may be related to viral hepatitis.
Hepatitis C virus infection is found in 20%-60% of patients with PHL.
Virus may play a role in the pathogenesis of PHL.
PHL is also seen in immunocompromised patients, but the relationship between PHL occurrence and immune deficiency has not yet been reported.
PHL also could occur in immunocompetent patients without any prior liver disease.
Epidemiology and clinical manifestations
Chickenpox
- Rash, low-grade fever, malaise
- Benign to immunocompetent patient
- Skin lesion : Hallmark of infection
maculopapule -> vesicle, scabs
(over hours to days)
Trunk and face -> other areas of the body
- Immunocompromised patients: hemorrhagic based lesion
Histoplasmosis
Acquired by inhalation of dust particles from contaminated soil
Markedly resemble Tbc
Macrophages are the major target of infection
Patients with acquired immunodeficiency syndrome are susceptible to disseminated infection with Histoplasma (opportunistic pathogen)
Diagnosis
Culture
Identification of the fungus in tissue lesions.
Serologic tests for antibodies and antigen.
The most likely pathogens
Local antimicrobial-susceptibility patterns
Risk factors for drug resistant S. pneumoniae
Medical comorbidities
PK and PD
Safety profile
Cost efficacy
Previously healthy
No recent antibiotics within 3 months and no risk for PRSP
Macrolide/ doxycycline
Comorbidities (COPD, chronic heart, liver lung renal disease)
Respiratory Fluroquino