56 results on '"AIDS-Related Opportunistic Infections microbiology"'
Search Results
2. Cryptococcal meningitis: an unusual presentation of primary HIV infection.
- Author
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Barletta J, Falak A, and Pérez H
- Subjects
- AIDS-Related Opportunistic Infections microbiology, Adult, Fatal Outcome, Female, HIV Infections complications, Humans, Magnetic Resonance Imaging, Meningitis, Cryptococcal complications, AIDS-Related Opportunistic Infections diagnosis, Brain diagnostic imaging, HIV Infections diagnosis, Meningitis, Cryptococcal diagnosis
- Abstract
Acute HIV infection presenting as severe opportunistic disease is a very uncommon event associated with more rapid HIV progression and higher mortality. We describe the case of a patient with cryptococcal meningitis in the setting of primary HIV infection.
- Published
- 2018
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3. A fast-growing cold skin abscess revealing disseminated Mycobacterium intracellulare infection in an HIV-infected patient.
- Author
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Mendes-Bastos P, Brás S, and Carvalho R
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, Abscess drug therapy, Aged, Antipruritics therapeutic use, Antitubercular Agents therapeutic use, Ethambutol therapeutic use, Female, HIV Infections drug therapy, Humans, Loratadine therapeutic use, Lung Diseases microbiology, Mycobacterium avium-intracellulare Infection drug therapy, Rifabutin therapeutic use, Skin Diseases, Bacterial drug therapy, Treatment Outcome, AIDS-Related Opportunistic Infections microbiology, Abscess microbiology, HIV Infections complications, Mycobacterium avium Complex isolation & purification, Mycobacterium avium-intracellulare Infection diagnosis, Skin Diseases, Bacterial microbiology
- Abstract
A 66-year-old woman with HIV-1 infection recently commenced on antiretroviral therapy (CD4+ 25 cells/mm
3 was referred to the Dermatology Clinic the following month due to a well-demarcated nodule in the extensor surface of the left arm with evident fluctuation but only slight pain on palpation, with no increase in temperature. Surgical drainage was performed with aspiration of yellowish-green exudate, with no characteristic smell. In culture of cutaneous exudate, Mycobacterium intracellulare was isolated. Upon careful review of the laboratory tests that were in progress at discharge, the same agent was isolated in one of the bronchoalveolar lavage cultures. The diagnosis of cutaneous abscess caused by M. intracellulare from hematogenous dissemination of lung infection was made. The patient was treated with clarithromycin, ethambutol and rifabutin for 24 months. M. intracellulare species and Mycobacterium avium constitute the Mycobacterium avium-intracellulare complex (MAC), responsible for the majority of human infections by atypical mycobacteria. They are ubiquitous bacteria and MAC infection mainly affect immunocompromised patients, with M. intracellulare being isolated in <5% of HIV patients with MAC infection. Cutaneous infection is rare and may present clinically with erythematous plaques, chronic ulcers or abscesses. When present, skin involvement is usually secondary to pulmonary infection.- Published
- 2018
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4. Epidemiology and trends of cryptococcosis in the United States from 2000 to 2007: A population-based study.
- Author
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Shaheen AA, Somayaji R, Myers R, and Mody CH
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections microbiology, Adult, Age Factors, Canada epidemiology, Cryptococcosis diagnosis, Cryptococcus gattii, Cryptococcus neoformans, Female, Humans, Incidence, Male, Middle Aged, Population Surveillance, Sex Factors, AIDS-Related Opportunistic Infections epidemiology, Cryptococcosis epidemiology, Health Care Costs statistics & numerical data, Hospitalization statistics & numerical data
- Abstract
Cryptococcal disease, caused by Cryptococcus neoformans and Cryptococcus gattii, is associated with significant morbidity and mortality but limited data exist on its incidence and impact. A study utilizing the Nationwide Inpatient Sample from 2000 to 2007 to examine the epidemiology and impact of cryptococcal disease in the United States was undertaken. The International Classification of Diseases 9th Version code was used to identify hospital discharges with diagnosis of Cryptococcus (117.5). Our primary outcome was the incidence rate of cryptococcal admissions. The impact of AIDS, age, and sex on hospitalization rates, mortality, and costs was assessed. The results showed that a total of 10,077 hospitalizations for cryptococcosis occurred corresponding to a weighted estimate of 49,010 cases. The median age was 43 years (interquartile range 34-54), and 26% were female. Approximately 64% of cases occurred in persons with AIDS. Although rates declined overall, age-adjusted rates were significantly higher in males with AIDS than in uninfected persons (p < 0.001). The mortality rate decreased but was greater in HIV-uninfected versus infected cohorts (12% versus 10%, p < 0.001). Conversely, hospital costs were greater in persons with AIDS ($40,671 versus $40,096, p=0.02). Although cryptococcal disease rates are decreasing over time, the associated mortality and costs remain concerning.
- Published
- 2018
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5. Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors - A retrospective cohort study.
- Author
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Hiesgen J, Schutte C, Olorunju S, and Retief J
- Subjects
- AIDS-Related Opportunistic Infections microbiology, AIDS-Related Opportunistic Infections mortality, Adult, Antiretroviral Therapy, Highly Active, Cohort Studies, Female, HIV Infections drug therapy, Hospital Mortality, Humans, Male, Meningitis, Cryptococcal microbiology, Meningitis, Cryptococcal mortality, Middle Aged, Retrospective Studies, Risk Factors, Socioeconomic Factors, South Africa epidemiology, Tertiary Care Centers, Young Adult, AIDS-Related Opportunistic Infections epidemiology, HIV Infections epidemiology, Meningitis, Cryptococcal epidemiology
- Abstract
Aim This retrospective cohort study analyzes the impact of possible risk factors on the survival chance of patients with cryptococcal meningitis. These factors include the patient's socio-economic background, age, gender, presenting symptoms, comorbidities, laboratory findings and, in particular, non-adherence versus adherence to therapy. Methods Data were collected from all adult patients admitted to Kalafong Hospital with laboratory confirmed cryptococcal meningitis over a period of 24 months. We analyzed the data by the presentation of descriptive summary statistics, logistic regression was used to assess factors which showed association between outcome of measure and factor. Furthermore, multivariable logistic regression analysis using all the factors that showed significant association in the cross tabulation was applied to determine which factors had an impact on the patients' mortality risk. Results A total of 87 patients were identified. All except one were HIV-positive, of which 55.2% were antiretroviral therapy naïve. A history of previous tuberculosis was given by 25 patients (28.7%) and 49 (56.3%) were on tuberculosis treatment at admission or started during their hospital stay. In-hospital mortality was 31%. Statistical analysis showed that antiretroviral therapy naïve patients had 9.9 (CI 95% 1.2-81.2, p < 0.0032) times greater odds of dying compared to those on antiretroviral therapy, with 17 from 48 patients (35.4%) dying compared with 1 out of 21 patients (4.8%) on treatment. Defaulters had 14.7 (CI 95% 1.6-131.6, p < 0.016) times greater odds of dying, with 9 from 18 patients dying (50%), compared to the non-defaulters. In addition, patients who presented with nausea and vomiting had a 6.3 (95% CI 1.7-23.1, p < 0.005) times greater odds of dying (18/47, 38.3%); this remained significant when adjusted for antiretroviral therapy naïve patients and defaulters. Conclusion Cryptococcal meningitis is still a common opportunistic infection in people living with HIV/AIDS resulting in hospitalization and a high mortality. Defaulting antiretroviral therapy and presentation with nausea and vomiting were associated with a significantly increased mortality risk.
