DOCSLIB.ORG

WORLD SURGERY Burn Wound Infections: Current Status

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
WORLD SURGERY Burn Wound Infections: Current Status World J. Surg. 22, 135–145, 1998 WOR L D Journal of SURGERY © 1998 by the Socie´te´ Internationale de Chirurgie Burn Wound Infections: Current Status Basil A. Pruitt, Jr., M.D.,1 Albert T. McManus, Ph.D.,2 Seung H. Kim, M.D.,2 Cleon W. Goodwin, M.D.2 1Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA 2U.S. Army Institute of Surgical Research, 3400 Rawley E. Chambers Avenue, Fort Sam Houston, Texas 78234-6315, USA Abstract. The burn wound represents a susceptible site for opportunistic incidence of infection in burn patients, and increased burn patient colonization by organisms of endogenous and exogenous origin. Patient survival. factors such as age, extent of injury, and depth of burn in combination with microbial factors such as type and number of organisms, enzyme and toxin production, and motility determine the likelihood of invasive burn wound infection. Burn wound infections can be classified on the basis of the causative organism, the depth of invasion, and the tissue response. The wound caused by thermal energy represents a locus minoris Diagnostic procedures and therapy must be based on an understanding of resistentiae, which until the development of effective topical the pathophysiology of the burn wound and the pathogenesis of the antimicrobial chemotherapeutic agents in the mid-1960s was various forms of burn wound infection. The time-related changes in the the most common site of infection which caused devastating predominant flora of the burn wound from gram-positive to gram- negative recapitulate the history of burn wound infection. Proper clinical morbidity and, when invasive, virtually universal mortality in burn and culture surveillance of the burn wound permits early diagnosis of patients [1]. The incidence of invasive burn wound sepsis is gram-positive cellulitis, and the stable susceptibility of b-hemolytic proportional to the extent of the burn and is influenced by both streptococci to penicillin has eliminated the threat of this once common the depth of the burn and the age of the patient. Invasive burn burn wound pathogen. Selection and dissemination of intrinsic and wound infections rarely occur in partial-thickness injuries; they acquired resistance mechanisms increase the probability of burn wound colonization by resistant species such as Pseudomonas aeruginosa. Even so, occur with greatest frequency in children, with an intermediate effective topical antimicrobial chemotherapy and early burn wound frequency in the elderly, and with lowest frequency in young excision have significantly reduced the overall occurrence of invasive burn adults (15–40 years) [2]. The susceptibility of the burn wound to wound infections. Individual patients, usually those with extensive burns infection results from the combined effect of the presence of in whom wound closure is difficult to achieve, may still develop a variety of bacterial and nonbacterial burn wound infections. Consequently, the coagulated proteins and other microbial nutrients in the wound entirety of the burn wound must be examined on a daily basis by the and the avascularity of the eschar, which prevents delivery of attending surgeon. Any change in wound appearance, with or without immunologically active cells, humoral factors, and even blood- associated clinical changes, should be evaluated by biopsy. Quantitative borne antibiotics to the eschar [3]. cultures of the biopsy sample may identify predominant organisms but The flora of the burn wound also influence the risk of infection are not useful for making the diagnosis of invasive burn wound infection. Histologic examination of the biopsy specimen, which permits staging the and the invasive potential of infections that do occur. The invasive process, is the only reliable means of differentiating wound microbial population of the wound immediately after burning is colonization from invasive infection. Identification of the histologic sparse (bacteria in skin appendages commonly survive the burn) changes characteristic of bacterial, fungal, and viral infections facilitates and predominantly gram-positive. As time passes gram-negative the selection of appropriate therapy. A diagnosis of invasive burn wound infection necessitates change of both local and systemic therapy and, in organisms colonize the eschar, and by the end of the first postburn the case of bacterial and fungal infections, prompt surgical removal of the week they have become the predominant inhabitants of the burn infected tissue. Even after the wounds of extensively burned patients have wound [4]. Prior to the discovery of antibiotics, group A b- healed or been grafted, burn wound impetigo, commonly caused by hemolytic streptococci were the most frequent cause of life- Staphylococcus aureus, may occur in the form of multifocal, small super- threatening burn wound and systemic infections, but penicillin ficial abscesses that require surgical de´bridement. Current techniques of burn wound care have significantly reduced the incidence of invasive burn therapy has essentially eliminated such mortality [5]. The use of wound infection, altered the organisms causing the infections that do penicillin led to the emergence of Staphylococcus aureus as the occur, increased the interval between injury and the onset of infection, most common gram-positive early colonizer of the burn wound reduced the mortality associated with infection, decreased the overall [6]. These organisms may penetrate the eschar and invade the