Chest
Henry J. Woodford in Essential Geriatrics, 2022
It has been identified in three types, called A, B and C, but only A and B are clinically important. They exist in numerous subtypes due to variations in haemagglutinin (H) and neuraminidase (N) proteins. The three subtypes that commonly affect humans are H1N1, H2N2 and H3N2. Seasonal variation in virus strains also occurs. ‘Antigenic drift' causes a minor change that results in annual epidemics because the virus is able to avoid memory T cells and circulating antibodies. ‘Antigenic shift' occurs following a major change of the virus (i.e. recombination of RNA), which can lead to pandemics. The virus rarely spreads beyond the respiratory tract. Bacterial infection typically occurs at five to seven days following initial symptoms. Viral culture takes three to five days. More rapid serological tests have been developed for diagnosis. Barrier nursing can reduce the spread of infection around hospitals or care homes.
Acute erythematous rash on the trunk and limbs
Richard Ashton, Barbara Leppard in Differential Diagnosis in Dermatology, 2021
The rash occurs 10–14 days after some precipitating cause: Viral infections, especially herpes simplex. This is the commonest cause of recurrent episodes of erythema multiforme (90%).Immunisations.Bacterial infections, especially streptococcal sore throats.Mycoplasma pneumoniae infection.Drugs – sulphonamides, phenylbutazone and other non-steroidal anti-inflammatory drugs.
Skin disorders in AIDS, immunodeficiency, and venereal disease
Rashmi Sarkar, Anupam Das, Sumit Sethi in Concise Dermatology, 2021
Ganciclovir and foscarnet are indicated for cytomegalovirus complications. Aciclovir is used for herpes simplex and herpes zoster. Various antibiotics and other antimicrobials are used as indicated for bacterial infections. Fluconazole, itraconazole, and ketoconazole are particularly useful for serious and life-threatening Candida infections. Recombinant interferon-alpha 2B and other interferons have been used with some success in Kaposi’s sarcoma. The new retinoid bexarotene (Targretin®) is used topically to induce regression in individual lesions. Other cutaneous manifestations also require symptomatic treatment like topical corticosteroids (psoriasis), antipruritics (generalized pruritus), and emollients (xerosis and ichthyosis).
Development over time in point-of-care test use in Danish daytime and out-of-hours general practice: a register-based study
Published in Scandinavian Journal of Primary Health Care, 2023
Niels Kjær, Malene Plejdrup Hansen, Henrik Schou Pedersen, Morten Bondo Christensen, Linda Huibers
Infections are a common cause of serious illness worldwide [1,2]. A substantial part of contacts with general practice concerns symptoms related to infections, in particular outside office hours [3–5]. In case of a bacterial infection, antibiotic treatment can be indicated. Antibiotic prescribing patterns vary significantly [6–9], and excessive use contributes to the increasing problems with antimicrobial resistance [10]. The last decades, several point-of-care tests (POCTs), such as C-reactive protein (CRP) and Rapid streptococcal detection test (RADT), have been introduced to perform on site testing in case of suspected infections. CRP and RADT POCTs aim to support general practitioners (GPs) to identify patients who will benefit from antibiotic treatment [11,12], thereby reducing diagnostic uncertainty and contributing to prudent use of antibiotics [9,11,13–15]. A recent study found that patient age, sociodemographic factors, and comorbidity influence the decision to perform a CRP test in Danish general practice [16].
Radioimmunotherapy for the treatment of infectious diseases: a comprehensive update
Published in Expert Review of Anti-infective Therapy, 2023
Jorge Luis Costa Carvalho, Ekaterina Dadachova
The RIT of bacterial infections results are summarized in Table 2. Bacterial infections are very easily spread through various means: air, unclean food, unclean bodies of water, bodily fluids and/or physical connection from individual to individual [22]. Twenty years ago, the world saw Bacillus anthracis spores being used as a bioterrorist weapon. Such spores are found in nature, can be made in a laboratory and can survive in harsh environment conditions [23]. Anthrax has a high mortality rate [24] and, therefore, new therapy approaches against it must be considered. RIT with the antibodies to the components to the tripartite B. anthracis toxin was effective in vitro and in vivo against B. anthracis germinating spores and live cells [25,26]. While both β-emitter 188Re, and α-emitter 213Bi were used in these experiments, α-emitter 213Bi exerted more pronounced effect on bacteria. These data not only suggest that RIT can be employed to act against anthracis infection but also target toxigenic bacteria with radiolabeled monoclonal antibodies.
Using risk factors and markers to predict bacterial respiratory co-/superinfections in COVID-19 patients: is the antibiotic steward’s toolbox full or empty?
Published in Acta Clinica Belgica, 2023
Johan Van Laethem, Jan Pierreux, Stephanie CM Wuyts, Deborah De Geyter, Sabine D Allard, Nicolas Dauby
Regarding the role of PCT in predicting bacterial superinfection, various studies have found higher PCT levels in patients with documented bacterial infections. The main bacterial infections were bacteremia, lower respiratory tract infection (LRTI), and urinary tract infections. A PCT level of >0.5 ng/mL is generally considered predictive of bacterial infection in the setting of a respiratory focus. In COVID-19 patients, however, a PCT level of >0.5 ng/mL was a poor predictor of documented bacterial infection. In contrast, a PCT level of <0.5 ng/ml had a high negative predictive value in different studies [11,12,23]. Some studies have assessed different thresholds of PCT and found similar findings [11,25,27]. In a retrospective study performed in one institution in the United Kingdom (UK), patients with low levels of PCT (<0.25 ng/mL) had lower prescription rates of antibiotics. The authors suggested PCT-guided antibiotic prescription as an effective strategy to reduce antibiotic consumption. However, high PCT levels were associated with a higher risk of antibiotic prescriptions, including carbapenems. It was not reported if antibiotic prescriptions were appropriate or not, highlighting the risk of overprescription when relying on PCT levels to guide prescription [28].
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