infectious disaeases Flashcards
where is crp synthesized
liver
crp production is controlled by
il-6
what is hs CRP?
A high-sensitivity CRP (hs-CRP) test measures low levels of CRP using laser nephelometry. The test gives results in 25 minutes with a sensitivity of 0.04 mg/L.
(Page 1348).
Where is procalcitonuiin synthesized during normal conditions
thyroid parafollicular c cells
In bacterial infection, PCT is ubiquitously synthesized in multiple extrathyroidal tissues.
(Page 1348).
in which infewctious conditions an increase in pct is seen
increase in pct is seen in bacteriaemia ,gram negative more than gram positive , less in fungaemia and viral and intra cellular infections
half life o0f pct
less than 24 hours
pct falsae positives
steroids. PCT can be elevated in renal impairment, severe trauma and surgery or in patients after cardiac shock, acute graft-versus-host disease, immunotherapy, autoimmune diseases, and paraneoplastic syndromes.
(Page 1349).
what are positive aand negative acute phase reactants ?
in reaction to infection and release of cytokines the liuver up regulate the synthersis of certain proteins ( poisitive acute phase reactants ) and downregulatews the synthesia of some ( negative acute phase reactants )
give the names of positive and negative acute phase reactants
positive C-reactive protein, mannose-binding protein,[2] complement factors, ferritin, ceruloplasmin, serum amyloid A and haptoglobin
negative : albumin,[8] transferrin,[8] transthyretin,[8] retinol-binding protein, antithrombin, transcortin.
is the mortality for hiv patients in the icu more ?
NO, N OWADAYS HIV INFECTED AND NON INFECTEF PATIENTS HAVE SIMILAR MORTALITY AND the prognosis is more related to the acute illness leading to admission
most commom reason for icu admission for hiv patients
The most common cause overall for admission to intensive care remains respiratory failure. Previously the predominant cause for this was PJP, but bacterial pneumonia and non-HIV-related respiratory illnesses such as chronic obstructive pulmonary disease (COPD) and asthma are increasing in prevalence.
(Page 710).
what is window period in hiv detection ?
It may take a number of weeks for HIV antibody to become positive during seroconversion.
(Page 711). Most patients who develop HIV will have positive antibodies by 3 months after their exposure to the virus; after this time, absence of HIV antibodies excludes HIV infection in almost all cases.
(Page 711).
what is IRIS ?
IRIS is a complication related to the commencement of antiretroviral therapy and the subsequent reconstitution of the immune system. The syndrome can lead to a worsening of treated opportunistic infections or even unmask untreated infections.
(Page 712).
IN Which patients is IRIS comkmon ?
infections. IRIS is more common in those patients with a history of cytomegalovirus retinitis, cryptococcal meningitis and tuberculosis,
(Page 712).
treatment of IRIS
infection. ART is usually continued if mild IRIS develops. Corticosteroids, other immunosuppressive agents and even cessation of ART may be considered for the management of severe IRIS.11–13
(Page 712).
should ART be continued in the icu
tes if possible
name some common art drug interactions
efavirenz and protease inhibitors are potent enz inhibitors of the cyt p 450 enzyme system.
in case of AIDS related opportunistic infections should art therapy be instituted in the icu ?
in case of mjost opportunistic infections therapy started vin the icu itself leads to0 better outcomes.
exceptions are cjmv meni9ngitis and tubercul;ar meningitis where the iris reactions may be particularly stro9ng.
critical finding in pneumocystis pneumoniua
hypoxia
definitive diagnosis of pneumocyustis pneumonia
A definitive diagnosis is made by demonstrating Pneumocystis cysts in an induced sputum specimen, bronchoalveolar lavage fluid or a transbronchial biopsy.