unburned, underlying subcutaneous tissues to form myriad vari- The opinions or assertions contained herein are the private views of the ably sized abscesses. S. aureus seldom traverses fascial planes but authors and are not to be construed as official or as reflecting the views of promotes formation of thickened abscess walls, which compro- the Department of the Army or the Department of Defense. Correspondence to: Basil A. Pruitt, Jr., Library Branch, U.S. Army mise the effectiveness of host defenses and antibiotic therapy. Institute of Surgical Research, 3400 Rawley E. Chambers Avenue, Fort Because the staphylococci may be seeded into the circulation from Sam Houston, Texas 78234-6315, USA. an undrained abscess, early diagnosis and prompt drainage can 136 World J. Surg. Vol. 22, No. 2, February 1998 Table 1. Classification of burn wound infections. Burn wound cellulitis Localized pain, tenderness, edema, erythema, and heat Involves unburned and undamaged skin at margin of burn or skin graft donor site May be associated with lymphangitis and systemic signs of infection Diagnosis by clinical signs, wound culture, or both Burn wound infections Invasive infections of unexcised eschar Modest to profound changes in appearance of burn wound Diagnosis by histologic examination of viable tissue in wound biopsy Invariably associated with systemic signs of infection Infection of excised burn wound or donor site Formation of neoeschar or focal necrosis on wound surface (or both) Diagnosis by histologic examination of viable tissue in wound biopsy Fig. 1. Organisms causing invasive burn wound infections. Marked Infection of “grafted” wound changes in the epidemiology of invasive burn wound infection have Histologic examination of wound bed biopsy may be required to occurred during two recent successive 7-year periods. The striking reduc- differentiate microbial colonization of nonviable graft from infection of wound bed tion in gram-negative rods as causative agents and the persistence of fungi b have resulted in the latter becoming the predominant causative agents. Culture of graft and wound to identify -hemolytic streptococci GNR: gram-negative rods; GPC: gram-positive cocci; YLO: yeast-like Burn wound impetigo organisms; Fungi: filamentous fungi. Loss of epithelium (initially focal and may become generalized) from a previously grafted or healed burn wound or skin graft donor site May be associated with systemic signs of infection minimize or prevent hematogenous dissemination of staphylococ- Diagnosis by wound culture (most often caused by Staphylococcus) cal infections. The subsequent development and use of broad-spectrum anti- biotics effective against Staphylococcus resulted in the emergence of gram-negative organisms, particularly Pseudomonas aeruginosa, high risk of invasive infection in such patients necessitates fre- as the predominant organisms causing invasive burn wound quent, scheduled monitoring of their burn wounds to identify infections in burn patients [7]. Gram-negative organisms appear infection in its earliest stages when surgical and pharmacologic to have much greater invasive potential than gram-positive organ- intervention can control the infection and reduce the associated isms. Virulence factors of gram-negative organisms include toxins mortality. The entirety of the burn wound, those areas with intact (both endotoxin and a variety of exotoxins), proteolytic enzymes, eschar and those that have been excised, and even those that have extracellular polysaccharides such as the slime produced by been grafted, must be examined on at least a daily basis. Although certain Pseudomonas organisms, and microbial motility imparted donor site infections are rare, they occur most often in patients by a functioning flagellum [8, 9]. Additionally, antibiotic resis- with massive burns, necessitating that donor sites on such patients tance, both intrinsic and acquired, can influence the course of an be examined each day as well. The wound examination is best infection once established. performed
Load more

Recommended publications
  • USMLE – What's It
    Purpose of this handout Congratulations on making it to Year 2 of medical school! You are that much closer to having your Doctor of Medicine degree. If you want to PRACTICE medicine, however, you have to be licensed, and in order to be licensed you must first pass all four United States Medical Licensing Exams. This book is intended as a starting point in your preparation for getting past the first hurdle, Step 1. It contains study tips, suggestions, resources, and advice. Please remember, however, that no single approach to studying is right for everyone. USMLE – What is it for? In order to become a licensed physician in the United States, individuals must pass a series of examinations conducted by the National Board of Medical Examiners (NBME). These examinations are the United States Medical Licensing Examinations, or USMLE. Currently there are four separate exams which must be passed in order to be eligible for medical licensure: Step 1, usually taken after the completion of the second year of medical school; Step 2 Clinical Knowledge (CK), this is usually taken by December 31st of Year 4 Step 2 Clinical Skills (CS), this is usually be taken by December 31st of Year 4 Step 3, typically taken during the first (intern) year of post graduate training. Requirements other than passing all of the above mentioned steps for licensure in each state are set by each state’s medical licensing board. For example, each state board determines the maximum number of times that a person may take each Step exam and still remain eligible for licensure.
