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Clinical Cass 33

Clinical Cass 33

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Clinical Cass 33

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  1. Clinical Cass 33 Pornpan Suksawadnumchok Sec C

  2. Case 33 • Having been confined in the hospital for almost a month due to recurrent pneumonia, Mr. xxy, 42 y/o, married, a dance instructor in Japan for almost 10 years was diagnosed to have AIDS

  3. Diagnosis • HIV infection almost 10 yerars lead to recerrent pneumonia

  4. Lab diagnosis • enzymeimmunoassay • Western blot assay • Indirect fluorescent antibody assay (IFA) • Radioimmunoprecipitation assay (RIPA)

  5. AIDS • Acquired Immune Deficiency Syndrome or acquired immunodeficiency syndrome (AIDS or Aids) is a collection of symptoms and infections resulting from the specific damage to the immune system caused by the human immunodeficiency virus (HIV) • HIV is a retrovirus that primarily infects vital components of the human immune system such as CD4+ T cells, macrophages and dendritic cells. • It directly and indirectly destroys CD4+ T cells. CD4+ T cells are required for the proper functioning of the immune system. • When HIV kills CD4+ T cells so that there are fewer than 200 CD4+ T cells per microliter (µL) of blood, cellular immunity is lost, leading to the condition known as AIDS. • The late stage of the condition leaves individuals prone to opportunistic infections and tumors

  6. Transmission of HIV Direct contact • mucous membrane • bloodstream with a bodily fluid containing HIV • semen • vaginal fluid • preseminal fluid • breast milk • This transmission can come in the form of anal, vaginal or oralsex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, or breastfeeding

  7. Main HIV symptoms: • Rapid weight loss • Dry cough • Recurring fever • Wollen lymph glands in the armpits, groin, or neck • Diarrhea that lasts for more than a week • White spots on the tongue, in the mouth, or in the throat • Pneumonia • Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids • Memory loss, depression, and neurological disorders

  8. Major pulmonary illnesses • Pneumocystis carinii pneumonia (PCP) is caused by the ubiquitous unicellular eukaryote, P carinii. • It is a rare cause of infection in the general population, but it is a frequent cause of morbidity and mortality in persons who are immunocompromised, especially patients with acquired immunodeficiency syndrome (AIDS).

  9. Treatment • The treatment of P carinii pneumonia is one of the first concerns in HIV treatment. • Nucleoside reverse transcriptase (RT) inhibitors - also called nucleoside analogs - Zidovudine (AZT) - also called ZDV - Zalcitibine (ddC) - Didanosine (ddI) - Stavudine (d4T) • Pneumonia - Clotrimazole - Clarithromycin - Azithromycin

  10. Zidovudine (AZT) • Zidovudine (INN) or azidothymidine (AZT) (also called ZDV) is an antiretroviral drug, the first approved for treatment of HIV. Machanism of action • inhibiting the action of reverse transcriptase, the enzyme that HIV uses to make a DNA copy of its RNA.

  11. Zidovudine (AZT) • Adult Dose: 200 mg PO tid 1-2 mg/kg/dose IV q4h • Pediatric Dose: 90-180 mg/m2/dose PO q6h 1-2 mg/kg/dose IV q4h • Contraindications: hypersensitivity • Interactions:Acetaminophen may decrease bioavailability; amphotericin B, flucytosine, vincristine, vinblastine, doxorubicin, cimetidine, indomethacin, lorazepam, aspirin, acyclovir, ganciclovir, dapsone, and pentamidine may increase toxicity • Precautions:Caution in impaired hepatic or renal function; reduce or stop therapy in hematologic disorders, such as thrombocytopenia, granulocytopenia, and severe anemia

  12. Clotrimazole • Clotrimazole -- Broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability. Pruritus usually relieved within first week of treatment.

  13. Clotrimazole • Adult Dose:10 mg PO 5 times/d for 14 d Pediatric Dose:<3 years: Not established>3 years: Administer as in adults • Contraindications: hypersensitivity • InteractionsNone reported Pregnancy- Usually safe but benefits must outweigh the risks. • Precautions:Not for treatment of systemic fungal infections; avoid contact with eyes; if irritation or sensitivity develops, discontinue use and institute appropriate therapy

  14. Clarithromycin • Clarithromycin (Biaxin) -- Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes causing RNA-dependent protein synthesis to arrest. • Another initial DOC in otherwise uncomplicated pneumonia. Appears to cause more GI symptoms (eg, gastric upset, metallic taste) than azithromycin.

  15. Clarithromycin • Adult Dose: 500 mg PO bid for 10 d • Pediatric: Dose<6 months: Not recommended>6 months: 7.5 mg/kg PO bid for 10 d; not to exceed 500 mg/dose • Contraindications: hypersensitivity; • coadministration of pimozide • Interactions: Toxicity increases with coadministration of fluconazole and pimozide; effects decrease and GI adverse effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, • Pregnancy: C - Safety for use during pregnancy

  16. Azithromycin • Azithromycin (Zithromax) -- In otherwise uncomplicated pneumonia, initial DOC; covers most potential etiologic agents, including Mycoplasma species. Compared with other drugs, causes less GI upset; potential for good compliance because of reduced dosing frequency. Has better action against H influenzae compared with erythromycin. Main disadvantage is cost. • Adult Dose:Day 1: 500 mg PODays 2-5: 250 mg PO qdAlternative: 500 mg IV qd • Pediatric: DoseDay 1: 10 mg/kg PODays 2-5: 5 mg/kg PO qd

  17. Azithromycin • Contraindications:Documented hypersensitivity; hepatic impairment; do not administer with pimozide • Interactions: May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine • Pregnanc: Usually safe but benefits must outweigh the risks. • Precautions: IV-site reactions can occur; bacterial or fungal overgrowth may result with prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in impaired hepatic function, prolonged QT intervals, or pneumonia; caution in hospitalized, geriatric, or debilitated patients

  18. Thank You