RESUMEN
Coronavirus disease 2019 (COVID-19), mediated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can manifest with flu-like illness and severe pneumonia with acute respiratory distress syndrome (ARDS). Immunocompromised patients merit particular attention as altered host immunity may influence both disease severity and duration of viral shedding as is described with several other ribonucleic acid respiratory viruses. Yet immunocompromised status alone, in the absence of other comorbidities, may not necessarily predict severe illness presentations and poorer clinical outcomes as indicated by recent reports of COVID-19-infected solid organ transplant recipients and people living with human immunodeficiency virus (HIV). Such patients may even be spared the robust inflammatory response that precipitates ARDS associated with COVID-19, complicating the management of iatrogenic immunosuppression in this setting. We present a case of an orthotopic liver transplant recipient with well-controlled HIV who successfully recovered from a mild, flu-like illness attributed to SARS-CoV-2.
Asunto(s)
Fármacos Anti-VIH/efectos adversos , COVID-19/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Trasplante de Hígado/efectos adversos , SARS-CoV-2/inmunología , Adulto , Fármacos Anti-VIH/administración & dosificación , COVID-19/inmunología , COVID-19/virología , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/cirugía , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada/métodos , Rechazo de Injerto/inmunología , Rechazo de Injerto/prevención & control , Infecciones por VIH/inmunología , Humanos , Hidroxicloroquina/administración & dosificación , Huésped Inmunocomprometido , Inmunosupresores/administración & dosificación , Inmunosupresores/efectos adversos , Masculino , Prednisona/administración & dosificación , SARS-CoV-2/aislamiento & purificación , Resultado del Tratamiento , Tratamiento Farmacológico de COVID-19RESUMEN
Community-acquired pneumonia significantly contributes to patient morbidity and healthcare costs. As our understanding of this common infection grows, collaborative efforts among researchers and clinical societies provide new literature and updated guidelines informing its management. This review discusses diagnostic methods, empiric treatment, and infection prevention strategies for patients with suspected community-acquired pneumonia.
Asunto(s)
Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/terapia , Neumonía/diagnóstico , Neumonía/terapia , Triaje/normas , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Manejo de la Enfermedad , Humanos , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
Tuberculosis (TB) in the health care worker demands orchestrated efforts from health care institutions to promptly identify cases and address community risk. We describe a pediatric intensive care unit nurse with latent TB infection who developed hemoptysis and a lung infiltrate concerning for active TB. Her evaluation and contact investigation were facilitated by our institution's command center. Although TB was ultimately ruled out, this case tested our team-based care in response to a suspected high-consequence pathogen.
Asunto(s)
Trazado de Contacto/métodos , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Tuberculosis Latente/transmisión , Infecciones por Mycobacterium no Tuberculosas/transmisión , Micobacterias no Tuberculosas , Diagnóstico Diferencial , Femenino , Personal de Salud , Humanos , Tuberculosis Latente/diagnóstico , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/diagnósticoRESUMEN
BACKGROUND: Antibiotic allergy de-labeling using penicillin allergy skin testing (PAST) can reduce the use and cost of alternative, non-ß-lactam antibiotics in general inpatient populations. This strategy's role in hematopoietic stem cell transplant (HSCT) recipients is unclear. METHODS: This study aimed to determine the effect of a pre-transplant PAST protocol on antibiotic use, days of therapy (DOT), and cost in an immunocompromised population at a single center from 7/1/2010-2/1/2019. Patients who received chimeric antigen receptor (CAR) T-cell therapy and those who underwent transplantation in the outpatient setting were excluded. RESULTS: Of 1560 patients who underwent inpatient HSCT during the study period, 208 reported ß-lactam allergy (136/844 [16%] pre- and 72/716 [10%] post-implementation; P < .001). PAST was performed on 7% and 54% of HSCT recipients pre- and post-implementation, respectively. Only two positive PAST were noted. There were no adverse reactions to PAST. There were no significant differences in the disease and transplant characteristics between the two groups. Days of therapy and cost of alternative antibiotics significantly decreased post-implementation (mean 788 vs 627 days, P = .01; mean $24 425 vs $17 518, P = .009). CONCLUSION: Penicillin allergy skin testing adjudicates reported ß-lactam allergy in HSCT recipients, lowering use, DOT, and cost of alternative antibiotics and promoting effective formulary agents to treat immunocompromised HSCT recipients.