- Published
- 2017
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6. Hemichorea in a patient with HIV-associated central nervous system histoplasmosis.
- Author
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Estrada-Bellmann I, Camara-Lemarroy CR, Flores-Cantu H, Calderon-Hernandez HJ, and Villareal-Velazquez HJ
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections microbiology, Adult, Amphotericin B therapeutic use, Anti-Infective Agents therapeutic use, Antifungal Agents therapeutic use, Athetosis drug therapy, Biopsy, Brain pathology, Chorea drug therapy, Histoplasma classification, Histoplasmosis drug therapy, Homosexuality, Male, Humans, Itraconazole therapeutic use, Magnetic Resonance Imaging, Male, Treatment Outcome, AIDS-Related Opportunistic Infections diagnosis, Athetosis diagnosis, Chorea diagnosis, Histoplasma isolation & purification, Histoplasmosis diagnosis
- Abstract
Central nervous system histoplasmosis is a rare opportunistic infection with a heterogeneous clinical presentation. We describe the first case of human immunodeficiency virus-associated cerebral histoplasmosis presenting with hemichorea. The patient recovered after treatment with conventional amphotericin B and itraconazole., (© The Author(s) 2015.)
- Published
- 2016
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7. Drug-induced haemolysis, renal failure, thrombocytopenia and lactic acidosis in patients with HIV and cryptococcal meningitis: a diagnostic challenge.
- Author
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Camara-Lemarroy CR, Flores-Cantu H, Calderon-Hernandez HJ, Diaz-Torres MA, and Villareal-Velazquez HJ
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections microbiology, Acidosis, Lactic diagnosis, Adult, Amphotericin B administration & dosage, Amphotericin B therapeutic use, Anemia, Hemolytic diagnosis, Antifungal Agents adverse effects, Cryptococcus neoformans isolation & purification, Drug Therapy, Combination, Female, Humans, Male, Meningitis, Cryptococcal diagnosis, Renal Insufficiency diagnosis, Thrombocytopenia diagnosis, Treatment Outcome, Trimethoprim, Sulfamethoxazole Drug Combination administration & dosage, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Acidosis, Lactic chemically induced, Amphotericin B adverse effects, Anemia, Hemolytic chemically induced, Antifungal Agents therapeutic use, Cryptococcus neoformans drug effects, Meningitis, Cryptococcal drug therapy, Renal Insufficiency chemically induced, Thrombocytopenia chemically induced, Trimethoprim, Sulfamethoxazole Drug Combination adverse effects
- Abstract
Patients with HIV are at risk of both primary and secondary haematological disorders. We report two cases of patients with HIV and cryptococcal meningitis who developed severe haemolytic anaemia, thrombocytopenia, renal failure and lactic acidosis while on treatment with amphotericin B and co-trimoxazole., (© The Author(s) 2015.)
- Published
- 2015
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8. Mycobacterium haemophilum bone and joint infection in HIV/AIDS: case report and literature review.
- Author
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Cross GB, Le Q, Webb B, Jenkin GA, Korman TM, Francis M, and Woolley I
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections microbiology, Adult, Ankle Joint, Anti-Bacterial Agents therapeutic use, Anti-HIV Agents therapeutic use, Debridement, HIV Infections drug therapy, Humans, Immune Reconstitution Inflammatory Syndrome microbiology, Magnetic Resonance Imaging, Male, Middle Aged, Mycobacterium Infections drug therapy, Mycobacterium Infections microbiology, Mycobacterium haemophilum genetics, Osteomyelitis diagnosis, Osteomyelitis therapy, Polymerase Chain Reaction, Tenosynovitis microbiology, Tenosynovitis surgery, AIDS-Related Opportunistic Infections drug therapy, HIV Infections complications, Immune Reconstitution Inflammatory Syndrome complications, Mycobacterium Infections diagnosis, Mycobacterium haemophilum isolation & purification, Osteomyelitis microbiology
- Abstract
We report a case of disseminated Mycobacterium haemophilum osteomyelitis in a patient with advanced HIV infection, who later developed recurrent immune reconstitution inflammatory syndrome after commencement of antiretroviral therapy. We review previous reports of M. haemophilum bone and joint infection associated with HIV infection and describe the management of M. haemophilum-associated immune reconstitution inflammatory syndrome, including the role of surgery as an adjunctive treatment modality and the potential drug interactions between antiretroviral and antimycobacterial agents., (© The Author(s) 2015.)
- Published
- 2015
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9. Central nervous system infection due to Mycobacterium haemophilum in a patient with acquired immunodeficiency syndrome.
- Author
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Buppajarntham A, Apisarnthanarak A, Rutjanawech S, and Khawcharoenporn T
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, Adult, Anti-Bacterial Agents therapeutic use, Biopsy, Central Nervous System Infections diagnosis, Central Nervous System Infections drug therapy, Fatal Outcome, Female, Humans, Molecular Sequence Data, Mycobacterium Infections, Nontuberculous drug therapy, Mycobacterium Infections, Nontuberculous pathology, Mycobacterium haemophilum genetics, RNA, Bacterial analysis, RNA, Ribosomal, 16S analysis, Thailand, AIDS-Related Opportunistic Infections microbiology, Acquired Immunodeficiency Syndrome complications, Central Nervous System Infections microbiology, Mycobacterium Infections, Nontuberculous microbiology, Mycobacterium haemophilum isolation & purification
- Abstract
Mycobacterium haemophilum is an environmental organism that rarely causes infections in humans. We report a patient with acquired immunodeficiency syndrome who had central nervous system infection due to M. haemophilum. The diagnosis required brain tissue procurement and molecular identification method while the treatment outcome was unfavourable., (© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)
- Published
- 2015
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10. Mycobacterium avium-complex pericarditis: a case of unmasking immune reconstitution inflammatory syndrome.
- Author
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Babu TM, Laguio M, Luque AE, and Larppanichpoonphol P
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections microbiology, Adult, Anti-Bacterial Agents therapeutic use, Anti-HIV Agents therapeutic use, CD4 Lymphocyte Count, Echocardiography, HIV Infections drug therapy, HIV-1 drug effects, Humans, Immune Reconstitution Inflammatory Syndrome drug therapy, Male, Mycobacterium avium-intracellulare Infection drug therapy, Pericarditis drug therapy, Treatment Outcome, Viral Load, AIDS-Related Opportunistic Infections diagnosis, HIV Infections complications, Immune Reconstitution Inflammatory Syndrome complications, Mycobacterium avium Complex isolation & purification, Mycobacterium avium-intracellulare Infection diagnosis, Pericarditis diagnosis
- Abstract
Immune reconstitution inflammatory syndrome is a clinical entity with a broad presentation, described in both HIV and non-HIV-infected patients. We report a case of Mycobacterium avium-complex pericarditis as a rare but life-threatening manifestation of this syndrome in a patient with AIDS.
- Published
- 2014
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11. Mycobacterium kansasii septicaemia in an AIDS patient complicated by acute respiratory distress syndrome and acute liver failure.
