1/29. central nervous system toxoplasmosis in acquired immunodeficiency syndrome: An emerging disease in india.With the incidence of patients infected with human immuno-deficiency virus (hiv) increasing in india, the central nervous system (CNS) manifestations of the disease will be seen more frequently. The CNS may be primarily afflicted by the virus or by opportunistic infections and neoplasms secondary to the immune suppression caused by the virus. In india, although mycobacterium tuberculosis has been reported to be the most common opportunistic infection, toxoplasmosis may become as common owing to the ubiquitous nature of the protozoan. Since an empirical trial of medical therapy without histopathological diagnosis is recommended, the true incidence of this condition may remain under estimated. The role of ancillary tests such as radiology and serology in the initial diagnosis of this condition remain crucial. This report highlights two patients who were diagnosed to have acquired immuno-deficiency syndrome (AIDS) only after the biopsy of the intracranial lesion was reported as toxoplasmosis. Presently all patients for elective neurosurgery are tested for hiv antigen. The management protocol to be followed in a known patient with AIDS presenting with CNS symptoms is discussed in detail. The value of ancillary tests is also reviewed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/29. hiv counselling--a luxury or necessity?WHO and UNAIDS have consistently promoted hiv counselling as a routine part of hiv testing in developing countries. Nevertheless, in many countries counselling is not considered a crucial accompaniment of testing services, and patients are tested without access to counselling during and after testing. Thus, information on the need for and results of counselling is needed to convince policy-makers and service managers to give greater priority to the development of counselling services. This qualitative study describes informational, social and emotional needs and problems of newly diagnosed seropositive patients attending public health services in zimbabwe. Their basic factual information on hiv/AIDS was reasonable, but many patients equalled hiv to AIDS and conceptualized their infection as 'social and physical death'. This seriously impeded their capacity to use knowledge of their test results in a constructive way, and stimulated coping by denial and/or secrecy about their hiv status. These avoidant coping strategies discouraged clients from using condoms, seeking social support and taking measures to protect their vulnerable health. The complex and changing nature of clients' needs indicates that common short-cuts in counselling (e.g. giving brief information before and after the hiv test) are seriously flawed as a strategy to prepare clients for effective coping. Comprehensive pre- and post-test counselling are an essential preparation for coping effectively during and immediately after testing. Availability of supportive counselling beyond this first phase is essential to assist clients with needs and problems which will appear over time. Development of counselling interventions should be guided by research into their effectiveness and by national policy guidelines. Replacing fear-inducing hiv campaigns with interactive, constructive information about hiv prevention and care will increase the preparedness of the community as a whole for effective living with hiv.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/29. Human herpesvirus type 8 in hiv-infected patients with interstitial pneumonitis.OBJECTIVES: The new human herpesvirus type 8 (HHV-8) has been detected in all types of Kaposi's sarcomas, as well as in body-cavity lymphomas and Castleman's disease. Recently, HHV-8 has also been associated with encephalitis in hiv-positive and hiv-negative patients. Interstitial pneumonitis, combined with detection of HHV-8 in non hiv-infected patients, indicates a pathogenetic role of HHV-8 in unexplained lung diseases. We have studied two hiv-infected patients, with otherwise unexplained interstitial pneumonitis for the presence of HHV-8. methods: Lung biopsies of both patients were investigated for HHV-8 sequences. A nested PCR method was used for amplification of HHV-8 dna fragments, and the nature of the amplification products was confirmed by Southern blot hybridization. In addition, we used an in situ hybridization technique and immunohistochemical staining for detection of HHV-8 infected cells. RESULTS: Amplification of HHV-8 dna fragments was seen with template dna from lung biopsies of both cases and the appropriate positive controls, but not with negative controls. in situ hybridization and immunohistochemical staining demonstrated HHV-8 infected lymphoid cells and alveolar macrophages in both patients as well. CONCLUSIONS: HHV-8 was found in hiv-infected patients with otherwise unexplained interstitial pneumonitis, but the pathogenic role of HHV-8 in patients with interstitial pneumonia remains unclear.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/29. Transmission of human immunodeficiency virus through bone transplantation: a case report.Human immunodeficiency virus (hiv) can be transmitted through tissue or organ transplantation. Since 1988, eight cases of bone transplantation-associated hiv infection have been reported. We describe a 34-year-old woman with osteoarthritis, who was hospitalized in 1996 because of painful locomotion and deformity in the right knee. An old fracture of the femur and genu varum in the right knee was repaired by open reduction and internal fixation, with allogeneic bone transplantation for defect reconstruction. Five months later, she presented at another hospital with pain and swelling of the right thigh, where screening for hiv was positive. The transmission was tracked to a 50-year-old man with no history of hiv screening, from whom the femoral head was procured when he underwent a hip replacement for left femoral neck fracture. This is the first reported case of hiv infection through bone transplantation in taiwan, and the preventable nature of this transmission should be underscored.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/29. Coexistence of metastatic neuroendocrine carcinoma of the uterine cervix with human immunodeficiency virus infection.women now constitute 28% of new cases of human immunodeficiency virus (hiv) infection. Cervical cancer in hiv-infected women has a high recurrence and death rate, as well as decreased intervals to recurrence and death. Neuroendocrine carcinomas of the cervix are characterized by a high frequency of early nodal and distant metastases. We present the first report of a neuroendocrine carcinoma of the cervix in an hiv-positive patient. A 28 year old with a 9-year history of hiv succumbed to metastatic neuroendocrine carcinoma of the cervix 5 months after diagnosis. Given the aggressive nature of the cell type, an extended metastatic workup should be considered prior to surgery. The immune suppression present in hiv-positive patients with neuroendocrine cervical carcinoma may make such a workup particularly crucial, such that surgery is offered only to those who can be expected to benefit.