidium infects the linings of the intestinal tract and causes diarrhea. In healthy people, diarrhea from a Cryptosporidium infection is normally mild, lasting only a few days. However, in AIDS patients, the diarrhea is prolonged and severe. The AIDS patient may have 20-50 watery stools per day, accompanied by abdominal cramps and profound weight loss. As a result, there is a serious loss of fluid and electrolytes. 

Serious and fatal blood dyscrasias occur after short-term and prolonged therapy with chloramphenicol. Aplastic anemia, which later terminated in leukemia, has been reported. Chloramphenicol must not be used when less potentially dangerous agents are effective. It must not be used to treat trivial infections or infections other than indicated, or as prophylaxis for bacterial infections. 

In many instances, the unaided immune response to such infections can be inadequate, leading to prolonged and/or serious illness. Examples include the malaria and tuberculosis agents, the HIV virus (which has infected at least 14 million people worldwide), leishmaniasis (caused by the protozoan Leishmania, from which 12 million people suffer) and schistosomiasis, (caused by the Schistoma mansoni helminth, which currently infects approximately 250 million people worldwide). 

TMP-SMX remains the antimicrobial therapy of choice in both the treatment and prevention of infections caused by P. carinii, a protozoan that produces serious pneumonitis in patients with hematological malignancies and AIDS. In those with AIDS, treatment is more prolonged and relapse is common. These patients are at increased risk for untoward effects such as fever, hepatitis, rash, and leukopenia. 

Serious life-threatening infections, including sepsis and pneumonia, have been reported with the use of TNF inhibitors. Patients should be evaluated for tuberculosisrisk factors and tested for latent tuberculosis infection prior to starting therapy. Concurrent use with other immunosuppressive therapy should be avoided. In clinical trials of all TNF-blocking agents more cases of lymphoma were observed compared with control patients. Patients with a prior history of prolonged phototherapy treatment should be monitored for nonmelanoma skin cancers. 

Uses. Zidovudine is indicated for serious manifestations of HIV infection in patients with acquired immunodeficiency s5mdrome (AIDS) or AIDS-related complex, i.e. those with opportunistic infection, constitutional or neurological symptoms, or with low CD4 counts treatment reduces the frequency of opportunistic infections and prolongs survival when used in effective combinations. It is also indicated alone for pregnant women and their offspring for prevention of maternal-fetal HIV transmission. 

The appearance of pseudomembranous colitis in clusters of patients (143-146) may explain the wide variation in occurrence, and suggests that the disease may result from cross-contamination among patients rendered susceptible by antibiotic treatment. This is especially true for epidemic outbreaks in hospitals, where the disease may be considered a nosocomial infection favored by serious illness, frequent and prolonged use of broad-spectrum antibiotics (especially cephalosporins), and poor compliance with the rules of hospital hygiene (147). In such an epidemic, a variable proportion of... 

In adults, about 70% of those with acute HAV infection develop jaundice much more commonly than with HBV or HCV. In children, acute HAV infection typically goes unrecognized and is often considered to be a viral gastroenteritis or other viral disease, since only 10% of children become jaundiced. The disease is more prolonged and serious in individuals over age 50. The specific etiological diagnosis is made with serological tests. An IgM antibody (anti-HAV IgM) appears early in the course of illness and persists for an... 

The risk of scarring after a TCA peel is also linked to the quality of the care surrounding it. Apart from some serious cases, scars do not form immediately, but are preceded by prolonged local erythema and/or infection that should be diagnosed and treated appropriately. Many problems (see below) can be avoided by proper patient selection, and post-peel monitoring can limit others. 

Since the seat of predilection of the liver flukes is liver or biliary passage, the clinical manifestations produced by them chiefly relate to liver and gastric problems. The early stage of the infection is marked by epigastric pain, fever and eosinophilia. Later the patient experiences diarrhea, anorexia, prolonged fever and abdominal pain. In chronic cases, the disease may lead to jaundice, cirrhosis of the liver and biliary duct, ascites and cachexia. Sometimes the patient may die of serious liver complications. 

Because gram-negative and mixed aerobic-anaerobic cellulitis can progress quickly to serious tissue invasion, therapeutic intervention should be immediate. If treated early, a quick response can be seen. Unfortunately, because these infections often occur in patients with compromised immune defenses, they may still progress, even with therapeutic intervention. If the infectious process is secondary to a systemic cause (e.g., diabetes), the treatment course often is prolonged and may be associated with high morbidity and mortality. 

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