Mark Corson

By K. Jensgar. Washington Bible College / Capital Bible Seminary. 2018.

The cutaneous lesions in acute meningococcemia: a clinical and pathological study order tetracycline 250mg with visa. Purpuric lesions in meningococcal infections: diagnosis from smears and cultures of the purpuric lesions order 500 mg tetracycline amex. Rapid diagnosis of acute meningococcal infections by needle aspiration or biopsy of skin lesions generic tetracycline 500 mg fast delivery. Value of a novel Neisseria meningitidis-specific polymerase chain reaction assay in skin biopsy specimens as a diagnostic tool in chronic meningococcemia. Human monocytic ehrlichiosis: similar to Rocky Mountain spotted fever but different. Analysis of risk factors for fatal Rocky Mountain Spotted Fever: evidence for superiority of tetracyclines for therapy. Rocky Mountain spotted fever complicated by gangrene: report of six cases and review. Influence of systemic inflammatory response syndrome and sepsis on outcome of critically ill infected patients. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Human immunodeficiency virus infection and infective endocarditis among injecting drug users. Capnocytophaga canimorsus infections in human: review of the literature and case report. Laboratory diagnosis of dengue virus infection: current and future perspectives in clinical diagnosis and public health. Erythema multiforme with mucous membrane involvement and Stevens-Johnson syndrome are clinically different disorders with distinct causes. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. West Nile virus: an overview of its spread in Europe and the Mediterranean basin in contrast to its spread in the Americas. Community-acquired West Nile virus infection in solid- organ transplant recipients. Innate and adaptive immune responses determine protection against disseminated infection by West Nile encephalitis virus. Epidemic West Nile encephalitis, New York, 1999: results of a household-based seroepidemiological survey. West Nile virus infection in 2002: morbidity and mortality among patients admitted to hospital in south-central Ontario. Use of immunoglobulin M cross-reactions in differential diagnosis of human flaviviral encephalitis infections in the United States. Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. A new staphylococcal enterotoxin, enterotoxin F, associated with toxic-shock-syndrome Staphylococcus aureus isolates. Identification and characterization of an exotoxin from Staphylococcus aureus associated with toxic-shock syndrome. Frequency of toxic shock syndrome toxin- and enterotoxin- producing clinical isolates of Staphylococcus aureus. Recurrent nonmenstrual toxic shock syndrome: clinical manifestations, diagnosis, and treatment. Exfoliative toxin production by Staphylococcus aureus strains isolated from animals and human beings in Nigeria. Nasal, axillary, and perineal carriage of Staphylococcus aureus among women: identification of strains producing epidermolytic toxin. Structural similarities and differences in Staphylococcus aureus exfoliative toxins A and B as revealed by their crystal structures. Staphylococci, streptococci and the skin: review of impetigo and staphylococcal scalded skin syndrome. Development and evaluation of detection systems for staphylococcal exfoliative toxin A responsible for scalded-skin syndrome. Action of staphylococcal exfoliative toxins on epidermal cell cultures and organotypic skin. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Varicella hepatitis in the immunocompromised adult: a case report and review of the literature. Varicella-zoster virus infection in children with underlying human immunodeficiency virus infection. A case report of successful treatment with liver transplantation and perioperative acyclovir. Acute abdominal pain as a presenting symptom of varicella-zoster virus infection in recipients of bone marrow transplants. Concomitant zoster myelitis and cerebral leukemia relapse after stem cell transplantation. Polymerase chain reaction detection and clinical significance of varicella-zoster virus in cerebrospinal fluid from human immunodeficiency virus- infected patients. The influence of environment on the survival of airborne virus particles in the laboratory.

