By A. Young, D. Spelman, A. Street et al. (eds.)
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Extra info for Infectious diseases : a clinical approach
Some infections produce distinctive patterns that vary little in different patients and are easily recognised at the bedside. Viral infections such as chickenpox, measles and rubella, and bacterial infections such as tetanus, leprosy and anthrax are examples of this group. g. Epstein-Barr virus or Mycoplasma pneumoniae infections). Some infections, although varying little in different patients, produce nondiagnostic clinical syndromes. For example, diseases such as brucellosis and Q fever present as nonspecific febrile illnesses.
If the illness has been present for several weeks, it is more important to determine the nature of its onset, its trend over time and whether it is a single continuous illness or a series of events. Patients with infections are often unable to recall fine details such as dates and names of medications. Inability to give a history or think clearly is an important sign of potential sepsis. Further information should be sought from family members and the patient’s previous doctors. A second history, taken the next morning, when patients have had time to reflect and are usually at their best, is often more accurate.
IL-10 and epoxyeicosanoids produced by the cytochrome P450 enzymes also have a role in regulating and limiting the febrile and inflammatory responses. In addition to their effect on temperature regulation, these cytokines have a wide range of biological properties, most of them beneficial. Nevertheless, sustained high blood levels of cytokines such as TNFα may produce damage to the microvasculature and lead to microthrombosis, tissue infarction or irreversible shock. This host-mediated process partly explains the massive skin destruction that sometimes complicates meningococcal sepsis.
Infectious diseases : a clinical approach by A. Young, D. Spelman, A. Street et al. (eds.)