By Joshua O. Benditt, et al. American College of Chest Physicians
Directly from the ACCP severe Care drugs Board evaluation 2009 path, this article covers each subject in a concise, easy-to-use structure. Use as a self-study source to organize for the serious care medication subspecialty board exam.
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Extra info for ACCP Critical Care Medicine Board Review, 20th Edition
The rifamycins (eg, rifampin and rifabutin) accelerate the metabolism of protease inhibitors through induction of hepatic P450 cytochrome oxidases. Rifabutin has comparable antituberculous activity but with less hepatic P450 cytochrome enzymeinducing effect than rifampin. 34 Two clinically relevant trends related to TB deserve comment. 36 Some recent attention has focused on measures that foster type 1 immunity as a means of treating patients with TB, including those who may not have responded to initial therapy.
Species causing such a process include Bartonella henselae and Bartonella quintana. Peliosis hepatitis refers to the blood-filled peliotic changes in the parenchyma of the liver or spleen that occur because of infection with these two species. Because these organisms are at present difficult to culture from blood or tissue, histopathology may be the study that directs further diagnostic evaluation. 42 26 Fungi Cryptococcus neoformans Cryptococcal meningitis is an important infection in HIV-infected persons, particularly when CD4+ counts are Ͻ100 cells/L, but may also occur in other populations, including elderly persons.
The risk of TB increases with a higher dose and longer duration of corticosteroids. Mycobacterium avium Complex Among individuals with defective cellmediated immunity, Mycobacterium avium complex (MAC) classically infects HIV-infected persons when their CD4+ cells are Ͻ50/L. 41 Adherence of the organisms to the gut wall is the initial event in invasion, followed by entry into the lamina propria and then phagocytosis by macrophages. Local replication of organisms leads to the endoscopically visible 2- to 4-mm punctate lesions that are the hallmark of MAC disease in the gut.
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