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Critical care infectious disease immunocompromised

Jordi Rello, Oriol Manuel, Philippe Eggimann, Guy Richards, Christian Wejse, Jorgen Eskild Petersen, Kai Zacharowski, Hakan Leblebicioglu
This position paper is the second ESCMID Consensus Document on this subject and aims to provide intensivists, infectious disease specialists, and emergency physicians with a standardized approach to the management of serious travel-related infections in the intensive care unit (ICU) or the emergency department. This document is a cooperative effort between members of two European Society of Clinical Microbiology and Infectious Diseases (ESCMID) study groups and was coordinated by Hakan Leblebicioglu and Jordi Rello for ESGITM (ESCMID Study Group for Infections in Travellers and Migrants) and ESGCIP (ESCMID Study Group for Infections in Critically Ill Patients), respectively...
July 2016: International Journal of Infectious Diseases: IJID
Sandrine Valade, Elie Azoulay, Lionel Galicier, David Boutboul, Lara Zafrani, Alain Stepanian, Emmanuel Canet, Virginie Lemiale, Marion Venot, Agnès Veyradier, Eric Mariotte
Reactive hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition related to a cytokine storm leading to multiorgan dysfunction. A better understanding of coagulation disorders, frequently reported in HLH patients, may improve outcomes. Critically ill HLH patients managed in a multidisciplinary national reference center were retrospectively included. Relationships between coagulation disorders, severe bleedings, and outcomes were assessed. One hundred and seventeen patients fulfilled the HLH 2004 criteria...
October 2015: Medicine (Baltimore)
Xin Yu, Xinhua Ma, Yuhang Ai
OBJECTIVE: To evaluate the diagnostic and prognostic value of the serum procalcitonin (PCT) level in the non-acquired immune deficiency syndrome (AIDS) immunocompromised critically ill patients suspected to have infection. METHODS: A retrospective study was conducted in the non-AIDS immunocompromised patients who were admitted to Department of Critical Care Medicine of Xiangya Hospital, Central South University during January 2011 to December 2014. Demographic characteristics, underlying disease, acute physiology and chronic health evaluation II (APACHEII) score at admission, and clinical records including baseline and peak levels of temperature, white blood count (WBC), PCT, and survival rate within 28 days, infection focus, infectious agents (bacterial, fungi or mixed infection), and the severity of infection (sepsis, severe sepsis, or septic shock) were recorded...
June 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
R Zaragoza, R Ferrer, E Maseda, P Llinares, A Rodríguez
INTRODUCTION: Although there has been an improved management of Invasive Candidiasis in the last decade, still controversial issues remain, especially in different therapeutic critical care scenarios. OBJECTIVES: We sought to identify the core clinical knowledge and to achieve high agreement recommendations required to care for critically ill adult patients with Invasive Candidiasis for antifungal treatment in special situations and different scenarios. METHODS: Second Prospective Spanish survey reaching consensus by the Delphi technique, conducted anonymously by electronic e-mail in the first phase to 23 national multidisciplinary experts in invasive fungal infections from five national scientific societies including Intensivists, Anesthesiologists, Microbiologists, Pharmacologists and Infectious disease specialists, answering 30 questions prepared by a coordination group after a strict review of literature in the last five years...
September 2014: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
Rafael Zaragoza, Ricard Ferrer, Emilio Maseda, Pedro Llinares, Alejandro Rodriguez
BACKGROUND: Although there has been an improved management of invasive candidiasis in the last decade, still controversial issues remain, especially in different therapeutic critical care scenarios. AIMS: We sought to identify the core clinical knowledge and to achieve high agreement recommendations required to care for critically ill adult patients with invasive candidiasis for antifungal treatment in special situations and different scenarios. METHODS: Second prospective Spanish survey reaching consensus by the DELPHI technique, conducted anonymously by electronic e-mail in the first phase to 23 national multidisciplinary experts in invasive fungal infections from five national scientific societies including intensivists, anesthesiologists, microbiologists, pharmacologists and infectious disease specialists, answering 30 questions prepared by a coordination group after a strict review of literature in the last five years...
July 2014: Revista Iberoamericana de Micología
Lisa M Chirch, Philip R Cataline, Kevin D Dieckhaus, Jane M Grant-Kels
Tumor necrosis factor-alfa levels are linked to disease severity in patients with inflammatory conditions, such as psoriasis. Inhibitors of this cytokine are commonly used with significant success in the treatment of such inflammatory disorders. Their use, however, can be plagued by infectious complications. An awareness of potential infections associated with these therapies is critical in order to maximize preventive efforts both before and during therapy. This review provides a guide for dermatologists caring for patients in need of this type of biologic therapy to preemptively address the infectious risks...