- Author
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Shaaban H, Layne T, Sensakovic JW, and Boghossian J
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections microbiology, Adult, Antitubercular Agents therapeutic use, Drug Therapy, Combination, Humans, Liver Failure, Acute drug therapy, Male, Mycobacterium Infections, Nontuberculous drug therapy, Mycobacterium Infections, Nontuberculous microbiology, Mycobacterium kansasii drug effects, Polymerase Chain Reaction, Sepsis drug therapy, Treatment Outcome, AIDS-Related Opportunistic Infections complications, HIV Infections complications, Liver Failure, Acute complications, Mycobacterium Infections, Nontuberculous diagnosis, Mycobacterium kansasii isolation & purification, Respiratory Distress Syndrome complications, Sepsis complications
- Abstract
Acute respiratory distress syndrome (ARDS) is a serious complication of sepsis. Only a few cases of non-tuberculous mycobacteria complicated by ARDS have been discussed in the literature to date. Mycobacterium kansasii is the most pathogenic non-tuberculous mycobacterium affecting the lung. In the late stages of acquired immunodeficiency syndrome (AIDS), it may also present as disseminated disease. The clinical course is usually chronic, and the time to clinical diagnosis can sometimes be long, requiring a careful and meticulous search for the pathogen. To our knowledge, this is the first case report of disseminated M. kansasii infection complicated by ARDS and acute liver failure in a patient with end-stage AIDS.
- Published
- 2014
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12. Ulcerating type 1 lepra reaction mimicking lazarine leprosy: an unusual presentation of immune reconstitution inflammatory syndrome in an HIV-infected patient.
- Author
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Bhat R, Pinto M, Dandakeri S, and Kambil S
- Subjects
- AIDS-Related Opportunistic Infections complications, AIDS-Related Opportunistic Infections microbiology, Adult, Anti-Inflammatory Agents therapeutic use, Diagnosis, Differential, HIV Infections complications, Humans, Immune Reconstitution Inflammatory Syndrome drug therapy, Leprosy, Borderline diagnosis, Leprosy, Tuberculoid diagnosis, Male, Mycobacterium leprae isolation & purification, Prednisolone therapeutic use, Treatment Outcome, Antiretroviral Therapy, Highly Active adverse effects, HIV Infections drug therapy, Immune Reconstitution Inflammatory Syndrome diagnosis, Leprosy, Borderline chemically induced, Leprosy, Tuberculoid chemically induced
- Abstract
Leprosy maybe "unmasked" in the context of immune reconstitution inflammatory syndrome and treating dermatologists, particularly in highly endemic areas for Hansen's disease, need to be cognizant to this possibility. It may also reflect emergence of a previously clinically silent infection in the course of immunologic restoration.
- Published
- 2013
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13. Cutaneous candidiasis caused by Candida glabrata in a HIV/AIDS patient.
- Author
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Demiraslan H, Alabay S, Kilic AU, Borlu M, and Doganay M
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections microbiology, Adult, Anti-Retroviral Agents therapeutic use, CD4 Lymphocyte Count, Candidiasis, Cutaneous diagnosis, Female, HIV Infections drug therapy, Humans, Treatment Outcome, Viral Load, Antifungal Agents therapeutic use, Candida glabrata isolation & purification, Candidiasis, Cutaneous drug therapy, Fluconazole therapeutic use, HIV Infections complications
- Abstract
Cutaneous Candida infections may occur in patients with HIV/AIDS, cancer, receiving chemotherapy and solid organ transplantation. A 32-year-old woman was admitted to the department suffering from pruritic and erythematous plaque on left side of her face for the past two months. The patient was HIV positive, diagnosed five years previously, and had been on antiretroviral therapy (tenofovir/emtricitabine and lopinavir/ritonavir) for a year. She was not compliant with the medication. Elevated HIV RNA load and decreased CD4+ lymphocyte count were observed. Fungal elements were detected from the skin scraping sample taken from the facial plaque. Fluconazole-sensitive Candida glabrata was isolated from this sample. Topical clotrimazole ointment and systemic fluconazole 400 mg/day were used. After systemic fluconazole therapy was continued for two months, the plaque was cured. C. glabrata rarely causes cutaneous infection without involving the mucous membranes. Presentation of cutaneous fungal infections in HIV patients with decreased CD4+ T lymphocyte counts can be atypical and require extensive antifungal treatment.
- Published
- 2013
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14. Mycobacterium arupense infection in HIV-infected patients from Iran.
- Author
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Heidarieh P, Hashemi-Shahraki A, Khosravi AD, Zaker-Boustanabad S, Shojaei H, and Feizabadi MM
- Subjects
- AIDS-Related Opportunistic Infections microbiology, Adult, Antitubercular Agents therapeutic use, HIV Infections virology, Humans, Iran, Male, Middle Aged, Mycobacterium genetics, Mycobacterium Infections microbiology, Mycobacterium avium Complex, RNA, Ribosomal, 16S genetics, Sequence Analysis, DNA, Sputum microbiology, Treatment Outcome, Tuberculosis, Pulmonary drug therapy, AIDS-Related Opportunistic Infections diagnosis, HIV Infections complications, Mycobacterium classification, Mycobacterium isolation & purification, Mycobacterium Infections diagnosis
- Abstract
Here we report two cases of infection caused by Mycobacterium arupense in HIV-infected patients who had received Mycobacterium avium complex medication after primary treatment with antituberculous drugs. The causative agents were isolated from the respiratory and blood specimens of the patients. The identification was based on conventional and molecular tests. Our study provides further evidence on the role of this microorganism in clinical cases.
- Published
- 2013
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15. A case of oral ulceration and disseminated histoplasmosis in HIV infection.
- Author
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Sharma D, McKendry A, Nageshwaran S, and Cartledge J
- Subjects
- Female, Histocytochemistry, Histoplasma isolation & purification, Humans, Middle Aged, Radiography, Thoracic, AIDS-Related Opportunistic Infections microbiology, HIV Infections microbiology, Histoplasmosis virology, Oral Ulcer microbiology, Oral Ulcer virology
- Abstract
A 51-year-old Malawian woman presented with persistent mouth ulceration and an eight-month history of non-specific respiratory symptoms. Histoplasma capsulatum was diagnosed on gum, gastric and lymph node biopsies. Identification of H. capsulatum prompted HIV testing and the patient tested positive with a CD4 count of 40 cells/mm(3). The diagnosis of histoplasmosis was delayed due to its unusual presentation.
- Published
- 2012
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16. Incidence of major clinical outcomes in a cohort of Ugandan and Zimbabwean women with HIV-1 infection followed from seroconversion.
