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Toxoplasma Gondii

General Considerations A. Epidemiology. Toxoplasma gondii infection, or toxoplasmosis, is a zoonosis (the definitive hosts are members of the cat family). The two most common routes of infection in humans are by oral ingestion of the parasite and by transplacental (congenital) transmission to the fetus. Ingestion of undercooked or raw meat that contains cysts or of water or food contaminated with oocysts results in acute infection. In humans, the prevalence of toxoplasmosis increases with age. There are also considerable geographic differences in prevalence rates (eg, 10% in Palo Alto, CA; 15% in Boston, MA; 30% in Birmingham, AL; 70% in France; = 90% in El Salvador). Differences in the epidemiology of …

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Toxoplasma Gondii: Treatment

A. Infection in Immunocompetent Adults and Children. Immunocompetent adults and children with toxoplasmic lymphadenitis do not require treatment unless symptoms are severe or persistent. Infections acquired by laboratory accident or transfusion of blood products are potentially more severe, and these patients should always be treated. The combination of pyrimethamine, sulfadiazine, and folinic acid for 4-6 weeks is the most commonly used and recommended drug regimen (Box 2). Treatment should be administered for 2-4 weeks, followed by reassessment of the patient’s condition. The decision to treat active toxoplasmic chorioretinitis should be based on the results of an examination performed by an ophthalmologist. Pyrimethamine and sulfadiazine plus folinic acid are commonly used for …

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Pneumocystis Carinii

Essentials of Diagnosis Pneumocystis carinii, when examined using molecular techniques, most closely resembles a fungus. Stains of either bronchoalveolar-lavage (BAL) or transbronchial-biopsy samples yield a diagnosis in > 90% of patients and should be considered the gold standard in diagnosis. BAL with transbronchial biopsy increases diagnostic yield to ~ 100%. P carinii has not yet been cultured in vitro. Polymerase chain reaction (PCR) (especially on sputum) increases sensitivity but reduces specificity. The prophylactic use of aerosolized pentamidine reduces the sensitivity of sputum and bronchoscopic samples. General Considerations A. Epidemiology. In 1983, P carinii pneumonia (PCP) was described as the AIDS-defining illness in = 60% of the first 1000 patients diagnosed with …

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Extrapulmonary P Carinii Infections

Extrapulmonary P carinii infections occur in < 3% of patients and must be diagnosed with histopathologic samples. Primary prophylaxis for PCP with pentamidine may confer a higher risk for extrapulmonary infection. Symptoms of extrapulmonary involvement are nonspecific, usually consisting of fevers, chills, and sweats. Although any area of the body may be involved, splenomegaly with cysts and thyroiditis are most common. Diagnosis The practice of diagnosing PCP morphologically by traditional staining methods (silver methenamine and toluidine blue) of induced sputum samples in HIV-infected individuals has fallen out of favor. Although relatively simple and inexpensive, staining of sputum samples induced by hypertonic saline inhalation is clearly dependent on operator and laboratory experience, …

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Actinomycetes

Actinomycetes are variably acid-fast, gram-positive bacilli that are sometimes filamentous and branched. Originally thought to be fungi due to their hyphae-like appearance, they are now recognized as bacteria based on their cell wall components, reproduction by fission without sporulation or budding, inhibition by antibacterial agents, and molecular phylogenetic analysis. The actinomycete chromosomes contain a high content of guanosine and cytosine. The actinomycetes include the genera Mycobacterium and Corynebacterium, which are discussed in site and site, respectively. The actinomycetes also include the genera Nocardia, Actinomyces, Rhodococcus, Tsukumurella, Gordona, Actinomadura, and Streptomyces, as well as the Whipple’s disease bacillus Tropheryma whippelii. Of these, members of the genus Nocardia are the most significant from …

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Other Mycobacteria

Essentials of Diagnosis Demonstration of the acid-fast bacillus. Infections more common in immunocompromised hosts. Infections mainly pulmonary or soft tissue. General Considerations The increasingly relative importance of the atypical mycobacteria, many of which are ubiquitous in the environment, was recognized with the decline in tuberculous disease. Generally, atypical mycobacteria are unusual causes of disease in patients who are immunocompetent but can in immunocompromised hosts such as AIDS and cancer patients. Most infections caused by atypical mycobacteria are skin and soft tissue abscesses, sometimes following pulmonary infection or implantation of prosthetic devices. There have been a few reports of epidemics of iatrogenic infection with atypical mycobacteria, associated with injection of contaminated materials. …

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Buy Generic Trecator-sc (Ethionamide) No Prescription 250mg

Ethionamide: Side Effects See also Antituberculosis drugs Ethionamide is a synthetic derivative of thio-isonicotinamide. The initial oral dosage for adults is 250 mg/day, slowly increasing up to 15-20 mg/kg/day (maximum 1 g/day). Protionamide is a pyridine derivative of ethionamide. The dosage is 250-300 mg/day. Ethionamide and protionamide have often proved to be effective in non-tuberculous mycobacterial infections. Acute rheumatic symptoms and difficulty in the management of diabetes have been reported. Organs and Systems Nervous system Mental depression, weakness, drowsiness, and hypotension are not rare in patients taking ethionamide or protionamide. Other neurological reactions include diplopia, olfactory disturbances, metallic taste, dizziness, paresthesia, headache, and tremor. Psychological, psychiatric Psychotic reactions have been described …

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Parasitic Infections

What does the infectious disease specialist mean by parasitic infection? Most infectious agents fulfill the definition of a parasite: an organism that grows, feeds, and shelters on or in a different organism and contributes nothing to the host. However, medical science has created the classification “parasite” to include a complex group of nonfungal eukaryotic human pathogens. Unlike fungi, parasites have no cell wall and are often motile. In addition, many parasites require two or more host species to complete their life cycle, and they reproduce both sexually and asexually. The host in which sexual reproduction takes place is called the “definitive host,” and the one in which asexual reproduction occurs is …

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Specific Causes Of Acute Community-Acquired Pneumonia

Great overlap occurs among the clinical manifestations of the pathogens associated with acute community-acquired pneumonia. However, constellations of symptoms, signs, and laboratory findings serve to narrow the possibilities. By developing an ability to focus on a few pathogens or to identify a specific pathogen, clinicians can better predict the clinical course of pneumonia and can narrow antibiotic coverage. Streptococcus pneumoniae Pathogenesis Pathogenic strains of S. pneumoniae have a thick capsule that prevents PMN binding and that blocks phagocytosis. Certain capsular types (1, 3, 4, 7, 8, and 12 in adults, and 3, 6, 14, 18, 19, and 23 in children) account for most pneumonia cases. Type 3 has the thickest polysaccharide …

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Infectious disorders

Infectious diseases comprise those illnesses that are caused by microorganisms or their products. Clinical manifestations of infection occur only when sufficient tissue injury has been inflicted directly by microbial products (e.g., endotoxins and exotoxins), or indirectly by host responses (e.g., cytokines and hydrolytic enzymes released by polymorphonuclear leukocytes). Despite the extraordinary recent advances that have occurred in therapeutics for infectious diseases, a number of basic principles should be followed to prescribe antimicrobials and vaccines is an optimal manner. This chapter addresses the broader issues of treating infectious diseases and provides a number of practical clinical examples to demonstrate rational therapeutics. A rational therapeutic strategy in the management of proved or suspected …

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