    [Show full text]
  • Cytomegalovirus Infection of the Human Gastrointestinal Tract
    Journal of Gastroenterology and Hepatology (1999) 14, 973–976 OESOPHAGOGASTRODUODENAL DISORDERS Cytomegalovirus infection of the human gastrointestinal tract SUSAMA PATRA, SUBASH C SAMAL, ASHOK CHACKO, VADAKENADAYIL I MATHAN1 AND MINNIE M MATHAN1 The Wellcome Trust Research Laboratory, Department of Gastrointestinal Sciences, Christian Medical College and Hospital,Vellore,India Abstract Background: Current interest in cytomegalovirus (CMV) is largely due to an increase in the number of cases of acquired immunodeficiency syndrome and organ transplantation in recent years.The proper recognition of CMV-infected cells in gastrointestinal mucosal biopsies is critical for effective treatment of this condition. Methods: A total of 6580 endoscopic mucosal biopsies from 6323 patients in the 8-year period (1989–1996) were examined for CMV inclusion bodies. The endoscopic appearance and particularly the presence of ulcers were also analysed. Results and Conclusions: The prevalence of cytomegalovirus (CMV) inclusions was 9 per thousand in the gastrointestinal mucosal biopsies from an unselected group of patients. Of the 54 patients with CMV infection, 37 were immunocompromised and 17 apparently immunocompetent. Typical Cowdry inclusions and atypical inclusions were present, the latter more frequently in immunocompromised patients. The maximum prevalence of inclusions was in the oesophageal mucosa in immunocompro- mised individuals. © 1999 Blackwell Science Asia Pty Ltd Key words: cytomegalovirus, gastrointestinal tract, immunocompetent, immunocompromised, inclu- sion bodies, mucosal biopsies. INTRODUCTION in haematoxylin and eosin (HE)-stained histological samples is regarded as being sensitive and specific for Cytomegalovirus (CMV), first described in 1956,1 is a CMV infection,6–9 especially for samples from the gas- double-stranded DNA virus belonging to the herpes trointestinal tract.
    [Show full text]
  • Cytomegalovirus Infection in Gastrointestinal Tract: a Case Series of Three Patients and Review of Literature
    Published online: 2019-10-01 Case Report Cytomegalovirus infection in gastrointestinal tract: A case series of three patients and review of literature Piyush Ranjan, Varun Gupta, Mohan Goyal, Shashi Dhawan1, Pallav Gupta1, Mandhir Kumar, Munish Sachdeva Departments of Gastroenterology and 1Pathology, Sir Ganga Ram Hospital, New Delhi, India Abstract Cytomegalovirus disease can involve any site of gastrointestinal tract from oral cavity to rectum. CMV disease most frequently occurs in patients’ with immune deficiency, such as the acquired immunodeficiency syndrome, after organ transplantation, after cancer chemotherapy and in patients on immunosuppressive medications. The number of patients with immune deficiency has increased in recent years and has lead to a substantial increase in incidence of opportunistic CMV virus. Gastrointestinal CMV infection has also been reported in immunocompetent adults. Symptoms and signs depend on part of the gastrointestinal tract involved. Diagnosis depends either on a positive mucosal biopsy or by serology, quantitative PCR or CMV antigenemia. We report three cases of CMV infection in patients with three different underlying conditions and discuss the clinical features, diagnostic approach and treatment. All patients had positive serology with high viral load on PCR. Histology with immunohistochemistry was positive for CMV in two of the three cases. Ganciclovir response was seen in all patients in respect to clinical improvement, endoscopic resolution of lesions and clearing of the virus load. Key words
