Presentation is loading. Please wait.

Presentation is loading. Please wait.

Clinical Case Conference #5

Similar presentations


Presentation on theme: "Clinical Case Conference #5"— Presentation transcript:

1 Clinical Case Conference #5
Amaro - Aribon

2 Pathomechanisms for Cytopenia in Active SLE

3 Cytopenia in SLE Most common hematologic manifestations of SLE:
Normochromic normocytic anemia due to autoimmune hemolysis, aplastic anemia, and pure red cell aplasia Leukopenia (<4000/uL) which usually consists of Lymphopenia (<1500/uL) primarily due to a fall in absolute lymphocyte count Thrombocytopenia (100,000/uL) - autoimmune hemolysis, aplastic anemia, and pure red cell aplasia - The decrease in WBC count is primarily due to a fall in absolute lymphocyte count accompanied by an increase in granulocyte percentage

4

5 Cytopenia in SLE Pathogenic auto-antibodies , and immune complexes bind to target tissues with activation of complement and phagocytic cells. Complement, and immune cells lead to release of chemotaxins, cytokines, chemokines, vasoactive peptides, and destructive enzymes. -

6 Define Ferbrile Neutropenia

7 Febrile Neutropenia Refers to the clinical presentation of fever (one temperature ≥ 38.5 °C or three readings ≥38° C but ≤38.5 °C per 24 hrs) in a neutropenic patient with an uncontrolled neoplasm involving the bone marrow, or in a patient undergoing treatment with cytotoxic agents. Braunwald, et al. Harrison’s Principles of Internal Medicine 17th ed.

8 Risk Factors for Candidiasis

9 Risk factors for Candidiasis
General Conditions causing a compromised host defense Neutropenia Glucocorticoid therapy Malnutrition Reference:

10 Risk factors for Candidiasis
Oropharyngeal thrush Diabetes mellitus HIV infection Common in acute HIV infection Increasingly common late in disease as the CD4+ cell count falls Dentures Inhaled or oral glucocorticoids Neonatal period Iron deficiency Reference:

11 Risk factors for Candidiasis
Vulvovaginal candidiasis Third trimester of pregnancy Antibiotic use Reference:

12 Risk factors for Candidiasis
Cutaneous candidiasis Macerated skin Diapered area of infants Under pendulous breasts or pannus Hands constantly in water Hands covered by occlusive gloves Reference:

13 Risk factors for Candidiasis
Esophageal candidiasis HIV infection Uncommon until CD4+ counts fall below 50/μL Reference:

14 Risk factors for Candidiasis
Invasive candidiasis Use of broad-spectrum antibiotic therapy Indwelling central venous catheter Total parenteral nutrition Perforation of the GI tract through trauma, surgery, or peptic ulceration Mucosal damage due to cytotoxic agents used for cancer chemotherapy Contamination of the hub or skin site of a catheter in an umbilical or central vein with secretions from the mouth, rectum, or vagina or with drainage from surgical wounds or tracheostomy sites Intravenous drug abuse Third-degree burns Very low birth weight (in neonates) Neutropenia Glucocorticoid therapy Reference:

15 Antimicrobial treatment of systemic candidiasis

16 Disseminated candidiasis with end organ infection
Triazole Antifungal Drug Fluconazole 800 mg (loading dose) 400 mg/d IV or oral, at least 2 weeks * Voriconazole 6 mg/kg IV or orally 2x/d (loading dose) 3 mg/kg orally twice per day or 200 mg orally twice per day Echinocandins Caspofungin 70 mg (loading dose) 50 mg/d IV, at least 2 weeks * Anidulafungin 200 mg (loading dose) 100 mg/d Micafungin Amphotericin B deoxycholate mg/kg/d intravenously to achieve a minimum of 1- to 2-g total dose. Liposomal preparations of amphotericin B Doses between 3 and 5 mg/kg/d * after a demonstrated negative blood culture result or clinical signs of improvement.

17 Define sepsis and septic shock

18 Sepsis a serious medical condition that is characterized by a whole-body inflammatory state (called a systemic inflammatory response syndrome or SIRS) and the presence of a known or suspected infection

19 Septic Shock State of sepsis with refractory arterial hypotension or hypoperfusion abnormalities in spite of aggressive fluid resuscitation (typically upwards of 6 liters or 40 ml/kg of crystalloid). Signs of systemic hypoperfusion may be either end-organ dysfunction or serum lactate greater than 4 mmol/dL. Other signs include oliguria and altered mental status


Download ppt "Clinical Case Conference #5"

Similar presentations


Ads by Google