- Author
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Beversluis D, Musoke R, Mandima P, Nyamapfeni P, Chipato T, Mukasa JB, Byamugisha J, Mugerwa R, Morrison C, and Salata RA
- Subjects
- AIDS-Related Opportunistic Infections microbiology, AIDS-Related Opportunistic Infections pathology, AIDS-Related Opportunistic Infections therapy, Adult, Female, HIV Infections microbiology, HIV Infections therapy, HIV Seropositivity therapy, Humans, Prospective Studies, Treatment Outcome, Tuberculosis pathology, Tuberculosis therapy, Tuberculosis virology, Uganda, Zimbabwe, HIV Infections pathology, HIV Seropositivity pathology, HIV-1 isolation & purification
- Abstract
We conducted a prospective cohort study of 306 HIV-1-infected women, followed from seroconversion for median 6.4 years in Uganda (UG) and Zimbabwe (ZM) to describe the incidence of major clinical outcomes (MCOs), defined as World Health Organization stage 4 conditions and any tuberculosis (TB). In Uganda, 19 MCOs occurred in 13 participants at median 4.6 years and a median CD4 count of 213 cells/mm(3). In Zimbabwe, 29 MCOs occurred in 27 participants at median 4.0 years (P < 0.001 versus UG) and median CD4 count of 219 cells/mm(3) (P = 0.83 versus UG). MCO incidence was not statistically different (UG: 2.82 cases/100 person-years versus ZM: 2.45; P = 0.64) except for TB (UG: 0.59 versus ZM: 2.02 cases/100 person-years; P = 0.02). This significant difference in TB incidence is primarily due to a TB screening and isoniazid prevention therapy programme that was implemented in Uganda, but not in Zimbabwe, highlighting the importance of integrated TB screening and treatment within HIV programmes.
- Published
- 2012
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17. Community-acquired pneumonia due to Panton-Valentine leukocidin-producing Staphylococcus aureus in an HIV-2-infected patient.
- Author
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Daneshvar C, Smith NC, Waghorn DJ, Luzzi GA, and Wathen CG
- Subjects
- AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections microbiology, Community-Acquired Infections epidemiology, Fatal Outcome, Female, Gambia, HIV Infections epidemiology, HIV Infections virology, Humans, Middle Aged, Pneumonia, Staphylococcal epidemiology, Staphylococcus aureus metabolism, Bacterial Toxins biosynthesis, Community-Acquired Infections microbiology, Exotoxins biosynthesis, HIV Infections complications, HIV-2, Leukocidins biosynthesis, Pneumonia, Staphylococcal microbiology, Staphylococcus aureus pathogenicity
- Abstract
Pneumonia caused by Panton-Valentine leukocidin-producing Staphylococcus aureus is associated with a high fatality rate. There have been few reported cases in HIV-1-co-infected patients. Here we report a fatal case of severe community-acquired pneumonia caused by Panton-Valentine leukocidin-producing S. aureus in a 45-year-old woman with HIV-2 infection.
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- 2011
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18. Long-term follow-up and survival of antiretroviral-naive patients with cryptococcal meningitis in the pre-antiretroviral therapy era, Gauteng Province, South Africa.
- Author
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Park BJ, Shetty S, Ahlquist A, Greenbaum A, Miller JL, Motsi A, McCarthy K, and Govender N
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections microbiology, Adult, Antifungal Agents therapeutic use, Delivery of Health Care, Female, Fluconazole, HIV Infections drug therapy, Humans, Male, Meningitis, Cryptococcal complications, Meningitis, Cryptococcal drug therapy, Meningitis, Cryptococcal microbiology, Proportional Hazards Models, South Africa epidemiology, Survival Analysis, Survival Rate, Treatment Outcome, AIDS-Related Opportunistic Infections mortality, Anti-HIV Agents therapeutic use, HIV Infections complications, HIV Infections mortality, Meningitis, Cryptococcal mortality
- Abstract
Cryptococcal meningitis (CM) is a major cause of death among HIV-infected persons in sub-Saharan Africa. We conducted a study to describe the long-term outcomes during the pre-antiretroviral post-ART therapy period. Enrolled cases were those detected through population-based surveillance in Gauteng Province, South Africa, and diagnosed during March-November 2002 and July-September 2003 from eight large hospitals representing academic, provincial and rural settings. Of 1089 case-patients diagnosed with CM, 721 (70%) survived to discharge. Among the 256 with follow-up information, 154 (60%) were established to have died, 44% of whom died as outpatients. Overall, the 14- and 90-day survival post-diagnosis was 68% and 41%, respectively. On Cox proportional hazards multivariable analysis, severe disease was associated with shorter survival time; having received any antifungal treatment for the cryptococcal episode was associated with increased survival time at follow-up. Although most patients in this cohort survived the initial hospitalization, only 41% were still alive three months after diagnosis, with nearly half of deaths occurring outside a hospital. These data are an important baseline from which to measure effectiveness of public health management of CM in South Africa.
- Published
- 2011
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19. Candida pelliculosa meningitis as an opportunistic infection in HIV: the first reported case.
- Author
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Ratcliffe L, Davies J, Anson J, Hales S, Beeching NJ, and Beadsworth MB
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections microbiology, AIDS-Related Opportunistic Infections pathology, Candida classification, Candidiasis drug therapy, Candidiasis microbiology, Candidiasis pathology, Fatal Outcome, Histocytochemistry, Humans, Male, Meninges microbiology, Meninges pathology, Meningitis, Fungal drug therapy, Meningitis, Fungal microbiology, Meningitis, Fungal pathology, Microscopy, Middle Aged, AIDS-Related Opportunistic Infections diagnosis, Candida isolation & purification, Candidiasis diagnosis, HIV Infections complications, Meningitis, Fungal diagnosis
- Abstract
We describe the first reported case of Candida pelliculosa meningitis in HIV infection. This case highlights the risk of uncommon opportunistic infections in association with the immunocompromised and the importance of autopsy as a diagnostic tool in HIV infection. We discuss the epidemiology, diagnosis and management of C. pelliculosa, a non-albicans species which is rarely associated with disease, and review current literature.
- Published
- 2011
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20. Effect of Ethiopian multiflora honey on fluconazole-resistant Candida species isolated from the oral cavity of AIDS patients.
- Author
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Mulu A, Diro E, Tekleselassie H, Belyhun Y, Anagaw B, Alemayehu M, Gelaw A, Biadglegne F, Desalegn K, Yifiru S, Tiruneh M, Kassu A, Nishikawa T, and Isogai E
- Subjects
- Candida isolation & purification, Candidiasis microbiology, Candidiasis therapy, Candidiasis virology, Dose-Response Relationship, Drug, Drug Resistance, Fungal, Ethiopia, Fluconazole pharmacology, Humans, Microbial Sensitivity Tests, Nephelometry and Turbidimetry, AIDS-Related Opportunistic Infections microbiology, Antifungal Agents pharmacology, Candida drug effects, Honey, Mouth microbiology
- Abstract
This study aimed to determine the antifungal effect of Ethiopian multiflora honey against Candida species isolated from the oral cavity of AIDS patients. Oral rinses were obtained from 13 AIDS patients and cultured on CHROMagar plates at 37°C for 48 hours. Candida species were identified by microbiological and molecular techniques. The antifungal effect of the honey sample on Candida was investigated by an agar dilution technique. Susceptibility of the Candida species to fluconazole was tested following a semi-modified microdilution method. Growth of both fluconazole-susceptible and -resistant Candida species was inhibited with a minimum fungicidal concentration (MFC) of 35-40% (v/v) honey. The MFC of different Candida species was not significantly different (P > 0.05). From the total of 25 Candida isolates tested for susceptibility, 11 (44%), eight (32%) and six (24%) of the isolates were sensitive (minimum inhibitory concentrations [MICs] < 8 µg/mL), susceptible (dose-dependent: MICs 16-32 µg/mL) and resistant (MICs > 64 µg/mL) to fluconazole, respectively. Ethiopian multiflora honey has antifungal activity against fluconazole-resistant Candida species isolated from the oral cavity of AIDS patients. This supports the existing folkloric practice of using honey to treat oral lesions. Nevertheless, identification of the bioactive agents in honey, their clinical evaluation and pharmacological standardization are crucial.