    [Show full text]
  • Cytomegalovirus Disease in Patient with HIV Infection
    ntimicrob A ia f l o A l g a e n n Fane et al., J Antimicro 2016, 2:1 r Journal of t u s o J DOI: 10.4172/2472-1212.1000108 ISSN: 2472-1212 Antimicrobial Agents Review Article Open Access Cytomegalovirus Disease in Patient with HIV Infection EL Fane M1*, Sodqi M1, EL Rherbi A2, Chakib A1, Oulad Lahsen A1, Marih L1 and Marhoum EL Filali K1 1Department of Infectious Diseases, CHU Ibn Rocd, Casablanca, Morocco 2Centre Poison Control and Pharmacovigilance Morocco, Rabat, Morocco Summary the incidence of CMV retinitis [3]. The frequency is described to be low in the sub-Saharan Africa (inferior to 10%). This can be explained by Cytomegalovirus (CMV) disease is a serious condition due to the high rate of early mortality and variable population susceptibility reactivation of previously latent infection or newly acquired infection, to develop a CMV disease [8,9]. In Morocco, Data concerning it occurs frequently in immunocompromised patients by HIV epidemiologic profile of CMV disease are lacking; there is a huge need infection. Even it is actually uncommon in the developed nations with of cohort studies in this field [1]. However, some small retrospective the widespread use of highly active antiretroviral therapy (HAART), studies showed CMV retinitis incidence rates close to 4% that remains CMV disease continues to be among the most common opportunistic too low comparing to other African countries [8, 9]. In south Asia, rates infections in patient living with HIV (PLWH) in developing countries. approaching 20 to 30% are noticed [10]. Its severity is linked to its tropism for retina and central nervous system (CNS).
    [Show full text]
  • F-Jonathan Eisenstat, MD-March 24, 2016
    In The Matter Of: Pressgrove, et al v. Byrd, et al Jonathan Eisenstat, MD March 24, 2016 D'Amico Gershwin, Inc. Court Reporters & Videoconferencing 11475 West Rd, Roswell, GA 30075 (770) 645-6111 or toll-free (888) 355-6111 Min-U-Script® with Word Index IN THE CIRCUIT COURT OF TENNESSEE FOR THE THIRTIETH JUDICIAL DISTRICT AT MEMPHIS, SHELBY COUNTY BEVERLY PRESSGROVE and ) PHILLIP SIMMS, individually ) and as next of kin of ) HOLLAND N. SIMMS, ) ) Plaintiffs, ) No. CT-004425-08 ) Division VII vs. ) ) JURY DEMANDED WILLIAM G. BYRD, MD, et al., ) ) Defendants. ) _____________________________) Videotaped deposition of JONATHAN EISENSTAT, M.D., taken on behalf of the Plaintiffs, pursuant to the stipulations contained herein, reading and signing of the deposition being reserved, in accordance with the Tennessee Rules of Civil Procedure, before Stephanie K. Feen, Certified Court Reporter, at 5855 Sandy Springs Circle, Suite 140, Atlanta, Georgia, on the 24th day of March, 2016, commencing at the hour of 12:08 p.m. D'AMICO GERSHWIN, INC. Court Reporters & Videoconferencing 11475 West Road Roswell, Georgia 30075 (770) 645-6111 www.AtlantaCourtReporter.com D'Amico Gershwin, Inc. www.AtlantaCourtReporter.com 1 I N D E X T O E X A M I N A T I O N S 2 Page 3 Examination by Mr. Smith 11 4 5 I N D E X T O E X A M I N A T I O N S 6 Plaintiffs' Description Marked/First Exhibit Identified 7 P-1 Notice of Video Deposition 15 8 of Jonathan Eisenstat, M.D. 9 P-2 Dr.
