The Mount Sinai journal of medicine, New York
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Case Reports
Pneumococcal vaccine failure in an HIV-infected patient with fatal pneumococcal sepsis and HCV-related cirrhosis.
Pneumoccocal vaccination of HIV-positive individuals is recommended to prevent pneumococcal infection. We present a case of a 44-year-old HIV-infected male who came to the emergency room with bacterial pneumonia and sepsis. The patient also had a history of HBV and HCV infection. ⋯ The patient had received Pneumovax two years before his death. The organism isolated from blood cultures was Streptococcus pneumoniae isotype 3, a strain included in Pneumovax. This is a case of pneumococcal vaccine failure with a fatal outcome in a person with an HIV infection and hepatitis C-related liver cirrhosis.
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Body fluid volume regulation is critically important in maintaining life. In this paper, we review our unifying hypothesis of body fluid volume regulation, which maintains arterial circulatory integrity in health and disease. The integrity of the arterial circulation, as determined by cardiac output and peripheral vascular resistance, is the predominant determinant of renal sodium and water retention. ⋯ However, over the long term, these adaptive responses may have detrimental effects, such as pulmonary congestion, increased myocardial demand, increased cardiac afterload, ascites and hyponatremia. The intensity of the neurohumoral responses correlates with the progression and severity of both cardiac failure and cirrhosis. The understanding of the pathogenesis of sodium and water retention in cardiac failure and cirrhosis has led to therapies that favorably affect the morbidity and mortality of these patients.