Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1134 Paracoccidioidomycosis Parainfluenza

■Amphotericin B

➣Side effects: fevers, chills, nausea, vomiting and headaches; rig-

ors may be prevented by the addition of hydrocortisone to bag,

meperidine may treat rigors; nephrotoxicity; electrolyte distur-

bance (renal tubular acidosis, hypokalemia, hypomagnesemia)

■Contraindications: if Cr 2.5–3.0, may consider giving lipid-based

Amphotericin products

follow-up

■Follow-up chest radiographs as necessary

■May also follow complement fixation titers for response to therapy

complications and prognosis

Complications

■Pulmonary disease may progress to right ventricular hypertrophy

and right heart failure

Prognosis

■Good with treatment; may need prolonged course of therapy

PARAINFLUENZA

CAROL A. GLASER, MD

history & physical

History

■RNA virus – paramyxoviruses; 4 distinct types – 1, 2, 3, and 4

■Several animal species hosts to parainfluenza but human infection

from humans only

■Transmission person to person – direct contact, contaminated secre-

tions and fomites

■incubation period: 2–6 days

■type 1: outbreaks (usually croup) in fall (2–6 yr old)

■type 2: sometimes cause outbreaks but less severe/irregular > type 1

(2–6 yr old)

■type 3: must prominent spring/summer

■type 4: can cause disease young chickens but is rarely isolated

■Reinfections can occur at any age milder > initial.

■Nosocomial infections are common.