Internal Medicine

0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Chronic Coronary Artery Disease (CAD) Chronic Granulomatous Disease 317

■Vital signs to assure optimal heart rate and BP control

■Yearly renal panel in diabetes

■Yearly lipid panel in all patients

■Exercise test every 1–3 years depending on symptoms.

complications and prognosis

■Chronic stable angina by itself: good prognosis

■Prognosis worse with increasing age, diabetes, prior MI with

decreased LV function, multivessel disease, poorly controlled BP,

continued smoking, female gender, renal failure, noncompliance

with medications, and progressive symptoms despite optimal med-

ical management

CHRONIC GRANULOMATOUS DISEASE

NANCY BERLINER, MD

history & physical

■Severe bacterial and fungal infections from early childhood

■Family history of the disorder: usually X-linked, but autosomal reces-

sive inheritance also occurs

■Examine for evidence of infection. Most common infections: pneu-

monia, lymphadenitis, cutaneous infections, hepatic abscesses,

osteomyelitis, aphthous ulcers, perirectal abscesses

tests

■Diagnosis confirmed by tests of neutrophil oxidative metabolism:

nitroblue tetrazolium (NBT) slide test or measurements of superox-

ide or peroxide production.

differential diagnosis

■Heterogeneous group of rare disorders

■Defective production of superoxide (O 2 −) by neutrophils, mono-

cytes, and eosinophils

■Caused by mutations in any of four genes encoding the respiratory

burst oxidase.

■Also evaluate for other immunodeficiency syndromes and neutro-

phil functional defects

management

■Aggressive prophylaxis with prophylactic trimethoprim-sulfame-

thoxazole or dicloxacillin