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1/3. The role of infections in primary hemophagocytic lymphohistiocytosis: a case series and review of the literature.

    There is a paucity of literature addressing infection-related morbidity and mortality in children with primary hemophagocytic lymphohistiocytosis (HLH), a rare condition characterized by abnormal proliferation of macrophages, hypercytokinemia, and T cell immunosuppression. Therefore, a retrospective chart review was done of patients diagnosed with primary HLH over a 15-year period. Significant infections present at diagnosis, during the course of illness, and just prior to death or at autopsy were noted. Of the 18 children identified with primary HLH, an infectious agent was documented at the initial presentation of HLH in 5. Significant infections occurred during therapy in 10 (56%) of 18. Of the 12 fatal cases, invasive infection was the cause of death in 8 children, and 6 of these deaths were directly attributable to invasive fungal infection. Significant infections were common during therapy in children with primary HLH, and fungal infections were an important cause of mortality in this group.
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keywords = death
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2/3. 9: Infections in the returned traveller.

    The usual presentation of a returned traveller is with a particular syndrome - fever, respiratory infection, diarrhoea, eosinophilia, or skin or soft tissue infection - or for screening for asymptomatic infection. fever in a returned traveller requires prompt investigation to prevent deaths from malaria; diagnosis of malaria may require up to three blood films over 36-48 hours. Diarrhoea is the most common health problem in travellers and is caused predominantly by bacteria; persistent diarrhoea is less likely to have an infectious cause, but its prognosis is usually good. While most travel-related infections present within six months of return, some important chronic infections may present months or years later (eg, strongyloidiasis, schistosomiasis). Travellers who have been bitten by an animal require evaluation for rabies prophylaxis.
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ranking = 0.33333333333333
keywords = death
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3/3. pneumonia in the elderly.

    pneumonia is not only a major cause of death for elderly persons, but also imposes substantial personal morbidity and burdens on the health care system. Timely, accurate diagnosis and therapy depend on recognition of important differences in the pathogenesis of pneumonia according to the settings in which it occurs. Active elderly persons living in the community, institutionalized seniors with "nursing home pneumonia," and those with hospital-acquired infections have different microbial causes of their respiratory infections that, together with altered host defenses and iatrogenic factors, dramatically influence outcomes. The presence of other common medical illnesses in older persons obscures the clinical presentations of pneumonia, predisposes to respiratory infection, and adversely influences prognosis. These clinical relationships and the variability and vulnerability of individual patients underlie largely empiric, setting-specific antimicrobial therapy. Whenever possible, prevention of this devastating illness is essential.
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ranking = 0.33333333333333
keywords = death
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