    [Show full text]
  • 1 Medical Student's Amnesia a Transient Selective Loss of Memory During an Exam That Prevents One from Remem
    Medical Student’s Amnesia A transient selective loss of memory during an exam that prevents one from remembering the eponymically-named diseases discovered by old, dead doctors. Addison’s Disease 1. Primary adrenocortical deficiency Addisonian Anemia 2. Pernicious anemia (antibodies to intrinsic factor or parietal cells → ↓IF → ↓Vit B12 → megaloblastic anemia) Albright’s Syndrome 3. Polyostotic fibrous dysplasia, precocious puberty, café au lait spots, short stature, young girls Alport’s Syndrome 4. Hereditary nephritis with nerve deafness Alzheimer’s 5. Progressive dementia Argyll-Robertson Pupil 6. Loss of light reflex constriction (contralateral or bilateral) 7. “Prostitute’s Eye” – accommodates but does not react 8. Pathognomonic for 3°Syphilis 9. Lesion pretectal region of superior colliculus Arnold-Chiari Malformation 10. Cerebellar tonsil herniation through foramen magnum = see thoracolumbar meningomyelocele Barrett’s 11. Columnar metaplasia of lower esophagus (↑ risk of adenocarcinoma)- constant gastroesophageal reflux Bartter’s Syndrome 12. Hyperreninemia Becker’s Muscular Dystrophy 13. Similar to Duchenne, but less severe (mutation, not a deficiency, in dystrophin protein) Bell’s Palsy 14. CNVII palsy (entire face; recall that UMN lesion only affects lower face) Berger’s Disease 15. IgA nephropathy causing hematuria in kids, usually following infection Bernard-Soulier Disease 16. Defect in platelet adhesion (abnormally large platelets & lack of platelet-surface glycoprotein) Berry Aneurysm 17. Circle of Willis (subarachnoid bleed) Anterior Communicating artery 18. Often associated with ADPKD Bowen’s Disease 19. Carcinoma in situ on shaft of penis (↑ risk of visceral ca) [compare w/ Queyrat] Brill-Zinsser Disease 20. Recurrences of rickettsia prowazaki up to 50 yrs later Briquet’s Syndrome 21.
    [Show full text]
  • Austrian Journal of Technical and Natural Sciences
    Austrian Journal of Technical and Natural Sciences № 7–8 2016 July–August «East West» Association for Advanced Studies and Higher Education GmbH Vienna 2016 Austrian Journal of Technical and Natural Sciences Scientific journal № 7–8 2016 (July–August) ISSN 2310-5607 Editor-in-chief Hong Han, China, Doctor of Engineering Sciences International editorial board Andronov Vladimir Anatolyevitch, Ukraine, Doctor of Engineering Sciences Bestugin Alexander Roaldovich, Russia, Doctor of Engineering Sciences Frolova Tatiana Vladimirovna, Ukraine, Doctor of Medicine Inoyatova Flora Ilyasovna, Uzbekistan, Doctor of Medicine Kushaliyev Kaisar Zhalitovich, Kazakhstan, Doctor of Veterinary Medicine Mambetullaeva Svetlana Mirzamuratovna, Uzbekistan, Doctor of Biological Sciences Nagiyev Polad Yusif, Azerbaijan, Ph.D. of Agricultural Sciences Nemikin Alexey Andreevich, Russia, Ph.D. of Agricultural Sciences Nenko Nataliya Ivanovna, Russia, Doctor of Agricultural Sciences Skopin Pavel Igorevich, Russia, Doctor of Medicine Suleymanov Suleyman Fayzullaevich, Uzbekistan, Ph.D. of Medicine Zhanadilov Shaizinda, Uzbekistan, Doctor of Medicine Proofreading Kristin Theissen Cover design Andreas Vogel Additional design Stephan Friedman Editorial office European Science Review “East West” Association for Advanced Studies and Higher Education GmbH, Am Gestade 1 1010 Vienna, Austria Email: [email protected] Homepage: www.ew-a.org Austrian Journal of Technical and Natural Sciences is an international, German/English/Russian language, peer-reviewed journal. It is published bimonthly with circulation of 1000 copies. The decisive criterion for accepting a manuscript for publication is scientific quality. All research articles published in this journal have undergone a rigorous peer review. Based on initial screening by the editors, each paper is anonymized and reviewed by at least two anonymous referees. Recommending the articles for publishing, the reviewers confirm that in their opinion the submitted article contains important or new scientific results.
