• 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...

  Serum Indicators for the Diagnosis of Pneumocystis Pneumonia (Chest)
  Treatment of Fungal Infections in Adult Pulmonary and Critical Care Patients (AJRCCM)
  
  

  Posted 12/07/16 10:43:55 AM by Anna Krigel

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