July 2014: Journal of the American Academy of Dermatology
L Scudeller, C Viscoli, F Menichetti, V del Bono, F Cristini, C Tascini, M Bassetti, P Viale
INTRODUCTION: Invasive candidiasis (IC) has primarily been studied in intensive care unit (ICU) patients, although, in reality, a vast majority of these infections occur outside of the ICU. The recent publication of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines also deal with the non-ICU population, but many uncertainties remain on the management of IC, particularly in non-critically ill patients. METHODS: The Italian Society of Antimicrobial Therapy, Società Italiana di Terapia Antimicrobica (SITA), produced practical, hospital-wide recommendations on the management of Candida infection in non-immunocompromised patients in the hospital ward...
April 2014: Infection
Vivian Laquer, Tuan Ta, Tien Nguyen, Belinda Tan
Psoriasis is a chronic, auto-inflammatory disease affecting millions of individuals worldwide. In addition to classic cutaneous manifestations, the condition is linked to significant co-morbidities including cardiovascular disease, metabolic syndrome, melanoma and non-melanoma skin cancer, and psychiatric disease. Therefore, more aggressive treatment and multi-disciplinary care is critical. Measures of disease burden (quantified by anatomic location, body surface area (BSA) of involvement, and impact on daily life) assist in determining the severity of disease and have been integral in objective assessment of treatment regimens and new drug therapies...
September 2013: Dermatology Online Journal
Bianca Harris, Franklin David Lowy, Diane Elizabeth Stover, Selim Mehmet Arcasoy
Fiberoptic bronchoscopy is a valuable diagnostic tool in solid-organ and hematopoietic stem cell transplant recipients presenting with a range of pulmonary complications. This article provides a comprehensive overview of the utility and potential adverse effects of diagnostic bronchoscopy for transplant recipients. Recommendations are offered on the selection of patients, the timing of bronchoscopy, and the samples to be obtained across the spectrum of suspected pulmonary complications of transplantation. Based on review of the literature, the authors recommend early diagnostic bronchoscopy over empiric treatment in transplant recipients with evidence of certain acute, subacute, or chronic pulmonary processes...
February 2013: Annals of the American Thoracic Society
Tschudin, Sponagel, Flückiger
Fever is a frequent symptom which can arise as a consequence of bacterial, viral and parasitic infections. Additionally, fever is a frequent symptom in non-infectious diseases, e.g. autoimmune diseases or lymphomas. The term dangerous fever describes febrile conditions which are associated with high mortality and, in most cases, mandate hospitalization, and even monitoring in an intensive care unit. As a rule, infections (bacterial infections in particular) may begin harmlessly; however, they can instantaneously change into life-threatening conditions even a few days later...
October 1, 2006: Therapeutische Umschau. Revue Thérapeutique
Cristóbal León-Gil, Alejandro Ubeda-Iglesias, Ana Loza-Vázquez, María Victoria de la Torre, Juan M Raurich-Puigdevall, Bernabé Alvarez-Sánchez, Carlos Ortiz-Leyva, José María Domínguez-Roldán, Lorenzo Socías-Crespi, José Garnacho-Montero
INTRODUCTION: Caspofungin is an echinocandin with proven efficacy in invasive candidiasis (IC) and invasive aspergillosis (IA). ProCAS is a study sponsored by the Working Group of the Infectious Diseases of the Spanish Society of Intensive Care Medicine, which analyzes the effectiveness and safety of caspofungin in routine clinical practice conditions in the critically ill. METHODS: A prospective, multicenter, observational study designed to estimate the clinical effectiveness and safety of caspofungin acetate in the treatment of IC and IA in patients refractory to or intolerant of conventional antifungal therapy...
December 2012: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
Peter Rabinowitz, Lisa Conti
To date, there has been little articulation of specific One Health clinical activities for veterinary and human health care providers regarding emerging infectious diseases, yet they could play a critical role. Under current clinical paradigms, both human and animal health professionals routinely diagnose and treat zoonotic infectious diseases in their patients, but tend to work in parallel with little cross-professional communication or coordination of care. For this to evolve toward a One Health model, both types of clinicians need to see how individual cases can be "sentinel events" indicating environmental risk for disease emergence, and develop mechanisms of rapid communication about these risks...
2013: Current Topics in Microbiology and Immunology
Francisco Álvarez-Lerma, Ana Rey-Pérez
BACKGROUND: In non-immunocompromised patients admitted to intensive care departments or units (ICU), it is difficult to establish a definitive diagnosis of pulmonary aspergillosis because the signs and symptoms of this infectious disease are non-specific, and serological techniques are not very specific as well. For this reason, a diagnosis of possible pulmonary aspergillosis is initially established, and the starting of the treatment is controversial. CASE REPORT: An immunocompetent subject had a work-related accident after a fall, which resulted in multiple injuries (head, thorax, lower extremities)...
