By Joshua O. Benditt, et al. American College of Chest Physicians
Immediately from the ACCP serious Care medication Board evaluate 2009 path, this article covers each subject in a concise, easy-to-use layout. Use as a self-study source to organize for the severe care medication subspecialty board exam.
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Extra resources for ACCP Critical Care Medicine Board Review, 20th Edition
Example text
This may be especially notable in patients who have received a bone marrow transplant or solid organ transplant. In AIDS patients with the concomitant problems of neutropenia, corticosteroid therapy, or ethanol use, invasive pulmonary or disseminated aspergillosis may occur. This tends to present in the later stages of HIV infection, especially when CD4+ cells are Ͻ50/L. 42 Aspergillus infection and its treatment provide some important insights into the evolving clinical importance of type 1 immunity.
It is this substance that stimulates macrophages to better ingest and kill pathogens. In contrast to polymorphonuclear leukocytes, macrophages can readily ingest microorganisms but have a difficult time with intracellular killing. 2 Some of the disorders and clinical situations associated with defects in cell-mediated immunity are listed in Table 5. With aging alone, patients have a decrease in cell-mediated immunity. 31 Immunosuppressive drugs (including corticosteroids and cyclosporine) and HIV infection are associated with defects in this limb of host defense.
83 Even with the overwhelming success of measles immunization programs, this case has prompted reappraisal of recommendations and some have suggested that it may be prudent to withhold measles-containing 31 vaccines from HIV-infected persons with evidence of severe immunosuppression. Emerging Viral Pathogens in Persons With Defects in Cell-Mediated Immunity There have been increasing reports of infections caused by respiratory syncytial virus or parainfluenza virus, particularly in persons who have received bone marrow or solid organ transplantation.