- Published
- 2010
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21. Penicillium marneffei infection presenting as an immune reconstitution inflammatory syndrome in an HIV patient.
- Author
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Ho A, Shankland GS, and Seaton RA
- Subjects
- AIDS-Related Opportunistic Infections immunology, Adult, Antifungal Agents therapeutic use, Dermatomycoses drug therapy, Dermatomycoses immunology, Dermatomycoses pathology, Face microbiology, Face pathology, Facial Dermatoses drug therapy, Facial Dermatoses immunology, Facial Dermatoses pathology, Forehead microbiology, Forehead pathology, Humans, Male, Phenotype, RNA, Viral blood, Viral Load, AIDS-Related Opportunistic Infections microbiology, Dermatomycoses microbiology, Facial Dermatoses microbiology, Immune Reconstitution Inflammatory Syndrome microbiology, Penicillium isolation & purification
- Abstract
We describe a case of Penicillium marneffei infection acquired in Thailand, manifesting as an immune reconstitution inflammatory syndrome (IRIS) in a Caucasian man with advanced HIV-related immunosuppression (CD4 72 cells/mm³). Initial presentation was consistent with Pneumocystis jirovecii pneumonia, and empirical co-trimoxazole resulted in clinical improvement. One month after initiating antiretroviral therapy (ART), an enlarging scaly lesion on his forehead and erythematous nodules on his face, trunk and limbs developed. P. marneffei was isolated from a skin aspirate. Response to antifungal therapy was complicated by drug interactions but cure was complete after four months of treatment. Few cases of IRIS associated with P. marneffei have been reported.
- Published
- 2010
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22. An update on Cryptococcus among HIV-infected patients.
- Author
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Warkentien T and Crum-Cianflone NF
- Subjects
- AIDS-Related Opportunistic Infections microbiology, AIDS-Related Opportunistic Infections mortality, AIDS-Related Opportunistic Infections pathology, Africa South of the Sahara, Cryptococcosis microbiology, Cryptococcosis mortality, Cryptococcosis pathology, Cryptococcus isolation & purification, Humans, Prevalence, AIDS-Related Opportunistic Infections epidemiology, Cryptococcosis epidemiology, HIV Infections complications
- Abstract
Cryptococcus remains an important opportunistic infection in HIV patients despite considerable declines in prevalence during the highly active antiretroviral therapy era. This is particularly apparent in sub-Saharan Africa, where Cryptococcus continues to cause significant mortality and morbidity. This review discusses the microbiology, epidemiology, pathogenesis and clinical presentation of cryptococcal infections in HIV patients. Additionally, a detailed approach to the management of cryptococcosis is provided.
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- 2010
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23. Long-term suppressive therapy for pulmonary aspergilloma in an immunocompromised man with AIDS. Is it always necessary?
- Author
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Yoganathan K
- Subjects
- AIDS-Related Opportunistic Infections microbiology, Adenine adverse effects, Adenine analogs & derivatives, Anti-HIV Agents adverse effects, Aspergillosis diagnostic imaging, Aspergillosis microbiology, Didanosine adverse effects, Drug Administration Schedule, Drug Interactions, Fatal Outcome, Humans, Lung Diseases, Fungal diagnostic imaging, Male, Middle Aged, Organophosphonates adverse effects, Pancreatitis etiology, Radiography, Reverse Transcriptase Inhibitors adverse effects, Tenofovir, Treatment Outcome, AIDS-Related Opportunistic Infections drug therapy, Antifungal Agents administration & dosage, Antifungal Agents therapeutic use, Aspergillosis drug therapy, HIV Infections complications, Immunocompromised Host, Lung Diseases, Fungal drug therapy
- Abstract
Aspergillus infections are rare opportunistic infections in the course of AIDS and they mostly present as invasive pulmonary disease. Owing to the prolonged survival of profoundly immunocompromised patients with AIDS, invasive pulmonary aspergillosis is being reported with increased frequency. However, although pulmonary aspergilloma has been well described in immunocompetent patients, it has been rarely reported in AIDS patients. The treatment for pulmonary aspergilloma remains challenging and often needs lifelong treatment to minimize fatal haemoptysis, which can occur in up to 25%, and progression to secondary invasive aspergillosis. We report a case of pulmonary aspergilloma in a severely immunocompromised patient with AIDS who stopped taking systemic antifungal treatment in April 1998 and remained well with little progression of invasive aspergillosis up until March 2002 when he died of acute pancreatitis related to a drug interaction of didanosine and tenofovir.
- Published
- 2009
- Full Text
- View/download PDF
24. Recurrent histoplasmosis in AIDS mimicking a colonic carcinoma.
- Author
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Aisenberg G, Marcos LA, and Ogbaa I
- Subjects
- AIDS-Related Opportunistic Infections microbiology, Adult, Diagnosis, Differential, Female, Gastrointestinal Hemorrhage microbiology, HIV Infections virology, HIV-1, Histoplasma isolation & purification, Histoplasmosis complications, Histoplasmosis microbiology, Humans, Recurrence, AIDS-Related Opportunistic Infections diagnosis, Carcinoma diagnosis, Colonic Neoplasms diagnosis, Gastrointestinal Hemorrhage etiology, HIV Infections complications, Histoplasmosis diagnosis
- Abstract
The prevalence rate of lower gastrointestinal bleeding in patients with AIDS is around 2.6%. A 42-year-old woman with AIDS (CD(4) count 9/microL) and recently treated for disseminated histoplasmosis presented to the emergency room with melena, severe anaemia and fever. A colonoscopy showed an umbilicated colonic nodule mimicking a carcinoma of the colon. The biopsy showed intracytoplasmic microorganisms compatible with Histoplasma capsulatum. She had poor compliance to the itraconazole when discharge on previous admission. Despite the fact that colonic histoplasmosis is uncommon, the mortality rate is around 8% and clinicians should be aware of the clinical presentation of histoplasmosis when recur, especially in patients not taking the itraconazole for long-term treatment.
- Published
- 2009
- Full Text
- View/download PDF
25. Haemophilus ducreyi detection by polymerase chain reaction in oesophageal lesions of HIV patients.
- Author
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Borges MC, Colares JK, Lima DM, and Fonseca BA
- Subjects
- AIDS-Related Opportunistic Infections microbiology, AIDS-Related Opportunistic Infections pathology, Adult, Aged, Chancroid microbiology, Chancroid pathology, DNA, Bacterial analysis, Esophageal Diseases microbiology, Esophageal Diseases pathology, Female, Haemophilus ducreyi genetics, Haemophilus ducreyi pathogenicity, Humans, Male, Middle Aged, Polymerase Chain Reaction, AIDS-Related Opportunistic Infections diagnosis, Chancroid diagnosis, Esophageal Diseases diagnosis, HIV Infections complications, HIV-1, Haemophilus ducreyi isolation & purification
- Abstract
HIV patients frequently have opportunistic oesophageal infections. We report Haemophilus ducreyi genetic material detected by polymerase chain reaction in biopsies of oesophageal lesions in three HIV-1-infected patients. This finding may be an indication of its aetiopathological role in oesophageal lesions of HIV patients.
- Published
- 2009
- Full Text
- View/download PDF
26. Chylous ascites: a late complication of intra-abdominal Mycobacterium avium complex immune reconstitution syndrome in HIV-infected patients.
