By Joshua O. Benditt, et al. American College of Chest Physicians
Immediately from the ACCP severe Care medication Board overview 2009 direction, this article covers each subject in a concise, easy-to-use structure. Use as a self-study source to organize for the severe care drugs subspecialty board exam.
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Additional resources for ACCP Critical Care Medicine Board Review, 20th Edition
21 Humoral Immunity To be ingested by polymorphonuclear leukocytes, there is a requirement that certain organisms undergo opsonization, a process in which those organisms are encased by a factor which then allows the phagocyte to attach. Once intracellular, these organisms are readily killed by the phagocyte. 2 The antibody component of humoral immunity is dependent on the transformation of B lymphocytes into plasma cells, which produce as major opsonins IgG and IgM. A structural part of these antibodies is a component referred to as the Fc segment.
Anatomic asplenia, as well as the hyposplenic states that occur in persons with sickle cell disease (due to autoinfarction of the spleen) and in patients with Hodgkin disease (especially after therapy), are also important predispositions to infection. The propensity for infection in these patients occurs on the basis of impairment of several immunologic functions: (1) relative to other lymphoid organs, the spleen has a greater percentage of B lymphocytes and is therefore involved in the production of antibody to polysaccharide antigens; (2) the spleen participates as a phagocytic organ, removing opsonin-coated organisms or damaged cells from the circulation; and (3) alternative complement-mediated activation of C3 may be decreased in patients after splenectomy.
With CD4+ counts in the 400 to 600 cells/L range, women may develop recurrent vulvovaginal candidiasis. At CD4+ levels of ∼250 cells/L, oral candidiasis is the expected clinical entity. The clinical presentation of odynophagia in a patient with oral candidiasis and a CD4+ count of Ͻ100 cells/L strongly raises the diagnosis of Candida esophagitis. These candidal infections generally respond well to therapy, and because of this, primary prophylaxis is not generally recommended. 66 Patterns of azole use have probably contributed to such problems.
ACCP Critical Care Medicine Board Review, 20th Edition by Joshua O. Benditt, et al. American College of Chest Physicians