April 2012: Revista Iberoamericana de Micología
Fabien Stucker, Hans-Peter Marti, Robert E Hunger
Transplantation is the treatment of choice for many different organ failures. Despite growing experience in surgery and immunosuppression protocols, the long-term mortality of the procedure remains much higher than in the general population. Second only to cardiovascular diseases as the cause of death in organ transplant recipients, cancer is now known to be at least partly related to the immunosuppression regimen. Nevertheless, if calcineurin inhibitors have a demonstrated pro-oncogenic effect, other classes, such as mTOR inhibitors, are antiproliferative, and even demonstrated as an efficient therapy in some advanced oncological situations...
2012: Current Problems in Dermatology
A Rodríguez, L Alvarez-Rocha, J M Sirvent, R Zaragoza, M Nieto, A Arenzana, P Luque, L Socías, M Martín, D Navarro, J Camarena, L Lorente, S Trefler, L Vidaur, J Solé-Violán, F Barcenilla, A Pobo, J Vallés, C Ferri, I Martín-Loeches, E Díaz, D López, M J López-Pueyo, F Gordo, F del Nogal, A Marqués, S Tormo, M P Fuset, F Pérez, J Bonastre, B Suberviola, E Navas, C León
The diagnosis of influenza A/H1N1 is mainly clinical, particularly during peak or seasonal flu outbreaks. A diagnostic test should be performed in all patients with fever and flu symptoms that require hospitalization. The respiratory sample (nasal or pharyngeal exudate or deeper sample in intubated patients) should be obtained as soon as possible, with the immediate start of empirical antiviral treatment. Molecular methods based on nucleic acid amplification techniques (RT-PCR) are the gold standard for the diagnosis of influenza A/H1N1...
March 2012: Medicina Intensiva
Raffaele De Gaudio, Valentina Selmi, Cosimo Chelazzi
Patients admitted to cardiac intensive care units are at high risk for infections, particularly nosocomial pneumonia, pacemaker's pocket and sternotomic wound infections. These complications delay recovery, prolong hospitalization, time on mechanical ventilation, and increase mortality. Both behavioral and pharmacological measures are needed to prevent and control infections in these patients, as well as specific antibiotic treatment and nutritional support. In infected critically ill patients, pathophysiological alterations modify distribution and clearance of antibiotics, and hypercatabolic state leads to malnutrition and immune paralysis, which both contribute to increased infectious risk and worsened outcome...
April 2010: Giornale Italiano di Cardiologia
Isaline Coquet, Juliette Pavie, Pierre Palmer, François Barbier, Stéphane Legriel, Julien Mayaux, Jean Michel Molina, Benoît Schlemmer, Elie Azoulay
INTRODUCTION: The widespread use of highly active antiretroviral therapy (ART) has reduced HIV-related life-threatening infectious complications. Our objective was to assess whether highly active ART was associated with improved survival in critically ill HIV-infected patients. METHODS: A retrospective study from 1996 to 2005 was performed in a medical intensive care unit (ICU) in a university hospital specialized in the management of immunocompromised patients...
2010: Critical Care: the Official Journal of the Critical Care Forum
Theoklis Zaoutis
Seriously ill or immunocompromised children are at increased risk of invasive fungal infections, particularly candidemia. Candida albicans and Candida parapsilosis are the two most frequent causes of candidemia in pediatric patients. Candidemia in children is associated with high morbidity and mortality, increased length of hospital stays, and higher healthcare costs. Early effective antifungal therapy is the key to improved outcomes. Risk factors for candidemia may be used to identify patients suitable for empiric therapy...
July 2010: Current Medical Research and Opinion
Franz X Lackner
In infectious diseases we can discern a cause and effect chain, which in particular offers the practicable perspectives of prophylaxis and treatment. However, to date we have not been able to control them. Apart from new epidemics, such as those caused by HIV and SARS, long-forgotten scourges like TB are enjoying a comeback. Furthermore, the advances made in clinical medicine mean that induced immunosuppression, for instance as a result of major surgery or organ transplantation, has become a serious problem in intensive care units...
2007: GMS Krankenhaushygiene Interdisziplinär
Karen D Price
Opportunistic infections (OIs) during the course of non-clinical toxicity studies can serve as a clinical indicator of immunosuppression. In monkeys, severity may be magnified since the possibility for fecal-oral and cage-to-cage transmission of bacteria exists, reserve capacity is low, and clinical signs of infection are not easily detected until the infectious process is well underway. This review summarizes a case study presented at the HESI-ILSI ITC-Sponsored workshop on Naturally Occurring Infections in Non-human Primates and Immunotoxicity Implications...
April 2010: Journal of Immunotoxicology
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