Author: Brian Holtry

Erythrocytic asexual phase

This begins with penetration into red blood cells by merozoites arising from the exoerythrocytic schizonts in the liver cells. The parasites grow rapidly, and a large central vacuole forms in the cytoplasm leading to the so-called ring form.

Management of Sepsis

Sepsis, sepsis syndrome, septic shock, and multiorgan dysfunction are all part of a continuum of infection-related systemic illness. Table Definitions for Sepsis, Sepsis Syndrome, Septic Shock and Multiorgan Dysfunction Syndrome gives definitions for each of these entities. The pathogenesis of sepsis is very complex, involving a large number of mediators.

Evaluation of the efficacy of vaccines

Adequate response to immunization is most frequently judged by measuring the development of specific serum immunoglobulins (e.g., antibodies) following a course of administration of vaccine. The concentration of specific immunoglobulin in plasma is usually proportional to the degree of protection from the viral agent.

Penicillins

Penicillin G is an acid that is combined with sodium, potassium, procaine, or benzathine to increase its stability or to regulate its absorption. The latter two are “long-acting” forms. Penicillin G is useful in the treatment of streptococcal infections due to S. pyogenes (group A), S. agalactiae (group B), S. pneumoniae, viridans streptococci, Corynebacterium diphtheria, N. meningitidis, many strains of N. gonorrhea, Treponema pallidum, and many anaerobic streptococci, such as peptococcus and peptostreptococcus.

Aminoglycosides – antibiotic agents

Aminoglycosides are very potent bactericidal antibiotic agents that are active against susceptible aerobic microorganisms. They kill by inhibiting protein synthesis and to some extent by lysing the cell envelope. All the aminoglycosides (streptomycin, kanamycin, neomycin, gentamicin, amikacin, tobramycin, sisomicin, and netilmicin) share common structural features. Streptomycin is used once a day in combination with other antibiotics to treat mycobacterial infections.

Vancomycin Glycopeptides

Vancomycin and teicoplanin are the only members of this class of antibiotics. Vancomycin is a high-molecular-weight glycopeptide that is bactericidal for gram-positive microorganisms. It inhibits cell-wall synthesis. Given parenterally, it is the drug of choice for methicillin-resistant staphylococcal infections.

Antifungal Drugs

A number of systemic fungal infections (e.g., histoplasmosis, coccidioidomycosis, and paracoccidioidomycosis) can also afflict otherwise healthy persons. Until recently, only amphotericin B was available to treat systemic fungal infection. However, with the rapid development and clinical assessment of azole compounds, a number of these agents are also considered appropriate for treatment of fungal infections.

Antiretroviral Agents General Statement

Decisions regarding when to initiate or modify antiretroviral therapy should be guided by monitoring plasma HIV-1 RNA levels (viral load), CD4+ T-cell counts, and the clinical condition of the patient. Although various other surrogate markers and laboratory parameters were used in the past to assess the risk of progression of HIV infection and evaluate efficacy of antiretroviral agents.

Antiretroviral Therapy in Previously Treated Pediatric Patients

Progressive neurodevelopmental deterioration is defined as persistence or progression of deterioration documented on repeated testing as demonstrated by the presence of 2 or more of the following findings: impairment in brain growth, decline in cognitive function documented by psychometric testing, or clinical motor dysfunction. If there is evidence of progressive neurodevelopmental deterioration, the new antiretroviral regimen optimally should include at least one drug that has substantial CNS penetration (e.g., zidovudine or nevirapine).