The route of drug elimination may be adversely affected by either preexisting or acquired abnormalities of renal or hepatic function discount 250 mg tetracycline visa. Disease processes affecting protein concentrations in plasma will particularly impact the drug that is highly protein bound order 250 mg tetracycline. In Figure 1 buy tetracycline 500mg lowest price, the concentrations of a hypothetical antibiotic in the serum of a patient are illustrated after intravenous administration. A rapid peak concentration is achieved that is largely dictated by the rate of infusion. The distribution of the drug throughout the various compartments and tissues that are accessed result in an equilibrium concentration, and from that point, the elimination of the drug proceeds in a consistent fashion. A semilogarithm plot is used for the concentration at each time point and this yields a linear configuration to the elimination plot. Extrapolation of the semilogarithm elimination plot to time-zero permits calculation of the volume of distribution (Vd) of the drug in this specific set of clinical circumstances. The volume of distribution equals the total dose of drug given (D) divided by 6 the time-zero theoretical concentration (T0), or D/(T0) ¼ Vd. Thus, 1 g of an antibiotic (1 Â 10 mg) with an extrapolated (T0) ¼ 50 m/mL results in a Vd ¼ 20,000 m, or 20 L. The linear configuration of drug elimination over time permits calculation of the biological elimination half-life (T1/2). The T1/2 is the period of time required for the equilibrated plasma concentration of the drug to decline by 50%. The expectation is that the plasma concentration reflects the dynamic processes of equilibration of the central pool (i. Antibiotics are generally considered to have a single T1/2 that describes elimination of the drug, but some may have a second T1/2 that describes clearance at low concentrations. Antibiotic Kinetics in the Multiple-System Trauma Patient 523 Figure 1 Illustrates the clearance curve of a theoretical antibiotic. Vd is a theoretical calculation that can be influenced by factors other than the actual body water of drug distribution. Knowledge of the Vd and T1/2 allows the design of dose and dosage intervals for the antibiotic. If our theoretical drug in Figure 1 was deemed to have toxicity at concentrations above 80 m/mL then it would be desirable to have the concentration below that threshold for the treatment interval. Thus, a rational configuration of the use of this drug would be a 1 g dose that was re- dosed every eight hours. Antibiotics with a significant post-antibiotic effect can have treatment intervals that are greater than would be predicted by the above model. Nevertheless, the above strategy is generally used for the design of the therapeutic application of drugs in clinical trials. The design is derived from studies in healthy volunteers and clinical trials are generally performed in patients without critical illness. Biotransformation is the process by which the parent drug molecule is metabolized following infusion. Biotransformation may occur via a number of pathways, although hepatic metabolism is most common. It may occur within the gastrointestinal tract, the kidney epithelium, the lungs, and even within the plasma itself. Hepatic biotransformation may result in the metabolite being released within the blood, resulting commonly in attenuation of action and facilitation of 524 Fry elimination via the kidney. Hepatic metabolism may result in the inactivated metabolite being eliminated within the bile. Clearly, abnormalities within the organ responsible for biotransformation will affect the process. The cytochrome P-450 system requires molecular oxygen, so poor perfusion or oxygenation of the liver from any cause will impact hepatic metabolism of specific drugs. Some drugs are eliminated unchanged by the kidney into the urine, or excreted by the liver into the bile. Excretion of unchanged drug via the biliary tract, which in turn can be reabsorbed, may create an enterohepatic circulation that results in prolonged drug presence in the patient. When either the intact drug or metabolic product is dependent on a specific organ system for elimination, intrinsic disease becomes an important variable in the overall pharmacokinetic profile. Extensive torso and extremity injuries result in soft tissue injuries that activate the human systemic inflammatory response. This systemic inflammatory response requires extensive volume resuscitation for maintenance of intravascular volume and tissue perfusion. Blunt chest trauma requires intubation and prolonged ventilator support, and exposure of the lung to environmental contamination. The patients are immunosuppressed from the extensive injuries, transfusions, and protein-calorie malnutrition. Following the injury itself, infection becomes the second wave of activation of systemic inflammation. Infection becomes a complication at the sites of injury, at the surgical sites of therapeutic interventions, and as nosocomial complications at sites remote from the injuries. Fever and hypermetabolism are common and add an additional compounding variable at a time when antimicrobial treatment is most important in the patient’s outcome. Antibiotics are invariably used in the febrile, multiple-injury patient, but they are dosed and re-dosed using the model of the healthy volunteer initially employed in the development of the drug. Are antibiotics dosed in accordance with the pathophysiologic changes of the injury and febrile state? Extensive tissue injury and invasive soft-tissue infection share the common consequence of activating local and systemic inflammatory pathways.