Pulmonary infections, risk patients

RA alone leads to changes in cellular immunity and causes a disproportionate increase in pulmonary infection and sepsis.11 Because medications that alter the immune system are linked to an increased risk of infection, it is difficult to distinguish between an increased risk of infection secondary to RA and the medications used to treat RA. Patients and clinicians must pay close attention to signs and symptoms of infection because of this increased risk.11... 

Therapy of coccidioidomycosis is difficult, and the results are unpredictable. Only 5% of infected persons require therapy. Candidates for therapy include those with severe primary pulmonary infection or concurrent risk factors (e.g., human immunodeficiency virus infection, organ transplant, or high doses of glucocorticoids), particularly patients with high complement fixation antibody titers in whom dissemination is likely. 

B. Indications and nse Daily administration of Pulmozyme in conjunction with standard therapies is indicated in the management of cystic hbrosis patients to improve pulmonary function. In patients with a forced vital capacity (FVC) >40% of predicted. Daily administration of Pulmozyme has also been shown to reduce the risk of respiratory tract infections requiring parenteral antibiotics. 

Patients with coexisting cardiovascular and pulmonary conditions (e.g., ARDS, pulmonary infection, pulmonary aspiration) may be more susceptible to the toxic effects or complications of tricyclic antidepressant poisoning. The influence of chronic exposure to tricyclic antidepressants on the risks of an acute overdose is unclear. Tricyclic antidepressants interact with other central nervous system depressant drugs, which together may lead to increased central nervous system and respiratory depression. 

A number of noncardiac events may also be associated with heart failure decompensation. Pulmonary infections frequently cause worsening of heart failure. At least some of these events would be preventable with more widespread use of the pneumococcal and influenza vaccines in these patients. Recent studies suggest that anemia occurs frequently in patients with heart failure and that it is associated with reduced survival and functional status and increased risk of hospitalization. Although correction of anemia with agents such as epoetin-a may improve symptoms, the effect on prognosis awaits the results of ongoing clinical trials. 

Chronic infection with C burnetii is usually manifested by infective endocarditis, which is also the most severe complication of Q fever. In addition, a report73 from France of 92 cases published in 1993 also listed hepatitis, infected vascular prostheses and aneurysms, osteomyelitis, pulmonary infection, cutaneous infection, and an asymptomatic form. In addition, 7 of the 92 patients described in this report experienced fever only. Also noted was the observation that although 81% of patients had an identifiable risk factor, only 31% lived in a rural area. In addition, some form of immunodeficiency was observed in 20% of the patients, raising the possibility that chronic Q fever occurs as a result of reactivation of latent infection.73 Inflammatory pseudotumor of the lung as a chronic complication of Q fever has also been reported.74,75... 

In a retrospective study of rheumatoid arthrihs pahents treated with leflunomide risk factors of severe infections were identified. Among the 401 patients that started on leflxmomide therapy, 8.2% developed severe infections (pneumonia, oral candidiasis, pyelonephrihs, pulmonary tuberculosis, cellulitis, disseminated herpes zoster, tonsil-lihs and pulmonary cryptococcosis). Risk factors for severe infections were older age, presence of diabetes mellitus and (increasing) daily dosage of corticosteroids [Sl ]. 

Infection risk In an attempt to examine the incidence of serious respiratory infections in patients with rheumatoid arthritis treated with tocilizumab, data from clinical trials and extension studies (tocilizumab cohort), and age- and sex-standardised rheumatoid arthritis patients treated in daily clinical practice in a Tokyo women s facility (subsample cohort), were analysed. Rates of serious respiratory infections were 1.77/100 patient-years from 1999 to 2008 in the tocilizumab cohort studies and 0.53/100 patient-years from 2000 to 2009 in the subsample cohort. After standardising for corticosteroid use, pre-existing pulmonary involvement and disease activity, the risk of serious respiratory infection in the tocilizumab cohort was approximately double that in the subsample cohort regarded as a standard population [209 ]. There may also be an increased risk of disseminated Staphylococcus infections, in particular Staphylococcus aureus, in patients with rheumatoid arthritis treated with tocilizumab [210 ]. 

Mechanically ventilated patients are at risk for pulmonary infections for several reasons (58-60). The natural glottic closure protective mechanism is compromised by an endotracheal tube. The tube itself impairs the cough reflex and serves as an additional potential portal for pathogens to enter the lungs, especially if the circuit is contaminated. The lung is more prone to infections, because of the underlying disease. And the intensive care unit environment is itself a risk for a variety of infections. 

The clinical scenario and the severity of the volume abnormality dictate monitoring parameters during fluid replacement therapy. These may include a subjective sense of thirst, mental status, skin turgor, orthostatic vital signs, pulse rate, weight changes, blood chemistries, fluid input and output, central venous pressure, pulmonary capillary wedge pressure, and cardiac output. Fluid replacement requires particular caution in patient populations at risk of fluid overload, such as those with renal failure, cardiac failure, hepatic failure, or the elderly. Other complications of IV fluid therapy include infiltration, infection, phlebitis, thrombophlebitis, and extravasation. 

Imipenem-cilastatin is one of the drugs of first choice for the empirical therapy of many polymicrobial pulmonary, intraabdominal, and soft tissue infections. The notable adverse effect of imipenem-cilastatin is seizures affecting 1% of patients. Risk factors for seizures are old age, head trauma, previous seizure disorder, cerebrovascular accident, and renal failure. Among patients with a history of penicillin allergy, 10% are cross-sensitive to imipenem-cilastatin. 

---