Current opinion in pulmonary medicine
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Fungi are ubiquitous in the environment. Opportunistic fungal pneumonias in the immunocompromised host continue to increase most commonly due to Aspergillus sp. Affected patients are usually hematopoietic stem cell and lung transplant recipients. ⋯ The detection of circulating fungal antigens and DNA seems promising, but more studies are needed. Value of prophylactic strategies or preemptive therapy remains contentious. New antifungal drugs for managing invasive pulmonary aspergillosis continue to emerge, with better safety, efficacy, and pharmacologic profiles.
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In 1914, Schottmueller wrote "Septicemia is a state of microbial invasion from a portal of entry into the blood stream which causes signs of illness." In the last few decades, the evidence that sepsis results from an exaggerated systemic inflammatory host response induced by infecting organisms is compelling; inflammatory mediators are the key players in the pathogenesis of septic shock and multiorgan failure. Sepsis and its sequelae represent a continuum of clinical syndrome encompassing systemic inflammation, coagulopathy, and hemodynamic abnormalities. ⋯ After many disappointments with strategies to manipulate the inflammatory response, modulation of coagulation cascade to decrease sepsis mortality has become a clinical reality. This review will highlight and discuss recent advances in the pathophysiology and management of sepsis.
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Antimicrobial prophylaxis and highly active antiretroviral therapy have changed the epidemiology and impact of pulmonary infection in patients infected with the human immunodeficiency virus (HIV). However, pulmonary infection remains a significant contributor to the morbidity and mortality of such patients. ⋯ Pneumonia related to Pneumocystis carinii also remains a significant problem, especially as a presenting illness in patients not yet known to be infected with HIV. Recrudescence of "treated" infection as a manifestation of the immune reconstitution syndrome may become more commonly encountered as more patients are treated with highly active therapy.