By Joshua O. Benditt, et al. American College of Chest Physicians
Instantly from the ACCP serious Care medication Board assessment 2009 direction, this article covers each subject in a concise, easy-to-use layout. Use as a self-study source to organize for the severe care medication subspecialty board exam.
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Additional resources for ACCP Critical Care Medicine Board Review, 20th Edition
83 Even with the overwhelming success of measles immunization programs, this case has prompted reappraisal of recommendations and some have suggested that it may be prudent to withhold measles-containing 31 vaccines from HIV-infected persons with evidence of severe immunosuppression. Emerging Viral Pathogens in Persons With Defects in Cell-Mediated Immunity There have been increasing reports of infections caused by respiratory syncytial virus or parainfluenza virus, particularly in persons who have received bone marrow or solid organ transplantation.
The characteristic pathogens infecting patients with impairment of immunoglobulin production are included in Table 4. Among the bacteria, the common feature is encapsulation, with the capsule essentially making them slippery and Table 3. Major Clinical Situations Resulting in Disorder of Immunoglobulin Production Congenital agammaglobulinemias Common variable immunodeficiency (acquired hypogammaglobulinemia) Heavy chain disease Waldenström macroglobulinemia Multiple myeloma B-cell lymphomas Chronic lymphocytic leukemia T-cell deficiency states Hyposplenic states ACCP Critical Care Medicine Board Review: 20th Edition therefore dependent on opsonization for phagocyte attachment.
It is this substance that stimulates macrophages to better ingest and kill pathogens. In contrast to polymorphonuclear leukocytes, macrophages can readily ingest microorganisms but have a difficult time with intracellular killing. 2 Some of the disorders and clinical situations associated with defects in cell-mediated immunity are listed in Table 5. With aging alone, patients have a decrease in cell-mediated immunity. 31 Immunosuppressive drugs (including corticosteroids and cyclosporine) and HIV infection are associated with defects in this limb of host defense.