[Preventing pneumonia in ventilated patients]. / Preventie van longontsteking bij beademde patiënten.

The application of oropharyngeal chlorhexidine is mainly active on Gram-positive microorganisms with only a minimal impact on colonisation by Gram-negative microorganisms. Seven randomized clinical trials have been published that showed a significant reduction in ventilator associated pneumonia (VAP) incidence, but not on survival. Some questions remain unanswered: it is presently unclear whether patients who benefit can be selected from the population at risk, and optimal formulation and dosage of chlorhexidine has not yet been established. International recommendations for using oro-pharyngeal topical chlorhexidine in ventilated patients have now been roborated by two Dutch studies.

[Misinterpreted lymphadenopathy and thrombocytopenia as unrecognised initial symptoms of an HIV-infection]. / Onbegrepen lymfklierzwellingen en trombopenie als niet herkende eerste symptomen van een hiv-infectie.

In a 28-year-old woman and a 30-year-old man with lymphadenopathy, shown by histopathology to be follicular hyperplasia, and in a 40-year-old woman and a 40-year-old man with a thrombocytopenia, HIV-infection was not diagnosed until years later. Three of the four patients did not belong to a 'classical high-risk group' for HIV/AIDS. All patients, meanwhile, suffered from minor or major complications. Moreover, the number of CD4+ cells had decreased to < or = 200/microl before antiretroviral therapy was started. After treatment, all four patients were in reasonable to good condition. An HIV-infection should be considered in every case of reactive lymphadenopathy or thrombocytopenia.