- Author
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Phillips P, Lee JK, Wang C, Yoshida E, Lima VD, and Montaner J
- Subjects
- AIDS-Related Opportunistic Infections microbiology, Adult, Ascitic Fluid chemistry, Chylous Ascites diagnosis, Humans, Immune Reconstitution Inflammatory Syndrome microbiology, Incidence, Male, Triglycerides analysis, AIDS-Related Opportunistic Infections complications, Acquired Immunodeficiency Syndrome complications, Chylous Ascites epidemiology, Chylous Ascites microbiology, Immune Reconstitution Inflammatory Syndrome complications, Mycobacterium avium Complex
- Abstract
Chylous ascites related to Mycobacterium avium complex (MAC) in HIV-infected patients is rare, with only six cases reported in the English literature. We report a series of six cases from a single institution. During the past six years, chylous ascites was diagnosed in six (35%) of 17 AIDS patients, all of whom had previously been diagnosed with intra-abdominal MAC immune reconstitution syndrome (MAC-IRS). A review of medical records identified no other cases of chylous ascites among HIV-positive patients over the past 13 years (1994-2007), and the incidence was estimated at one in 2248 HIV-positive admissions. The ascitic fluid had a milky appearance and a median triglyceride level of 4.07 mmol/L (range 3.19-29.6 mmol/L) (360 mg/dL, range 282-2620 mg/dL). After a median follow-up of 20 months, five (83%) of six patients survived. Chylous ascites is a late complication of intra-abdominal MAC-IRS, and is usually associated with a favourable prognosis.
- Published
- 2009
- Full Text
- View/download PDF
27. Non-tuberculous mycobacteria in the sputum of HIV-infected patients: infection or colonization?
- Author
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Alvarez-Uria G, Falcó V, Martín-Casabona N, Crespo M, Villar Del Saz S, Curran A, Ocaña I, Ribera E, and Pahissa A
- Subjects
- AIDS-Related Opportunistic Infections microbiology, Adult, CD4 Lymphocyte Count, Female, Hemoglobins analysis, Humans, Male, Middle Aged, Mycobacterium Infections, Nontuberculous microbiology, Mycobacterium avium Complex isolation & purification, Mycobacterium avium-intracellulare Infection microbiology, Mycobacterium kansasii isolation & purification, Mycobacterium xenopi isolation & purification, Statistics, Nonparametric, Weight Loss, AIDS-Related Opportunistic Infections epidemiology, Mycobacterium Infections, Nontuberculous epidemiology, Mycobacterium avium-intracellulare Infection epidemiology, Nontuberculous Mycobacteria isolation & purification, Sputum microbiology
- Abstract
It can be difficult to establish the clinical significance of the isolation of non-tuberculous mycobacteria (NTM) from the sputum of HIV-infected patients. In this observational study, we have investigated factors associated with having NTM infection. During the period of the study, 10 patients had NTM infection and 14 had NTM colonization. Factors associated with having NTM infections were: CD4 lymphocyte count <50 cells/mL (odds ratio [OR] 10; 95% confidence interval [CI] 1.4-69.3), haemoglobin <11 g/dL (OR 7.2; 95% CI 1.08-47.9), weight loss (OR 9; 95% CI 1.3-63.9), duration of symptoms for more than a month (OR 54; 95% CI 4.2-692.5), the presence of acid fast bacilli (AFB) in sputum (OR 30.3; 95% CI 2.6-348.9) and repeated positive NTM cultures in other sputum samples (OR 4.3; 95% CI 1.6-11.7). In conclusion, we must suspect NTM infection in patients with long-standing symptoms, anaemia, low CD4 lymphocyte count, several positive sputum cultures and when AFB are seen.
- Published
- 2009
- Full Text
- View/download PDF
28. Gastrointestinal histoplasmosis in an HIV-infected patient living in a non-endemic area.
- Author
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Peppa D, Plumb I, du Parcq J, Taylor S, and Miller RF
- Subjects
- Adult, Gastrointestinal Tract microbiology, HIV Infections virology, HIV-1, Humans, Male, AIDS-Related Opportunistic Infections microbiology, Gastrointestinal Diseases microbiology, HIV Infections complications, Histoplasma isolation & purification, Histoplasmosis microbiology
- Abstract
Summary: A 36-year-old HIV-infected man presented with non-specific gastrointestinal symptoms and weight loss. Biopsy of the duodenum and an intra-abdominal lymph node showed Histoplasma capsulatum. The diagnosis of histoplasmosis was delayed as the presentation was initially ascribed to intercurrent enteric pathogens and the patient's lifetime travel history was not obtained.
- Published
- 2008
- Full Text
- View/download PDF
29. Outpatient management of severe gonococcal ophthalmia without genital infection.
- Author
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Annan NT and Boag FC
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections microbiology, Adult, Conjunctivitis, Bacterial diagnosis, Conjunctivitis, Bacterial microbiology, Gonorrhea diagnosis, Gonorrhea microbiology, Humans, Male, Treatment Outcome, Anti-Bacterial Agents therapeutic use, Ceftriaxone therapeutic use, Conjunctivitis, Bacterial drug therapy, Gonorrhea drug therapy, HIV Infections complications, Neisseria gonorrhoeae drug effects
- Abstract
We report a case of severe gonococcal ophthalmia and peri-orbital cellulitis in an HIV-positive man without genital infection who was treated successfully in the outpatient department. We also highlight the importance of early diagnosis, treatment and liaison with ophthalmology in order to prevent visual complications.
- Published
- 2008
- Full Text
- View/download PDF
30. Focal Salmonella enteritidis infection in a patient with HIV infection and other multiple causes of immunodeficiency.
- Author
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Peppa D, Sutton JK, Bin-Reza F, Morris-Jones SD, and Miller RF
- Subjects
- AIDS-Related Opportunistic Infections microbiology, Adult, Biopsy, Humans, Male, HIV Infections complications, Immunologic Deficiency Syndromes complications, Osteomyelitis microbiology, Salmonella Infections microbiology, Salmonella enteritidis, Soft Tissue Infections microbiology
- Abstract
An HIV-infected man receiving antiretroviral therapy-who also had lupus-like vasculitis and membranous glomerulonephritis (treated with prednisolone and azathioprine), beta-thalassaemia minor trait and post-radiotherapy functional asplenia (mimicking sickle cell disease-induced hyposplenism)-developed focal soft issue and bone infection caused by Salmonella enteritidis at the site of previous mycobacterial infection.
- Published
- 2008
- Full Text
- View/download PDF
31. Papulonecrotic tuberculid in an HIV-positive patient.
- Author
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Akhras V and McCarthy G
- Subjects
- Adult, Humans, Male, Mycobacterium tuberculosis drug effects, Tuberculosis, Cutaneous drug therapy, Tuberculosis, Cutaneous immunology, AIDS-Related Opportunistic Infections microbiology, HIV Infections complications, Mycobacterium tuberculosis immunology, Tuberculosis, Cutaneous complications
- Abstract
We present a 33-year-old HIV-positive man who presented with a two-year history of a non-itchy papular eruption, associated with night sweats, headaches, poor memory and weight loss. On examination, he had erythematous papular lesions with necrotic centres on the face, arms and torso with no systemic abnormalities. A skin biopsy eventually led to the diagnosis of papulonecrotic tuberculid, and treatment with quadruple therapy resulted in resolution of his rash and systemic symptoms. Papulonecrotic tuberculid is thought to be a immunological response to Mycobacterium bacillus components in a previously sensitized patient following haematogenous spread from a focus of infection elsewhere. Cultures from the skin are typically negative and there are no acid-fast bacilli seen, but mycobacterial DNA can be detected using polymerase chain reaction. This case is an example of the paradoxical activation of the immune system seen in patients with HIV. It highlights the importance of skin biopsy in patients with unexplained systemic symptoms and a rash, as the differential diagnosis can be wide in HIV.
