By Joshua O. Benditt, et al. American College of Chest Physicians
Instantly from the ACCP severe Care medication Board evaluate 2009 direction, this article covers each subject in a concise, easy-to-use structure. Use as a self-study source to organize for the serious care drugs subspecialty board exam.
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Extra resources for ACCP Critical Care Medicine Board Review, 20th Edition
In situations such as the acute development of pneumococcal infection, there is an immediate need for host defense that cannot wait for antibody production. It is in this setting that the alternative complement pathway (also known as the properdin system) Infections in AIDS Patients and Other Immunocompromised Hosts (Karam) becomes important. Instead of requiring an antigen-antibody complex to turn on the cascade, the alternative pathway is dependent on cell wall components such as teichoic acid and peptidoglycans found in Gram-positive organisms and lipopolysaccharides found in Gram-negative organisms.
36 Some recent attention has focused on measures that foster type 1 immunity as a means of treating patients with TB, including those who may not have responded to initial therapy. 37 In this trial, IL-2 did not enhance bacillary clearance or improvement in symptoms in HIV-seronegative adults with drugsusceptible TB. A significant change has recently occurred regarding TB infection. For many decades, the terms “preventive therapy” and “chemoprophylaxis” were used to describe the status of persons with a positive tuberculin test but no symptoms or signs of active TB.
Persons with serologic evidence of HIV infection and pulmonary TB fulfill the case definition for AIDS. 34 After initiation of antituberculosis therapy, some patients experience a paradoxical reaction, which is the temporary exacerbation of TB symptoms in the form of hectic fevers, lymphadenopathy, worsening of chest radiographic findings, and worsening of extrapulmonary lesions. These reactions are not associated with changes in M tuberculosis bacteriology, and patients generally feel well with no signs of toxicity.