Pneumonia is the most common infectious cause of death in the United States. It occurs in persons of all ages, although the clinical manifestations are most severe in the very young, the elderly, and the chronically ill. The course of anaerobic pneumonia is typically indolent with cough, low-grade fever, and weight loss, although an acute presentation may occur. Putrid sputum, when present, is highly suggestive of the diagnosis.
Intra-abdominal infections are those contained within the peritoneum or retroperitoneal space. Two general types of intra-abdominal infection are discussed throughout this chapter: peritonitis and abscess.
P. carinii pneumonia is the most common life-threatening opportunistic infection in patients with AIDS. The taxonomy of the organism is unclear, having been classified as both protozoan and fungal.
The goal of antiretroviral therapy is to achieve the maximum suppression of HIV replication (HIV RNA level that is less than the lower limit of quantitation). Secondary goals include an increase in CD4 lymphocytes and an improved quality of life. The ultimate goal is decreased morbidity and mortality.
Gastrointestinal infections are among the more common causes of morbidity and mortality around the world. Most are caused by viruses and some are caused by bacteria or other organisms. In underdeveloped and developing countries, acute gastroenteritis involving diarrhea is the leading cause of mortality in infants and children younger than 5 years of age. In the United States, there are approximately 211 million episodes of acute gastroenteritis each year, causing over 900,000 hospitalizations and over 6000 deaths.
Enterotoxigenic (cholera-like) Diarrhea. Escherichia coli. Pseudomembranous Colitis (Clostridium difficile).
Bacillary Dysentery (Shigellosis). Salmonellosis. Campylobacteriosis.
Systemic mycoses, such as histoplasmosis, coccidioidomycosis, cryptococcosis, blastomycosis, paracoccidioidomycosis, and sporotrichosis, are caused by primary or “pathogenic” fungi that can cause disease in both healthy and immunocompromised individuals. In contrast, mycoses caused by opportunistic fungi such as Candida albicans, Aspergillus spp., Trichosporon, Torulopsis (Candida) glabrata, Fusarium, Alternaria, and Mucor are generally found only in the immunocompromised host.
bItraconazole plasma concentrations should be measured during the second week of therapy to ensure that detectable concentrations have been achieved. If the concentration is below 1 mcg/mL, the dose may be insufficient or drug interactions may be impairing absorption or accelerating metabolism, requiring a change in dosage. If plasma concentrations are greater than 10 mcg/mL, the dosage may be reduced.
Endocarditis is an inflammation of the endocardium, the membrane lining the chambers of the heart and covering the cusps of the heart valves. Infective endocarditis refers to infection of the heart valves by microorganisms. Endocarditis is often referred to as either acute or subacute depending on the clinical presentation. Acute bacterial endocarditis is a fulminating infection associated with high fevers, systemic toxicity, and death within a few days to weeks if untreated.