1/137. Resolution of microsporidial sinusitis and keratoconjunctivitis by itraconazole treatment.PURPOSE: To report successful treatment of ocular infection caused by the microsporidium encephalitozoon cuniculi in a person with acquired immunodeficiency syndrome (AIDS) and nasal and paranasal sinus infection. METHOD: Case report. RESULTS: Microsporidial infection in a person with AIDS and with chronic sinusitis and keratoconjunctivitis was diagnosed by Weber modified trichrome stain and transmission electron microscopy. Symptoms completely resolved with itraconazole treatment (200 mg/day for 8 weeks) after albendazole therapy (400 mg/day for 6 weeks) was unsuccessful. CONCLUSION: itraconazole can be recommended in ocular, nasal, and paranasal sinus infection caused by E. cuniculi parasites when treatment with albendazole fails.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
2/137. Identification of mycobacterium shimoidei by molecular techniques: case report and summary of the literature.A 53-year-old woman from Melbourne, australia, with squamous cell carcinoma of the oesophagus was shown by computed tomography (CT) scan to have a left apical cavity and inflammatory changes in the right lung consistent with aspiration. Acid-fast bacilli isolated from bronchial washings were identified biochemically first as mycobacterium terrae, but later as M. shimoidei on the basis of 1) restriction fragment analysis and 2) sequencing of polymerase chain reaction (PCR) amplified 16S rDNA. Nine other descriptions of patients with M. shimoidei isolates were collated. The salient feature of isolates considered to be pathogenic was pulmonary cavitation. Most patients had underlying lung disease, including past tuberculosis or malignancy. Six of eight patients died of progressive respiratory illness, although the contribution of M. shimoidei was not always clear, and two patients improved. One patient with the acquired immune-deficiency syndrome (AIDS) died with salmonella enteritidis and M. shimoidei isolated from blood cultures. One isolate was regarded as a coloniser. There are insufficient clinical or sensitivity data on which to base recommendations for therapy, but a combination of ethambutol, rifabutin and pyrazinamide could be considered.- - - - - - - - - - ranking = 0.0048879424211147keywords = illness (Clic here for more details about this article) |
3/137. Suggestions for improving AIDS treatment in hospitals.On July 26, 1994, John William George Swaffer died of AIDS in an Ottawa hospital. His partner shares his experience while caring for John at the hospital. While the hospital did many things well, it seemed that requests for palliative care were poorly communicated among the various physicians involved with John's care. Coordination between hospital doctors and those from a local hiv clinic also seemed poor. The author recommends eight changes to better serve patients with AIDS and other terminal illnesses.- - - - - - - - - - ranking = 0.0048879424211147keywords = illness (Clic here for more details about this article) |
4/137. corynebacterium pseudodiphtheriticum: an easily missed respiratory pathogen in hiv-infected patients.Despite being a well-known respiratory pathogen for immunocompromised patients, corynebacterium pseudodiphtheriticum has uncommonly been reported to occur in persons with infection attributable to hiv virus. We report three cases of respiratory tract infection attributable to C. pseudodiphtheriticum in hiv-infected patients and review the four previous cases from the medical literature. All of them were male with a median cd4 lymphocyte count of 110 cells/mm3 (range, 18-198/mm3); five of the seven cases occurred in persons for whom AIDS was diagnosed previously. The onset of symptomatology was usually acute and the most common radiographic appearance was alveolar infiltrate (six patients) with cavitation (two patients) and pleural effusion (two patients). In five of the seven cases, C. pseudodiphtheriticum was isolated from bronchoscopic samples and in the remaining two cases was recovered from lung biopsy (one patient) and sputum (one patient). In the three patients reported herein and in one previous case from the medical literature, quantitative culturing of bronchoscopic samples obtained through either bronchoalveolar lavage or protected brush catheter procedures yielded more than 10(3) CFU/mL. All the strains tested were susceptible to penicillin and vancomycin. Resistance to macrolides was common. Recovery was observed in six of the seven patients. C. pseudodiphtheriticum should be regarded as a potential respiratory pathogen in hiv-infected patients. This infection presents late in the course of hiv disease and it seems to respond well to appropriate antibiotic treatment in most of the cases. This easily overlooked pathogen should be added to the list of organisms implicated in respiratory tract infections in this population.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
5/137. Resolution of recalcitrant hand warts in an hiv-infected patient treated with potent antiretroviral therapy.Human papilloma virus (HPV)-related cutaneous manifestations occur with increased frequency and severity among hiv-infected persons. In this report, we describe an hiv-infected man with persistent, severe cutaneous hand warts that did not respond to multiple therapies, including liquid nitrogen cryotherapy, topical dinitrochlorobenzene, topical podophyllin, and intralesional interferon-alfa injections. Approximately 1 year after starting a potent protease inhibitor-containing antiretroviral regimen, the patient's recalcitrant cutaneous warts markedly diminished in size, even though the patient did not receive any specific therapy for the warts after starting aggressive antiretroviral therapy. The patient continued on a potent protease inhibitor-containing antiretroviral regimen and, approximately 2 years later, the warts completely resolved. Our patient's dramatic clinical improvement of cutaneous HPV infection that followed protease inhibitor-containing antiretroviral therapy provides a clear-cut example that protease inhibitor-containing combination antiretroviral therapy can produce significant clinical benefit.- - - - - - - - - - ranking = 0.5keywords = person (Clic here for more details about this article) |
