By Joshua O. Benditt, et al. American College of Chest Physicians
Immediately from the ACCP serious Care drugs Board overview 2009 path, this article covers each subject in a concise, easy-to-use structure. Use as a self-study source to organize for the severe care drugs subspecialty board exam.
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38 It acknowledged the role of LTBI as an important element in control of TB. 40 Based on such facts, it is recommended that HIV-infected persons with a tuberculin skin test with Ն5-mm induration be given treatment for latent tuberculosis. In the 2000 guidelines for treatment of LTBI, tuberculin positivity was also set at Ն5-mm induration for patients with organ transplants and other immunosuppressed patients receiving the equivalent of Ն15 mg/d of prednisone for 1 month or more. The risk of TB increases with a higher dose and longer duration of corticosteroids.
Following the onset of the AIDS epidemic in the early 1980s, PCP was most often diagnosed in HIV-infected persons. 85 Host defense against Pneumocystis includes humoral immunity; however, because of the overwhelming predominance of infection by this pathogen in HIV-infected persons, it has been included in this section of pathogens that infect patients with defective cell-mediated immunity. Although diffuse interstitial infiltrates are the most characteristic pulmonary finding with PCP, patients may present with focal infiltrates, cavitary 32 lesions, or nodular lung lesions.
Gram stain of the CSF is positive in only about one fourth of patients. The infection has a predilection for the base of the brain with resultant focal neurologic signs, particularly cranial nerve involvement, in up to 40% of patients. 50 Even though the organism has been rarely reported to cause infection in immunocompetent patients, immunocompromised patients, especially those with HIV infection, are the ones most likely to develop clinical disease due to this pathogen. The most characteristic pattern of infection is described as a progressive pneumonia that may cavitate.
ACCP Critical Care Medicine Board Review, 20th Edition by Joshua O. Benditt, et al. American College of Chest Physicians