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Chapter 128 Pneumococcal Infections (Part 1) H pot

Chapter 128. Pneumococcal Infections (Part 1) H pot

Chapter 128. Pneumococcal Infections (Part 1) H pot

... capsular polysaccharides. Epidemiology Chapter 128. Pneumococcal Infections (Part 1) Harrison's Internal Medicine > Chapter 128. Pneumococcal Infections Pneumococcal Infections: Introduction ... choline residues serve as a site of attachment for potential virulence factors, such as pneumococcal surface protein A (PspA) and pneumococcal surface adhesin A (PsaA), which may prevent phagocytosis. ... the alternative pathway; the reaction between cell-wall structures and antibody (present in all humans) also activates the classic complement pathway. The result is the release of C5a, a potent...
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Chapter 128. Pneumococcal Infections (Part 3) potx

Chapter 128. Pneumococcal Infections (Part 3) potx

... nontypable Haemophilus influenzae) from cultures of the infected site. Pneumonia The distinctive symptoms and signs of pneumonia, whether due to the pneumococcus or to other bacteria, are (1) cough ... been under extreme physical and/or psychological stress and/or have had an antecedent viral-type illness that may have reduced their normal host resistance. Infections with respiratory viruses, ... follows a hyperacute pattern in which the patient suddenly has a single episode of shaking chills followed by sustained fever and a cough productive of blood-tinged sputum. In the elderly, the onset...
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Chapter 128. Pneumococcal Infections (Part 4) pot

Chapter 128. Pneumococcal Infections (Part 4) pot

... not limited to) the following: H. influenzae or Moraxella catarrhalis in persons with little to predispose them other than chronic or acute inflammation of the airways; Staphylococcus aureus, ... persons who have acute-onset inflammatory pulmonary conditions of uncertain etiology or those with pulmonary embolus and infarction. The breadth of this list vividly illustrates the deficiency ... modestly elevated in one-third of cases; hypoxia, inflammatory changes in the liver, and breakdown of red blood cells in the lung are all thought to contribute to this increase. A serum albumin...
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Chapter 128. Pneumococcal Infections (Part 5) pot

Chapter 128. Pneumococcal Infections (Part 5) pot

... often in persons who have connective tissue diseases or HIV infection. The appearance of any of these unusual pneumococcal infections may suggest that tests for HIV infection should be undertaken. ... the organisms. When obtained from a patient with pneumonia, a sample like this one is highly specific in identifying the pneumococcus as the etiologic agent. Complications Empyema is the ... of patients hospitalized for pneumococcal pneumonia. Figure 128- 2 Gram-stained sputum from a patient with pneumococcal pneumonia shows polymorphonuclear cells with no epithelial cells,...
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Chapter 128. Pneumococcal Infections (Part 8) pot

Chapter 128. Pneumococcal Infections (Part 8) pot

... others; high-dose amoxicillin remains the best option worldwide. Chapter 128. Pneumococcal Infections (Part 8) Acute Sinusitis Just as the pathogenesis and microbial etiology of acute rhinosinusitis ... isolates has been amply documented in patients treated empirically with azithromycin. As noted above, rates of resistance to all these antibiotics are lower in some countries and much higher in others; ... population where these drugs are used widely or who have themselves been treated recently with a quinolone. Clindamycin is effective in 90% of cases and doxycycline, azithromycin, or clarithromycin...
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Chapter 128. Pneumococcal Infections (Part 9) potx

Chapter 128. Pneumococcal Infections (Part 9) potx

... pneumococci; there is no clear Chapter 128. Pneumococcal Infections (Part 9) Inpatient Therapy Pneumococcal pneumonia is readily treatable with β-lactam antibiotics. The conventional dosages shown ... against pneumococci; this drug or a quinolone should be used together with a third-generation cephalosporin for initial therapy in a patient who is likely to be infected with a highly antibiotic-resistant ... younger physicians tend to treat the infection for 10–14 days. In the opinion of this author, a few days of close observation and parenteral therapy followed by an oral antibiotic—with the entire...
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Chapter 128. Pneumococcal Infections (Part 2) pptx

Chapter 128. Pneumococcal Infections (Part 2) pptx

... The liver can remove opsonized (antibody-coated) pneumococci from the circulation; in the absence of antibody, however, only the slow passage of blood Chapter 128. Pneumococcal Infections (Part ... PMNs and macrophages. Most patients hospitalized for pneumococcal pneumonia have one or more of these conditions (Table 128- 1). Once a pneumococcal infection has been initiated, the absence of ... Nonimmunologic Mechanisms Nonimmunologic mechanisms that protect against pneumonia include filtration of air as it passes through the nasopharynx, the glottal reflex, laryngeal closure, the cough reflex,...
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Chapter 128. Pneumococcal Infections (Part 6) pdf

Chapter 128. Pneumococcal Infections (Part 6) pdf

... generally <2–3% in the United States but is higher elsewhere and may be much higher in closed environments where these drugs are heavily prescribed, such as nursing homes and assisted-living ... incubated overnight at 37°C. The organism on the left is inhibited by a penicillin concentration of 0.016 µg/mL and is fully susceptible to this drug. The organism on the right is inhibited only ... mechanism; to some extent, M-type resistance can be overcome by clinically achievable levels of macrolides. In Europe, most macrolide resistance is Chapter 128. Pneumococcal Infections (Part...
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Chapter 128. Pneumococcal Infections (Part 7) doc

Chapter 128. Pneumococcal Infections (Part 7) doc

... cure with a 10-day course of amoxicillin and a single dose of azithromycin (30 mg/kg). Chapter 128. Pneumococcal Infections (Part 7) Antibiotic Regimens Otitis Media (Table 128- 4) Current ... are high. If otitis media is clearly diagnosed, high-dose amoxicillin is recommended (Table 128- 4). If this regimen fails, highly penicillin-resistant pneumococci or β-lactamase-producing Haemophilus ... pneumoniae is more likely than Haemophilus and much more likely than Moraxella to cause progression to serious complications without specific therapy. (6) Antibiotics that are effective against...
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Chapter 128. Pneumococcal Infections (Part 10) ppsx

Chapter 128. Pneumococcal Infections (Part 10) ppsx

... life-threatening infections. Others who might fall within these recommendations are persons who (1) are over the age of 65; (2) have a CSF leak, diabetes mellitus, alcoholism, cirrhosis, chronic renal ... Chapter 128. Pneumococcal Infections (Part 10) Prevention Capsular Polysaccharide Vaccine The pneumococcal capsular polysaccharide vaccine administered to adults since the early ... individuals with severe chronic lung disease), vaccine has not been shown conclusively to be effective. Persons who most need the vaccine because of poor IgG responses (e.g., those with lymphoma or...
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