Browsing by Author "Petrak, Russell"

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    Glucocorticoids as Adjunctive Therapy in Infectious Diseases—Immunomodulation in the Management of Infection-Related Inflammation
    (2026-9-30) Petrak, Russell
    Abstract: Glucocorticoids (GCs) represent a critical adjunctive strategy in the management of select infectious diseases, particularly those in which the host inflammatory response, rather than direct pathogen toxicity, is the primary driver of morbidity and mortality. This review synthesizes evidence-based indications for GC use across bacterial, viral, fungal, and parasitic infections, with emphasis on agent selection, dosing, duration, and the clinical principle that steroids must always be co-administered with definitive antimicrobial therapy. The conditions discussed include bacterial meningitis, tuberculosis (meningitis and pericarditis), PCP, COVID-19, septic shock, croup, and selected fungal and parasitic infections. Contraindications, most notably cerebral malaria, are highlighted. The evidence base ranges from landmark randomized controlled trials to consensus guidelines.
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    Secondary Immunodeficiencies: Clinical Immunology for Infectious Disease Specialists
    (2026-9-30) Petrak, Russell
    Abstract: Secondary immunodeficiencies (SIDs) are acquired disorders of immune function arising from extrinsic insults to an otherwise intact immune system. Unlike primary immunodeficiencies, which are heritable, SIDs are far more prevalent, and encompass a broad spectrum of etiologies including infection, malignancy, malnutrition, metabolic disease, and iatrogenic causes. Among the latter, B cell depletion therapy has emerged as a clinically significant and increasingly utilized modality in the management of autoimmune disease, hematologic malignancy, and transplant medicine. This paper presents a structured review of secondary immunodeficiency states with particular attention to the mechanisms, clinical indications, immunological sequelae, infectious complications, and management strategies associated with B cell depletion therapy.