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Reinfection rather than relapse may have accounted for the late infections diabetes kidney problems precose 25 mg buy line, but relapse seems more likely in view of the following results in experimental animals [309]. These human and animal data are particularly relevant to the design of prophylactic regimens to prevent Pneumocystis infection in humans. They provide a compelling argument for the need to continue prophylaxis for as long as host defenses are considered to be too compromised to keep latent Pneumocystis infection in check. Reactivation of pneumocystosis is not surprising in light of the pathogenesis and pathology of the infection in the immunodeficient subject. Frenkel and colleagues [19] showed clearly in the earliest experimental animal models of Pneumocystis pneumonia that anti-Pneumocystis therapy alone was not completely curative and that relapse was to be anticipated unless factors provoking the infection (namely, corticosteroid administration) were minimized. Long-term ultrastructural studies of Pneumocystis pneumonia in the rat confirmed that even with tapering of corticosteroid and apparent restoration of immune function, focal clusters of P. Furthermore, in humans, drugs might not reach organisms residing within the foci of fibrosis and calcifications formed during especially severe infection [310]. Indeed, Dutz [24] contended that drugs play no therapeutic role in epidemic pneumocystosis once the chronic plasma cellular infiltrate is established. Radiographic resolution is slow, and survival and permanent immunity to reinfection relate not to chemotherapy but to specific anti-Pneumocystis immunoglobulin production in the affected infants. Unfortunately, the congenitally immunodeficient or exogenously immunosuppressed child does not possess such normal immune responsiveness and thus is subject to recurrent infection. In a controlled trial conducted in an Iranian orphanage where the infection was endemic (attack rate of 28%), the biweekly administration of a pyrimethamine and sulfadoxine combination to marasmic infants before the second month of life entirely eradicated Pneumocystis pneumonia from the institution [24]. During the 6 years of the study, Pneumocystis infection did not develop among 536 premature babies who received this treatment, whereas 62 fatal cases were recorded elsewhere in the city [311]. Administration of the drug for the duration of antineoplastic therapy has become standard practice. The source of infection was thought to be infected grain on the farm where the infant lived. Infection in two of these four infants was considered secondary to prematurity or to antibiotic or corticosteroid therapy [325,326], but predisposing causes for disseminated aspergillosis were not found in the others [327,328].
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Lukjan, 63 years: Stage of myeloid maturation Understand progenitor cell differentiation and maturation Recognize morphologic features of myeloid precursors b.