6/137. Fatal campylobacter jejuni bacteraemia in patients with AIDS.Two fatal cases of campylobacter jejuni septicaemia in patients with AIDS were characterised by severe hiv-related immunodeficiency, negative stool cultures and presentation during hospitalisation, developing a clinical picture of fulminant septic shock despite therapy with appropriate antibiotics. Campylobacter spp. are important opportunist pathogens in hiv disease and may cause a septicaemic illness in the absence of enteric disease.- - - - - - - - - - ranking = 0.0048879424211147keywords = illness (Clic here for more details about this article) |
7/137. hiv infection and seizures.New-onset seizures are frequent manifestations of central nervous system disorders in patients infected with human immunodeficiency virus (hiv). seizures are more common in advanced stages of the disease, although they may occur early in the course of illness. In the majority of patients, seizures are of the generalised type. status epilepticus is also frequent. Associated metabolic abnormalities increase the risk for status epilepticus. Cerebral mass lesions, cryptococcal meningitis, and hiv-encephalopathy are common causes of seizures. phenytoin is the most commonly prescribed anticonvulsant in this situation, although several patients may experience hypersensitivity reactions. The prognosis of seizure disorders in hiv-infected patients depends upon the underlying cause.- - - - - - - - - - ranking = 0.0048879424211147keywords = illness (Clic here for more details about this article) |
8/137. pneumococcal infections in hiv-infected adults.Bacterial pneumonia, specifically pneumococcal infection, is a frequent cause of morbidity and mortality in persons infected with human immunodeficiency virus (hiv). It causes morbidity directly and possibly progression of hiv infection. The clinical presentation and response to therapy are usually similar to that of patients without hiv infection, although radiographic presentations may be atypical. There is a higher incidence of invasive disease and extrapulmonary disease, and mortality may be increased in hiv-infected patients. hiv infection impairs the host response to pneumococcus in a variety of ways. Colonization with streptococcus pneumoniae may be prolonged for reasons that are incompletely understood. Concern about the rising prevalence of resistant pneumococcal strains is increasing, but the clinical relevance is uncertain. At least 90% of the strains that cause invasive disease are present in the 23-valent pneumococcal vaccine. The response to vaccination declines as immunodeficiency progresses; however, the potential benefit to responders is great and the risk is minimal. Therefore, this vaccine is recommended for all hiv-infected persons.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
9/137. aspergillus mastoiditis in acquired immunodeficiency syndrome.OBJECTIVE: This study aimed to analyze the clinical presentation, diagnosis, management, and results of treatment in a series of three patients with acquired immunodeficiency syndrome (AIDS) in whom aspergillus mastoiditis developed. This study also aimed to compare these aspects of aspergillus mastoiditis in patients with AIDS with three additional cases present in the current literature. A classification system for fungal infections of the ear and temporal bone is proposed. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at multiple tertiary referral centers. patients: Three individuals with diagnosed AIDS and mastoiditis resulting from culture-proven aspergillus were studied. INTERVENTION: patients were treated with both medical and surgical methods including local and systemic antimicrobial/antifungal agents and mastoidectomy. MAIN OUTCOME MEASURES: These measures included return of facial nerve function, control/resolution of disease, and survival. RESULTS: All three patients in this series initially presented with otalgia and otorrhea and intact facial nerve function. facial nerve paresis developed in all patients between 5 and 12 weeks after initial symptoms. paresis uniformly improved or resolved after mastoidectomy. Two patients treated with systemic antifungal therapy and prompt surgical debridement after development of facial palsy had full resolution of infection. One patient had full recovery of facial paresis and the other had partial recovery. The third patient was lost to follow-up after initial treatment with antimicrobials and surgery and died 3 months later without a clear etiology. CONCLUSIONS: aspergillus mastoiditis is an unusual infection in patients with AIDS. Because of its rarity, fungal mastoiditis in immunocompromised individuals can result in a significant delay in diagnosis and treatment. The decision between conservative antimicrobial therapy and aggressive surgical treatment also can present a therapeutic challenge in the management of these life-threatening infections, especially in patients with existing immunodeficiency and illness. Early surgical debridement followed by antimicrobial therapy may be life preserving in this patient population.- - - - - - - - - - ranking = 0.0048879424211147keywords = illness (Clic here for more details about this article) |
10/137. A case of hiv-associated cerebral histoplasmosis successfully treated with fluconazole.Clinically apparent involvement of the central nervous system is a rare event in cases of disseminated histoplasmosis, even in hiv-infected persons. Despite therapy with amphotericin b, mortality remains very high. Reported here is the case of an hiv-infected patient with a 3-month history of fever, cough, weight loss and miliary lung infiltrates. Four weeks after initiation of tuberculostatic therapy, high-grade fever, neurological symptoms, personality changes and respiratory deterioration occurred. magnetic resonance imaging of the brain showed multiple mass lesions, and a chest radiograph revealed worsening of pulmonary infiltrates. methenamine silver staining of a lung biopsy specimen demonstrated histoplasma capsulatum. Subsequently, this pathogen was cultured from lavage fluid. Following high-dose intravenous fluconazole therapy (800 mg once daily), the patient's condition improved markedly within 10 days, followed by an almost complete resolution of pulmonary and cerebral mass lesions. This is believed to be the first documented case of rapid improvement of disseminated histoplasmosis with central nervous system involvement in an hiv-infected patient upon induction of therapy with fluconazole.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
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