- Published
- 2007
- Full Text
- View/download PDF
32. Clinical features of HIV/AIDS patients presenting to an inner city clinic in Ho Chi Minh City, Vietnam.
- Author
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Klotz SA, Nguyen HC, Van Pham T, Nguyen LT, Ngo DT, and Vu SN
- Subjects
- AIDS-Related Opportunistic Infections epidemiology, Adolescent, Adult, Candidiasis epidemiology, Cross-Sectional Studies, Female, HIV Infections epidemiology, HIV Infections ethnology, Humans, Male, Tuberculosis epidemiology, Vietnam epidemiology, AIDS-Related Opportunistic Infections microbiology, CD4 Lymphocyte Count, HIV Infections blood, HIV Infections complications
- Abstract
An outpatient HIV clinic was opened in March 2005 in Binh Thanh District, a poor section of Ho Chi Minh City, Vietnam. Over 1500 patients were seen in the first year. The average age of patients was 27 years. Men represented 77% of the clinic population, women, 23% and children under the age of 16 years of age, 5% of the population. The most common risk factor among men was being an injecting drug user (IDU), 76%, and among women, being married to an IDU HIV-positive man, 35%. Physical signs of disease were uncommon: lymphadenopathy in 24% and hepatomegaly and splenomegaly in 4% and 3%, respectively. Men and women were anaemic at presentation, with a mean haemoglobin of 11.9 g/dL and 11.1 g/dL, respectively. An overwhelming majority of patients had profound immunodeficiency. The mean CD4+ cell count was 164 cells/mL and the median was 69 cells/mL. No correlation was found between the World Health Organization's stage of disease and the CD4+ cell count. Thus, the former is a poor predictor of immunity in this population. Data regarding opportunistic infections diagnosed at the first visit were studied. Candidiasis of the oral pharynx, oesophagus or vagina was found in 34.5% of the patients, and pulmonary and extrapulmonary tuberculosis was found in 32% of the patients. Pneumocystis carinii pneumonia (PCP) was diagnosed in only 3% of the patients. Cotrimoxazole prophylaxis is advocated for HIV-infected Vietnamese, but the incidence of PCP is negligible and resources could be spent elsewhere. The various opportunistic infections seen in this resource-poor clinic setting is likely to be a pattern of presentation of HIV-infected Vietnamese for some time to come.
- Published
- 2007
- Full Text
- View/download PDF
33. Multi-skeletal Pneumocystis jiroveci (carinii) in an HIV-seropositive patient.
- Author
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Panos GZ, Karydis I, Velakoulis SE, and Falagas ME
- Subjects
- AIDS-Related Opportunistic Infections diagnostic imaging, AIDS-Related Opportunistic Infections microbiology, Brain Diseases diagnostic imaging, Brain Diseases microbiology, HIV Infections complications, Humans, Male, Middle Aged, Pneumonia, Pneumocystis microbiology, Radiography, Spinal Diseases microbiology, Brain diagnostic imaging, HIV Seropositivity complications, Lumbar Vertebrae diagnostic imaging, Pneumocystis carinii, Pneumonia, Pneumocystis diagnostic imaging, Spinal Diseases diagnostic imaging
- Abstract
We present our experience with skeletal involvement of Pneumocystis jiroveci (ex P. carinii) infection in an HIV-seropositive patient. The objective of this study was to alert clinicians to the possibility that extrapulmonary P. jiroveci could affect the skeletal system in HIV-infected patients with extremely rapid progression. P. jiroveci infection of skeletal system has been rarely described elsewhere. A 51-year-old man complained of fever for six weeks, cough, anorexia, fatigue, and chest pain. He was found to be HIV seropositive. Repetitive (six samples) sputum and bronchoalveolar lavage fluid microbiologic tests were negative. High-resolution chest computed tomography (CT) scan revealed a small pulmonary mass. Abdominal CT scan revealed lesions in liver, spleen, kidneys, adrenal glands, lumbar vertebrae, and sacrum. Brain and skull CT scan was normal. A fine-needle biopsy of the lung mass was unrevealing. Cytological examination of sputum specimens showed findings consistent with non-small-cell lung carcinoma. Nineteen weeks post-presentation, the patient reported low-back pain. Within 24 hours after the onset of low-back pain, he developed focal neurological deficits, and a magnetic resonance imaging (MRI) of the skull and spine showed osteolytic lesions of the temporal bones bilaterally, multiple vertebral lesions, and lesions of sacrum and iliac bones. Radiotherapy of the lumbar spine and pelvis was given. Sternal aspiration was performed. Cytological examination revealed P. jiroveci. In conclusion, we describe a rare case of disseminated P. jiroveci infection in an HIV-seropositive patient, with multiple skeletal lesions, especially in the skull and in vertebrae region, and concomitant non-small-cell lung cancer, with a very poor prognosis.
- Published
- 2007
- Full Text
- View/download PDF
34. Septic shock and multi-organ failure in HIV infection-'sepsis tuberculosa gravissima'.
- Author
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Ferrand RA, Herman J, Elgalib A, Cartledge J, and Miller RF
- Subjects
- AIDS-Related Opportunistic Infections microbiology, HIV Infections immunology, Humans, Male, Middle Aged, Mycobacterium tuberculosis isolation & purification, Tuberculosis, Pulmonary microbiology, HIV, HIV Infections microbiology, Multiple Organ Failure microbiology, Multiple Organ Failure virology, Shock, Septic microbiology, Shock, Septic virology, Tuberculosis, Pulmonary virology
- Abstract
A profoundly immunosuppressed HIV-infected man developed sepsis syndrome with multi-organ failure. A septic screen failed to identify a bacterial or fungal cause and despite empirical treatment for these pathogens the patient remained unwell. Investigations revealed disseminated tuberculosis. With specific anti-tuberculosis therapy the patient rapidly recovered. Although most cases of sepsis syndrome in HIV-infected patients are due to bacteria, tuberculosis should be added to the differential diagnosis of this presentation.
- Published
- 2006
- Full Text
- View/download PDF
35. Bilateral psoas abscesses in an HIV-positive patient.
- Author
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Kozakis L and Ballachandran T
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections microbiology, Adult, Humans, Male, Mycobacterium tuberculosis isolation & purification, HIV Infections complications, Psoas Abscess diagnosis, Psoas Abscess microbiology, Tuberculosis diagnosis, Tuberculosis microbiology
- Abstract
Patients with HIV can often present a diagnostic challenge and may have atypical presentations of more common diseases. This case demonstrates such a scenario; we describe a 35-year-old man with a recent diagnosis of HIV infection complaining of backache, anorexia and weight loss. On investigation he was found to have bilateral tuberculous psoas abscesses. A review of the literature shows that this is a rare presentation of an already unusual problem, with subtle signs requiring a high index of clinical suspicion. However, with HIV-positive patients more likely to present with extrapulmonary tuberculosis, there is need for increased awareness of this diagnosis.
