Prevention of Hepatitis A

In the United States, hepatitis A is a preventable infection through the use of either of two vaccines that are commercially available, VAQTA, manufactured by Merck, Sharp, and Dohme (West Point, Pennsylvania), and HAVRIX, manufactured by SmithKline Beecham Biologicals (Rixensart, Belgium). Table 105-1 depicts the principal characteristics and doses for both commercially available vaccines. Although hepatitis A vaccine is the first line of preventive therapy, administration of serum IgG is...

Parasitic Pathogens

The protozoans Cryptosporidium parvum and Giardia lam-blia are the most common causes of diarrhea from parasites in the United States. Both occur sporadically and in outbreaks associated with contaminated food and water. Less common parasitic causes of diarrhea in North America include Entamoeba histolytica, Cyclospora cayen-tensis, and Microsporidia sp, particularly in immunocompromised patients, travelers, and patients with the AIDS. There is a separate chapter on the treatment of intestinal...

Giardia lamblia Giardiasis

A protozoal infection of the upper small intestine, giardiasis results from ingestion of cysts that can be transmitted by fecally contaminated water or food, person-to-person contact, or oralanal sexual contact. The parasite occurs worldwide. With an estimated 2 million infections occurring annually in the United States it is the most common intestinal protozoan pathogen in the United States. A large proportion of infected persons remain asymptomatic and the infection resolves spontaneously....

PBlockers

Nonselective p-blockers, such as propranolol or nadalol,are the recommended first line agents for the prevention of a first variceal bleed in compliant patients without contraindications to their use. Nonselective p-blockers act by decreasing splanchnic arterial blood flow, which results in a decrease in portal venous blood flow, and their use is associated with a 40 reduction in the risk of bleeding. Typically patients are started on a nonselective p-blocker and the dose TABLE 117-2. Drugs...