Communicable diseases
Liam J. Donaldson, Paul D. Rutter in Donaldsons' Essential Public Health, 2017
Chagas disease is caused by a protozoan parasite, Trypanosoma cruzi. It largely occurs in Latin America, where around 7 million people are affected. It is starting to appear in some other countries. Its main route of infection is via the faeces of triatomine bugs, but it can result from blood transfusion or transplantation of organs. In the early stages of infection, symptoms are mild and nonspecific, although in a proportion of people there is a characteristic unilateral purple swelling of the eyelid. If the infection is not treated, it progresses so that parasites enter the heart, bowel or nervous system. It can then become life threatening. In the early stage of infection, antimicrobial drugs are highly effective but therapeutic benefit wanes the longer the person has the disease. Insecticide spraying in and around homes (the vector bug lives in the cracks and crevices within houses) can be very effective in destroying this vector.
Dental Disease, Inflammation, Cardiovascular Disease, Nutrition and Nutritional Supplements
Stephen T. Sinatra, Mark C. Houston in Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
A hallmark of periodontal disease management is biofilm control involving mechanical debridement and pharmacotherapeutics which include oral rinses, systemic antibiotics and other biofilm reduction strategies based on disease severity. Pathogens identified by the most common microbial tests are classified in two taxa: facultative and anaerobic. This data plus data about their concentration can help determine if antibiotic antimicrobial therapy should be used to help stabilize the disease. Antimicrobial therapy may be used systemically or locally with use of antiseptics and topically applied medications. However, without knowing the virulence and pathogenic properties of the bacteria, there is no organized way to determine which patients are best suited for which antimicrobials. Salivary tests help identify the bacteria present to guide the use and selection of medicaments and antimicrobials. The graphical portion of the report shows the types of pathogens present, and the pathogen load (Figure 14.3).
HIV and AIDS Pain
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
In HIV, cholangitis is usually associated with opportunistic infection, malignancy, or immunologic destruction of the biliary epithelium. Manifestations include sclerosing cholangitis and/or papillary stenosis. Cryptosporidium and CMV are the most commonly identified associated infections. The clinical presentation is similar to that of cholecystitis. The alkaline phosphatase is usually markedly elevated, with minimally elevated transaminases and bilirubin, and a CD4 count <100. Ultrasound or CT will usually show dilated biliary ducts. Evaluation with endoscopic retrograde cholangiopancreatography (ERCP) is indicated, during which biopsy and bile cultures may be obtained. Stents can be placed to relieve obstruction from strictures, and sphincterotomy may help treat pain in some cases (Slaven et al., 2003). Celiac plexus neurolysis should be considered in patients with refractory pain (Collazos et al., 1996). Antimicrobial therapy is indicated when an infection is identified.
The war against bacteria, from the past to present and beyond
Published in Expert Review of Anti-infective Therapy, 2022
Lucrezia Bottalico, Ioannis Alexandros Charitos, Maria Assunta Potenza, Monica Montagnani, Luigi Santacroce
Antimicrobial therapy should be performed, whenever possible, with molecules that target pathogenic microorganisms showing sensitivity to the antimicrobial agent administered; however, for infections sustained by unknown microorganisms of undetermined sensitivity, treatment is generally initiated on an empirical basis with molecules able to interfere with a wide spectrum of pathogens; moreover, under specific circumstances, antimicrobial agents might be administered for preventing infections in vulnerable subjects. The most desirable features of an antibiotic substance to be useful for therapy are as follows: (a) a selective toxicity (higher antimicrobial activity and lower toxicity to human tissues), (b) a minimum risk of hypersensitivity reactions in the host, (c) a reduced interference with the human microbiota, (d) the appropriate pharmacokinetic characteristics (absorption, distribution, metabolism, and excretion), and (e) a low economic cost. Thus, the correct choice of the appropriate antibiotic/antimicrobial agent depends on multiple factors, recapitulated in Figure 2 [12].
Inhibition of Candida albicans and Staphylococcus aureus biofilms by centipede oil and linoleic acid
Published in Biofouling, 2020
Yong-Guy Kim, Jin-Hyung Lee, Jae Gyu Park, Jintae Lee
Antimicrobial agents either inhibit bacterial growth or kill microorganisms, ideally without harming the host or the environment. However, overuse of these agents has caused the worldwide emergence of drug-resistant pathogens that pose serious life-threatening issues. Microbial biofilms produced by sessile communities play an important role in antimicrobial resistance and in a variety of device-related infections (Donlan 2002; Hall-Stoodley et al. 2004; Simoes et al. 2010). Multispecies biofilms of Candida albicans and Staphylococcus aureus already demonstrated increased tolerance to conventional antimicrobial agents (Harriott and Noverr 2009; 2011; Peters et al. 2013). Hence, alternative strategies are required to control these pathogenic biofilms. Unlike conventional strategies based on antimicrobial agents that aim to inhibit planktonic cell growth, it is important to reduce the risk of drug resistance (Wright 2015).
Empirical antimicrobial therapy for bloodstream infections not compliant with guideline was associated with discordant therapy, which predicted poorer outcome even in a low resistance environment
Published in Infectious Diseases, 2022
Kornelius Grøv, Erling Håland, Bjørn Waagsbø, Øyvind Salvesen, Jan Kristian Damås, Jan Egil Afset
To describe the appropriateness of administered antimicrobial therapy, several methods were applied. The Norwegian national guideline for the appropriate use of antimicrobial therapy in hospitals was used to evaluate whether the initiated empirical regimen was compliant or not [28]. Empirical antimicrobial therapy was considered concordant or discordant depending on whether or not the patient received antimicrobial therapy that covered the detected pathogen based on ID and AST. If the microbe had not been tested for any of the given empirical antimicrobials, inferred values from antimicrobials within the same class were used, as recommended by EUCAST and NordicAST in 2019 [29]. If the AST report did not contain sufficient information for definite classification, the concordance of empirical antimicrobial therapy was classified as partial or uncertain. Targeted antimicrobial therapy was defined as any antimicrobial therapy given after the AST report was released by the microbiology department. Dosing of antimicrobial therapy was registered only for episodes with BSIs caused by S. aureus and treated with third-generation cephalosporins. In all other cases, dosing regimens were presumed to follow the standard regimen for each drug.
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