Critical care clinics
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The urinary tract is a common source for life-threatening infections. Most patients with sepsis or septic shock from a urinary source have complicated urinary tract infection. This article explains the epidemiology, risk factors, and treatment. Effective management, appropriate collection of microbiology specimens, prompt initiation of antimicrobial therapy, source control, and supportive therapy are described.
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Viral encephalitis causes an altered level of consciousness, which may be associated with fever, seizures, focal deficits, CSF pleocytosis, and abnormal neuroimaging. Potential pathogens include HSV, VZV, enterovirus, and in some regions, arboviruses. ⋯ Timely initiation of anti-viral therapy is crucial while relevant molecular and serological test results are being performed. Supportive care should be directed at the prevention and treatment of cerebral edema and other physiological derangements which may contribute to secondary neurological injury.
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Sepsis accounts for approximately 10% of all maternal deaths. Pregnant women are susceptible to certain infections because of alterations in their cell-mediated immunity. Obstetric sepsis requires early broad-spectrum antibiotic therapy and may necessitate surgical intervention. ⋯ Pyelonephritis remains a common cause of sepsis during pregnancy, and associated acute respiratory distress syndrome occurs more commonly than in the nonpregnant population. Severe pneumonitis caused by influenza virus and varicella zoster infection may occur. Malaria may be more severe in the pregnant woman, and carries significant risk to both mother and fetus.
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This article outlines infections in the submandibular, lateral pharyngeal, retropharyngeal, danger, and prevertebral spaces, in conjunction with infections of the sinuses and mediastinum. By understanding the anatomy and pathophysiology, the reader will gain insight into the rationale for various therapeutic options.
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Myocarditis is most often caused by a viral infection. Less common causes include other infectious agents and autoimmune diseases. ⋯ Cardiac transplantation is required in a small minority of patients. Cardiac magnetic resonance imaging is becoming a frequently used modality to aid in the diagnosis of myocarditis.