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/29. Case report on a rare lesion in an hiv-infected child: hairy leukoplakia.This report describes a case of hairy leukoplakia in an hiv-infected child, and the treatment adopted. It was diagnosed by clinical and laboratory examinations, using exfoliative cytology (staining by the Papanicolaou method) and additional information was obtained by optical microscope analysis. In view of the lack of painful symptoms, of the innocuous nature of the lesion and large amount of medicines used by the patient, we decided to preserve and monitor the lesion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/29. Diffuse ulcerations due to disseminated histoplasmosis in a patient with hiv.Disseminated histoplasmosis is a serious disease that affects the skin, lungs, and internal organs. It is one of the diseases that characterize acquired immunodeficiency syndrome (AIDS), and in endemic areas is one of the more commonly observed infections in AIDS patients. The mortality rate in patients with AIDS and histoplasmosis is high if untreated. Disseminated histoplasmosis may have a variety of dermatological manifestations. In this article, we provide the first report of diffuse ulcerations due to disseminated histoplasmosis. These ulcers developed while the patient was on stavudine, lamivudine, and indinavir, and had a CD-4 count of 525 mm3. The patient's histoplasmosis resolved with itraconazole monotherapy. histoplasmosis is a well-described opportunistic infection that accompanies human-immunodeficiency virus (hiv) infection. We report an unlikely victim of disseminated histoplasmosis who suffered this infection while on antiretroviral therapy and with a CD-4 count of 525/mm3. Notably, he had a normal chest x-ray and disseminated cutaneous ulcers. The diagnosis was made by skin biopsy, and his infection responded promptly to itraconazole therapy. This case serves as a reminder that the immunological derangements and cutaneous alterations wrought by hiv remain unpredictable in nature and extent.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/29. hiv-infected client care: case management and the hiv team.No one discipline can meet the complex needs of the hiv-infected client. Because of the diverse nature of disease manifestations, an hiv Team concept is promoted. The clinical nurse specialist (CNS) is uniquely prepared to initiate the team and support holistic client care through case management. Current hiv statistics with implications for the rural community are provided, and reasons for the lack of community involvement with hiv care are suggested. The case study illustrates complex needs of an hiv-infected woman, as well as issues that evolve during hiv-infected client care. Interventions that promote care for persons living with hiv in addition to support of involved health care workers are addressed. Practical suggestions for initiating this process are included.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/29. Epidemic (human immunodeficiency virus-related) Kaposi's sarcoma in West African women.BACKGROUND: Most patients infected with human immunodeficiency virus (hiv) experience skin disease at some stage of their illness, either as a presenting feature or as a later manifestation. Different dermatoses may coexist during the course of the infection, and the unusual nature of the skin lesions can make an accurate diagnosis difficult. Kaposi's sarcoma is one of the acquired immunodeficiency syndrome (AIDS)-defining skin diseases and may coexist with other lesions in AIDS patients. Kaposi's sarcoma is caused by human herpesvirus 8 (HHV8), which is mainly transmitted through male homosexual behavior, and is less common in women than in men. methods: The clinical, histopathologic, and therapeutic aspects of AIDS-related Kaposi's sarcoma in three women (age, 18-34 years) who presented to the dermatology clinic of the University of nigeria teaching Hospital, Enugu, nigeria, were studied over 18 months, beginning in August and September 1998. RESULTS: At presentation, the condition of the three patients was generally poor, with severe anemia and extensive dark-brown papules, plaques, and nodules. Mucosal involvement was extensive. Generalized lymphadenopathy was found in two patients, one of whom had extensive coexisting dermatophytosis. All three women were in stage III/IV of the disease at the time of initial presentation. death occurred within days in one and within 7-8 months in two. CONCLUSIONS: Because these female patients with epidemic Kaposi's sarcoma lived in an almost entirely heterosexual population, the mode of contamination with HHV8 was obscure. The course of the disease was pervasive, aggressive, and devastating.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/29. Acute myeloid leukemia secondary to a myelodysplastic syndrome with t(3;3) (q21;q26) in an hiv patient treated with chemotherapy and highly active antiretroviral therapy.We describe the first case of secondary acute myeloid leukemia (AML) with t(3;3) (q21;q26) occurring in a human immunodeficiency virus (hiv)-infected patient sequentially treated with chemotherapy and highly active antiretroviral therapy (HAART). The t(3;3) is a nonrandom abnormality found in a small percentage of patients with myelodysplastic syndrome, secondary AML or chronic myeloid leukemia and is strongly associated with abnormal thrombopoiesis and a particularly poor prognosis. So far, it has never been observed in hiv-positive patients. Sporadic cases of AML have been reported in hiv patients and the feasibility of chemotherapy in association with HAART and disease outcome are still not clearly defined. Despite the poor response to chemotherapy in our case, which might also be related to the unfavorable karyotype, the secondary nature of the disease and the hiv positivity, the patient had a relatively long period of survival that could be due to the use of HAART. The association of chemotherapy with HAART appeared to be feasible and tolerable and could be suggested as a choice treatment in this peculiar subset of hiv/AML patients.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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