    [Show full text]
  • Prezentacja Programu Powerpoint
    C5. INFECTIOUS DISEASES LEARNING OBJECTIVES MICROBIAL 1. Compare and contrast various routes of entry of infectious PATHOGENESIS agents (skin, respiratory, gastrointestinal and urogenital tract). Describe mechanisms by which infectious agents evade local defenses. Give examples of microbes that use these routes of entry. 2. Describe routes of dissemination of infectious agents. Give examples of microorganisms that use various modes of dissemination. 3. Describe routes of transmission of infectious agents from person to person. Give examples of pathogens that use various „exit strategies”. 4. Describe routes through which vertical transmission of infectious agents may occur. Give examples of microobes that use these routes of transmission. 5. List mechanisms by which infectious agents damage host tissues. 6. Describe morphologic patterns of tissue responses to infection with regard to pathogenesis and macro- and microscopic features. Give examples of microorganisms that evoke such responses. C4. Inflammation and Repair VIRAL 7. Discuss mechanisms by which viruses cause injury to cells. INFECTIONS 8. Describe acute viral infections (measels and mumps) in terms of pathogenesis, morphologic features and clinical manifestations. Define Koplik spots and Warthin-Finkeldey cells. 9. Describe latent viral infections (HSV, VZV and CMV) with regard to pathogenesis, morphologic features and clinical manifestations. Define intranuclear inclusions, Cowdry bodies, cold sores, chickenpox and shingles. LEARNING OBJECTIVES BACTERIAL 10. Discuss mechanisms by which bacteria cause injury to cells. INFECTIONS Give examples of bacteria that use particular mechanisms. 11. Define endotoxins and exotoxins. List types of exotoxins. 12. Describe staphylococcal infections in terms of pathogenesis, morphologic features and clinical manifestations. Define furuncule (boil), carbuncule, hidradenitis, paronychia, felons and staphylococcal scalded-skin syndrome.
    [Show full text]
  • Laboratory Workbook in Virology
    LABORATORY WORKBOOK IN VIROLOGY Student name ________________________________ Faculty _____________________________________ Group ___________ Minsk BSMU 2016 МИНИСТЕРСТВО ЗДРАВООХРАНЕНИЯ РЕСПУБЛИКИ БЕЛАРУСЬ БЕЛОРУССКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ КАФЕДРА МИКРОБИОЛОГИИ, ВИРУСОЛОГИИ, ИММУНОЛОГИИ ЛАБОРАТОРНЫЙ ПРАКТИКУМ ПО ВИРУСОЛОГИИ LABORATORY WORKBOOK IN VIROLOGY 3-е издание Минск БГМУ 2016 УДК 578.7(811.111)-054.6(076.5) (075.8) ББК 52.63(81.2 Англ-923) Л12 Рекомендовано Научно-методическим советом университета в качестве лабораторного практикума 18.11.2015 г., протокол № 3 А в т о р ы: Д. А. Черношей, В. В. Слизень, Т. А. Канашкова, Т. Г. Адамович Р е ц е н з е н т ы: канд. мед. наук, доц. В. Э. Бутвиловский; канд. мед. наук, доц. А. М. Дронина Лабораторный практикум по вирусологии = Laboratory workbook in virology : лаб. Л12 практикум / Д. А. Черношей [и др.]. – 3-е изд. – Минск : БГМУ, 2016. – 24 с. ISBN 978-985-567-397-3. Содержит информацию для подготовки к практическим занятиям по разделу «Вирусология». Приведены схемы, алгоритмы, справочные сведения, методики выполнения лабораторных работ. Первое издание вышло в 2013 году. Предназначен для студентов 3-го курса медицинского факультета иностранных учащихся (специальность «Лечебное дело»), обучающихся на английском языке. УДК 578.7(811.111)-054.6(076.5) (075.8) ББК 52.63(81.2 Англ-923) ___________________________________________ Учебное издание Черношей Дмитрий Александрович Слизень Вероника Вячеславовна Канашкова Татьяна Александровна Адамович Татьяна Григорьевна ЛАБОРАТОРНЫЙ ПРАКТИКУМ ПО ВИРУСОЛОГИИ LABORATORY WORKBOOK IN VIROLOGY На английском языке 3-е издание Ответственная за выпуск Т. А. Канашкова Переводчик Д. А. Черношей Подписано в печать 19.11.15. Формат 60 84/8. Бумага писчая «Снегурочка». Ризография. Гарнитура «Times».
