Shorter Course Antibiotic Therapy (SCAT): Principles, Current Data, and Caveats
Lautenbach Ebbing in Antimicrobial Resistance, 2007
This chapter provides an overview of the background and available evidence for the use of shorter course antibiotic therapy (SCAT) for selected infectious diseases. Effective use of SCAT should decrease the number and amount of antibiotics prescribed, improve outcomes, particularly in terms of better adherence, and reduce adverse effects, complications, and selection of antibiotic-resistant pathogens. The literature on SCAT for tonsillopharyngitis is difficult to interpret, due to differences in study design, adherence issues, and inconsistent endpoints. Bacteriologic eradication and clinical success rates were equivalent, but there were three cases of rheumatic fever and one of acute glomerulonephritis in the SCAT group versus one patient with acute glomerulonephritis in the 10-day group. SCAT may be possible and should be studied in patients with no underlying diseases who are currently treated as outpatients and those who are younger or have a prompt response to initial therapy.
Case 39 Autoimmune Hemolytic Anemia 243
Raif Geha, FRED Rosen in Case Studies in Immunology, 2008
There are only a few conditions in which the infection has been identified as the direct cause of the autoimmune disease. We have seen how some infections with Streptococcus pyogenes may lead to rheumatic fever (see Case 29). Some strains of S. pyogenes lead to a type III autoimmune disease (caused by immune-complex formation; see also Case 43) of the renal glomeruli called post-streptococcal acute glomerulonephritis. These streptococcal strains are said to be nephritogenic (causing nephritis). About 3-4% of children infected with a nephritogenic strain of streptococcus will develop acute glomerulonephritis within a week or two of the onset of the streptococcal infection. What predisposes this subset of children to develop the complication is unknown.
Renal transplantation
Harold Ellis in Operations that Made History, 2018
Organ homotransplantation, without saintly intervention, has had to wait until just a few years ago for similar success. At the end of the eighteenth century, John Hunter transplanted teeth from one person to another with success, and also demonstrated that a human tooth could be transplanted to a cock's comb, teeth apparently being relatively inert antigenically. In the early twentieth century, Alexis Carrel, the pioneer of the vascular suture, carried out renal transplantations in dogs. He was clearly aware that although he could overcome the technical surgical problems, he was defeated by the biology of transplantation. By 1961, at least twenty-five more renal transplantations had taken place between human identical twins; of these, the Boston team performed seventeen. Three of their patients died, one from thrombosis of the renal vessels and two from glomerulonephritis of the transplant in patients who had suffered from it before surgery.
Familial risks of glomerulonephritis – a nationwide family study in Sweden
Published in Annals of Medicine, 2016
Delshad Saleh Akrawi, Xinjun Li, Jan Sundquist, Erik Fjellstedt, Kristina Sundquist, Bengt Zöller
Objective: Familial risks of glomerulonephritis (acute, chronic and unspecified glomerulonephritis) have not been studied. This study aims to determine the familial risks of glomerulonephritis. Methods: Individuals born from1932 onwards diagnosed with glomerulonephritis (acute [n = 7011], chronic [n = 10,242] and unspecified glomerulonephritis [n = 5762]) were included. The familial risk (Standardized incidence ratio = SIR) was calculated for individuals whose parents/full-siblings were diagnosed with glomerulonephritis compared to those whose parents/full-siblings were not. The procedure was repeated for spouses. Familial concordant risk (same disease in proband and exposed relative) and discordant risk (different disease in proband and exposed relative) of glomerulonephritis were determined. Results: Familial concordant risks (parents/full-sibling history) were: SIR = 3.57 (95% confidence interval, 2.77–4.53) for acute glomerulonephritis, SIR = 3.84 (3.37–4.36) for chronic glomerulonephritis and SIR = 3.75 (2.85–4.83) for unspecified glomerulonephritis. High familial risks were observed if two or more relatives were affected; the SIR was 209.83 (150.51–284.87) in individuals with at least one affected parent as well as one full-sibling. The spouse risk was only moderately increased (SIR = 1.53, 1.33–1.75). Conclusions: Family history of glomerulonephritis is a strong predictor for glomerulonephritis, and is a potentially useful tool in clinical risk assessment. Our data emphasize the contribution of familial factors to the glomerulonephritis burden in the community.Key MessagesThe familial risks (full-sibling/parent history) of glomerulonephritis (acute, chronic and unspecified glomerulonephritis) have not been determined previously.The familial risks of glomerulonephritis were increased among individuals with family history of acute, chronic or unspecified glomerulonephritis.The familial risks of glomerulonephritis were slightly increased among spouses indicating a modest non-genetic contribution.Very high familial risks were observed in multiplex families, i.e. with one or more affected first-degree relatives.
Some Aspects of the Natural History and Treatment of Chronic Glomerulonephritis
Published in Postgraduate Medicine, 1962
Inapparent streptococcal infection may be complicated by equally inapparent (latent) glomerulonephritis which leads eventually to active chronic glomerulonephritis. Photomicrographs are presented illustrating the progression, in one year, from latent glomerulonephritis related to type 12 streptococci to an early nephrotic state with hypertension. The discouraging outlook of nephrotic glomerulonephritis in adults forces the consideration of heroic therapy with massive doses of corticosteroids, but it is not yet established whether or not such therapy is justified in latent chronic glomerulonephritis without the nephrotic state.
Crescentic glomerulonephritis with antimyeloperoxidase antibodies developing during the course of IgA nephropathy in a patient with rheumatoid arthritis
Published in Modern Rheumatology, 2001
M. Uchiyama, T. Akahoshi, T. Matsui, H. Watabe, K. Koredo, S. Tanaka, T. Matsuo, H. Tatsumi, K. Kamata, Y. Kobayashi, H. Kondo
Glomerulonephritis, such as membranous nephropathy, IgA nephropathy, and p-antineutrophil cytoplasmic autoantibody (ANCA)-related crescentic glomerulonephritis, has been shown to occur in rheumatoid arthritis (RA). However, the occurrence of two types of glomerulonephritis in a patient with RA is rarely observed. Here, we describe a patient with RA who developed crescentic glomerulonephritis with antimyeloperoxidase (MPO) antibodies during the course of IgA nephropathy. This case indicates that crescentic glomerulonephritis and IgA nephropathy may occur together in association with p-ANCA in RA.
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