-
Induction immunosuppression therapy in renal transplantation
- rabbit antithymocyte globulin (rATG-thymoglobulin) or alemtuzumab/Campath-1H (humanized monoclonal antilymphocyte antibody)
Maintenance immunosuppression therapy
- calcineurin inhibitor - tacrolimus
- antimetabolite - mycophenolate mofetil
- steroids - prednisone 1mg/kg then gets tapered after week 1
Most amount of immunosuppression is required for lung and small bowel transplants, least amount is needed for liver transplants, heart and kidney transplants fall in the middle
Posted 12/07/16 10:14:04 AM by Anna Krigel
-
Branching gram positive rods
- Nocardia - partially acid fast, most commonly causes pneumonia but can be disseminated especially to the CNS in immunosuppressed patients
- Actinomyces - more commonly causes ENT/sinusitis infections
Posted 12/07/16 10:16:12 AM by Anna Krigel
-
Ribavirin - has known activity against RSV and shown to have activity against human metapneumovirus in vitro; systemic and inhaled ribavirin has been use to treat human metapneumovirus, but inhaled version is exorbitantly expensive and essentially taken off the market
Posted 12/07/16 10:24:55 AM by Anna Krigel
-
Fungal pneumonias tend to cause nodular pneumonias, except for PCP which causes more of a patchy alveolar process
Posted 12/07/16 10:25:41 AM by Anna Krigel
-
Causes of fungitell false positives:
- Hemodialysis with cellulose membranes
- Albumin
- IVIG
- Gauze packing on serosal surfaces (post-op)
- Some IV antibiotics (though Zosyn commonly causes falsely elevated galactomannan but not Fungitell)
- Infections with certain bacteria that contain cellular beta glucans, such as Pseudomonas aeruginosa
Posted 12/07/16 10:30:02 AM by Anna Krigel
-
Risk factors for PCP in HIV-uninfected patients
- Glucocorticoid use - median dose in one large case-series was 30mg/day, though some patients received as little as 16mg/day
- Defects in cell-mediated immunity
- Hematologic malignancies
- Hematopoietic cell or solid organ transplantation
- Organ rejection
- Treatment for certain inflammatory conditions, particularly rheumatologic diseases
Posted 12/07/16 10:39:08 AM by Anna Krigel
-
For further reading...
Posted 12/07/16 10:43:55 AM by Anna Krigel