By Joshua O. Benditt, et al. American College of Chest Physicians
Directly from the ACCP serious Care medication Board overview 2009 direction, 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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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.
45 Listeria may be acquired via consumption of certain contaminated raw vegetables (with coleslaw as a source in some outbreaks), certain contaminated canned products (with sterile canned corn kernels as the source in one outbreak), raw food from animal sources (eg, beef, pork, or poultry), unpasteurized milk, or foods made from raw milk (notably, certain soft cheeses). The most common clinical presentations are of CNS infection, sepsis, or a flu-like illness. When it causes acute meningitis, Listeria may be associated with a variable glucose level or with a CSF lymphocytosis or monocytosis.
Infection in the HIV population may present as a noninflammatory infection of the CNS, and the clinical features are therefore different from what one might expect in classic forms of meningitis caused by other pathogens. The history is frequently of a subacute or chronic illness associated mainly with headache. Physical examination may not reveal classic findings such as nuchal rigidity. Because of the lack of inflammation in the CNS, the CSF formula may include Ͻ20 WBC/mm3, normal glucose, and normal protein.