(Page 713).
treatment of severe pneumocystosis pneumonia
iv cotrimoxazole
steroids if p/f ratio less than 140 or alveolar arterial gradient greater than 35
what is to be done hypersensitivity reactions to cotrimoxazole
the drug is to be continued in case ofg
mild hypersensitivity reactions
only in severe reactions iv pentamidine is to be used
which patients should receive pneumocystis prophylkaxis?
cd4 count vless than 200
Most common comp-licaqtion assosciated with pneumopcystis
pneumothorax, low tidal volume ventlation
most cmmon cryptococcal infec tion in hiv
cryptocovval meningitis
peculiar featires of cryptococcal meningitis found in hiv
minimal inflammation and neck rigidity
also minimal signs of csf inflammation
how is cryptococcal meningitis diagnpo0sed
detection of cryptococcal antifen in serum an d csf
how to treat cryptococcal meningitis
iv amphotericin and 5 fc …followed by fluconaziole top prevent relapses
how to diagnosetoxoplasma encep[halitis
Toxoplasmosis can be diagnosed by ring enhancing lesion found on the CT scan or by serological evidence of toxoplasmosis. to differentiate with cns malignaanmncies Toxoplasmosis can be diagnosed by ring enhancing lesion found on the CT scan or by serological evidence of toxoplasmosis to differentiate to differentiate with us brain biopsy may be used
What is the treatment of toxoplasmosis
Treatment is oral pyrimethamine, together with either intravenous sulfadiazine or clindamycin. Hypersensitivity reactions to sulfadiazine and clindamycin are common, and an alternative drug regimen may be necessary.
(Page 714).
what is The most common site for reactivation of CMV infection
(Page 714).
retina
in which pastients does cmv occur
CMV disease most often occurs in patients with very severe immunodeficiency (CD4 T-cell count <50/mL).
(Page 714).
when to remove 1. bloodc t5ransfusion sets
2. pressure transducers 3. propofol lines 4. all other lines
- 24 hrs 2.96 hrs
- 12 hrs
- 2 to 4 daysew
what is the order of colonization in the icu
MV; the oropharynx is the first site to be colonized by pathogens (36 hours), followed by the stomach (36-60 hours), the lower respiratory tract (60-84 hours), and the ETT thereafter (60-96 hours).
(Page 612).
when is the risk of developing vap more early or late during the icu stay?
MV; the oropharynx is the first site to be colonized by pathogens (36 hours), followed by the stomach (36-60 hours), the lower respiratory tract (60-84 hours), and the ETT thereafter (60-96 hours).
(Page 612).
most common viral etiology of vaP
HSV 1
ROLE OF CUFF MATERIAL IN PREVENTING VAP
In particular, the polyurethane cuff has a thickness of 5 to 10 µm, in comparison to 50 µm for PVC cuffs. Hence, upon inflation, smaller folds form with polyurethane cuffs, and aspiration of secretions above the cuff can be prevented or reduced. Some investigators have attempted to prevent aspiration by modifying the shape of the cuff.161 In comparison to standard cuffs with cylindrical shapes, cuffs designed with a smooth, tapering shape allow elimination of folds for a full circumference of the trachea or cuff contact zone, irrespective of the cuff material.
(Page 615).
roloe of ventilatory settings
effects of 5 to 8 cm H2O PEEP in normoxemic ventilated patients and showed a reduction in the rate of VAP.
(Page 615).
role of specialloy treated ett
In conclusion, ETT coated with antimicrobial agents could reduce the incidence of VAP, but the evidence supporting its use comes only from one study, with significant limitations.180
(Page 615).
(Page 615).
has closded tracheal suctioning found to have any advantage
no
is there any advantage ofd hme or heated humidifiers in vap prevention ? how soon should they be changed ?
no role of hme or heated humidifiers in vap prevention anmd changing them frequentrly has no role in vaop prevention
they should be changed in 72 hours for humidiofication efficacy
role of chlorhexidine oral decontamination
oral decontamination with chlorhexidine should be routinely used, specifically in cardiothoracic patients. In other ICU populations, the use of higher chlorhexidine concentrations could be a promising option. Alternatively, some investigators recently tested once-daily bathing of all patients with disposable cloths impregnated with 2% chlorhexidine as a preemptive strategy for nosocomial infections, but they did not find any significant benefit with this approach.233
(Page 616).