    [Show full text]
  • PATHOLOGY of HIV/AIDS 32Nd Edition
    PATHOLOGY OF HIV/AIDS 32nd Edition by Edward C. Klatt, MD Professor of Pathology Department of Biomedical Sciences Mercer University School of Medicine Savannah, Georgia, USA July 20, 2021 Copyright © by Edward C. Klatt, MD All rights reserved worldwide 2 DEDICATION To persons living with HIV/AIDS past, present, and future who provide the knowledge, to researchers who utilize the knowledge, to health care workers who apply the knowledge, and to public officials who do their best to promote the health of their citizens with the knowledge of the biology, pathophysiology, treatment, and prevention of HIV/AIDS. 3 TABLE OF CONTENTS 3.................................................................................................................................2 CHAPTER 1 - BIOLOGY AND PATHOGENESIS OF HIV INFECTION.....6 INTRODUCTION......................................................................................................................6 BIOLOGY OF HUMAN IMMUNODEFICIENCY VIRUS................................................10 HUMAN IMMUNODEFICIENCY VIRUS SUBTYPES.....................................................29 OTHER HUMAN RETROVIRUSES....................................................................................31 EPIDEMIOLOGY OF HIV/AIDS.........................................................................................36 RISK GROUPS FOR HUMAN IMMUNODEFICIENCY VIRUS INFECTION.............46 NATURAL HISTORY OF HIV INFECTION......................................................................47 PROGRESSION OF HIV
    [Show full text]
  • Lennette's Laboratory Diagnosis of Viral
    Lennette’s Laboratory Diagnosis of Viral Infections NFECT I OUS I SEASE Fourth Edition Fourth I D Edition AN D THERAPY SER I ES About the book Volume 50 • Written from the perspective of the diagnostician, this bestselling book is the definitive text on the laboratory diagnosis of human viral diseases. • Contains a wealth of illustrations, tables, and algorithms to enhance your understanding of Viral Infections Viral of Lennette’s Lennette’s of this ever-evolving field. • A ready reference source for virologists, microbiologists, epidemiologists, laboratorians, infectious disease specialists and students. Laboratory Unique features • Has a new syndromic approach and discusses the differential diagnosis of potential causative agents along with suggestions for the appropriate diagnostic response. Diagnosis of • Examines the field’s rapid changes in technology, the continuing emergence of new viruses, and the newly described viral etiologies for clinical syndromes. Laboratory Diagnosis • Explores the increasingly important subject of molecular techniques in detail, covering the design of molecular tests, the importance of genotyping and viral Viral Infections sequence analysis, and the use of microarrays in diagnostic virology. Reviews of previous editions Fourth Edition a worthy addition to the bookshelves of the specialised virus laboratory as it contains a wealth of information not readily available elsewhere. The Journal of Clinical Pathology a comprehensive and valuable addition to any medical library. It will appeal to all students of virology, medical microbiology and infectious diseases. The information is set out in a user-friendly fashion and allows the reader to obtain pertinent information without being deluged with too many data [...] recommend[ed] highly.
    [Show full text]
  • An Electrodermal Analysis of Biological Conductance
    An Electrodermal Analysis of Biological Conductance Guidebook for Locating Electrodermal Detection Sites Surface Atlas of Detection Sites Glossary of Computer Codes in Plain Language Protocol for Electrodermal Screening Process of Iteration for Correcting Non-Conductance Conductance in the Complex Human Biological System By Vincent J. Speckhart, M.D., M.D.(H) Published by: Biological Conductance Inc. 1340-1272 N. Great Neck Road Box 188 Virginia Beach, VA 23454 E-mail orders: [email protected] All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the author, except for the inclusion of brief quotations in a review. Copyright © 2004 First Printing 2004 Printed in the United States of America ISBN 0-9741533-0-3 i ii Acknowledgments I wish to thank Jim Jose, Douglas C. Leber and John Shell for developing the Acupro II System. Most of the data for this study was obtained using this software system. Other good detection devices are available and have been used successfully in obtaining similar data, but the Acupro II System gave me the best range of data that I wanted to include in this study. As a graphic artist, Lee Troxell demonstrated exceptional talent in developing the open and clear graphics for use in the Atlas. He has shown equal skill in converting these images into my computerized program for electrodermal detection. It has been a rocky road in getting a study of this technology to be approved or at least tolerated by those appointed to regulate such activities.
    [Show full text]