- Published
- 2004
- Full Text
- View/download PDF
36. Disseminated nocardiosis presenting with cardiac tamponade in an HIV patient.
- Author
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Leang B, Lynen L, Lim K, Jacques G, Van Esbroeck M, and Zolfo M
- Subjects
- AIDS-Related Opportunistic Infections complications, Adult, Female, Humans, Nocardia Infections complications, Pericardial Effusion microbiology, AIDS-Related Opportunistic Infections microbiology, Cardiac Tamponade etiology, HIV Infections complications, Nocardia Infections microbiology, Nocardia asteroides isolation & purification
- Abstract
The incidence of nocardial infection in HIV-positive patients is increasing. In immune suppression the infection is often disseminated and can present as cardiac tamponade.
- Published
- 2004
- Full Text
- View/download PDF
37. Spectrum of opportunistic infections in hospitalized HIV-infected patients in Phnom Penh, Cambodia.
- Author
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Senya C, Mehta A, Harwell JI, Pugatch D, Flanigan T, and Mayer KH
- Subjects
- AIDS-Related Opportunistic Infections microbiology, AIDS-Related Opportunistic Infections parasitology, Adolescent, Adult, Age Distribution, CD4 Lymphocyte Count, Cambodia epidemiology, Diarrhea epidemiology, Encephalitis epidemiology, Female, Hospital Mortality, Hospitals, Public statistics & numerical data, Humans, Male, Marital Status statistics & numerical data, Meningitis, Cryptococcal epidemiology, Middle Aged, Pneumonia, Pneumocystis epidemiology, Population Surveillance, Residence Characteristics statistics & numerical data, Retrospective Studies, Severity of Illness Index, Sex Distribution, Tuberculosis epidemiology, AIDS-Related Opportunistic Infections epidemiology, Hospitalization statistics & numerical data
- Abstract
The aim of the study was to provide more comprehensive data on the clinical characteristics of hospitalized AIDS patients in Cambodia. Chart review of 381 HIV-infected patients admitted to a public hospital in Phnom Penh, Cambodia between December 1999 and May 2000 was performed. The in-hospital mortality rate was 43.6%. Approximately 50% of patients had two or more concurrent illnesses. Very advanced HIV disease was common, with CD4 cell counts below 10 cells/mm(3) in 43.2%. Only 28.3% of the patients had documentation of their HIV infection prior to hospitalization. Chronic diarrhoea was the most frequent opportunistic illness (41.2%), followed by tuberculosis (26%), cryptococcal meningitis (12.6%), Pneumocystis carinii pneumonia (8.4%), and encephalitis (4.7%). Chronic diarrhoea and tuberculosis were the most important opportunistic infections observed in HIV-infected hospitalized patients in Cambodia. These findings illustrate the need for early diagnosis of HIV-infection, effective prophylaxis for opportunistic infections and improved access to antiretroviral therapy in Cambodia.
- Published
- 2003
- Full Text
- View/download PDF
38. Vulvovaginal candidiasis: a comparison of HIV-positive and -negative women.
- Author
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Sobel JD
- Subjects
- Antifungal Agents therapeutic use, Candida classification, Female, HIV Seronegativity, Humans, Recurrence, AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections microbiology, AIDS-Related Opportunistic Infections physiopathology, Candidiasis, Vulvovaginal drug therapy, Candidiasis, Vulvovaginal microbiology, Candidiasis, Vulvovaginal physiopathology, HIV Infections complications
- Abstract
Although considerable information has accumulated in the last decade regarding rates of both vaginal colonization and vulvovaginal candidiasis (VVC) in HIV-positive women, gaps in our knowledge remain, particularly with regard to pathophysiology of clinical disease. Unfortunately, early and possibly premature conclusions were reached in the late 1980s which resulted in the widespread dissemination of information indicating that recurrent VVC (RVVC) was a manifestation of HIV infection and that women with RVVC should be tested for HIV. Unfortunately, subsequent data from cohort studies involving HIV-positive women failed to determine attack rates of symptomatic Candida vaginitis requiring therapy. Recent studies indicate that Candida vaginitis, even if more frequent in HIV infected women, is clinically similar to that experienced in HIV-negative women and does not appear to be of increased clinical severity. VVC in HIV-positive women can be treated by conventional methods including the use of maintenance suppressive antifungal therapy and most importantly RVVC in women is not in itself a sentinel of HIV infection. Ongoing concerns include vaginal acquisition of non-albicans Candida species and the development of antimycotic drug resistance in C. albicans vaginal isolates.
- Published
- 2002
- Full Text
- View/download PDF
39. Nocardia nova Infection in a HIV-positive Man.
- Author
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Jenney AW, McLean CA, and Wesselingh SL
- Subjects
- AIDS-Related Opportunistic Infections pathology, AIDS-Related Opportunistic Infections physiopathology, Adult, Fatal Outcome, Humans, Male, Nocardia, Nocardia Infections pathology, Nocardia Infections physiopathology, AIDS-Related Opportunistic Infections microbiology, Nocardia Infections microbiology
- Published
- 2001
- Full Text
- View/download PDF
40. Cutaneous cryptococcosis in two patients with acquired immunodeficiency syndrome.
- Author
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Sánchez P, Bosch RJ, de Gálvez MV, Gallardo MA, and Herrera E
- Subjects
- Adult, Cryptococcosis drug therapy, Cryptococcosis pathology, Cryptococcus neoformans, Humans, Male, Skin Diseases drug therapy, Skin Diseases pathology, AIDS-Related Opportunistic Infections microbiology, Cryptococcosis complications, Skin Diseases complications
- Abstract
We present 2 cases of systemic cryptococcosis with cutaneous involvement in patients with acquired immunodeficiency syndrome (AIDS). Both patients were male, intravenous drug abusers, 31 and 35 years old, with severe immunodepression and a CD4+ lymphocyte count of 10/ml and 1/ml, respectively. They both had papular lesions reminiscent of molluscum contagiosum and in one patient with concomitant systemic leishmaniasis, there were spores of Cryptococcus neoformans coexisting with the leishmanias in the cutaneous lesions, constituting the first reported case of this particular association. Both patients responded well to amphotericin B followed by fluconazole.
- Published
- 2000
- Full Text
- View/download PDF
41. Actinomycosis in HIV infection: a review of a rare complication.
- Author
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Chaudhry SI and Greenspan JS
- Subjects
- Gastrointestinal Diseases diagnosis, Gastrointestinal Diseases microbiology, Gastrointestinal Diseases therapy, Humans, Mouth Diseases diagnosis, Mouth Diseases microbiology, Mouth Diseases therapy, Thoracic Diseases diagnosis, Thoracic Diseases microbiology, Thoracic Diseases therapy, AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections microbiology, AIDS-Related Opportunistic Infections therapy, Actinomyces pathogenicity, Actinomycosis diagnosis, Actinomycosis microbiology, Actinomycosis therapy
- Abstract
The emergence of the human immunodeficiency virus (HIV) and the onset of the AIDS epidemic has been associated with the frequent presentation of otherwise rare opportunistic infections and neoplasms. Despite the impairments of cellular and humoral immunity that accompany HIV infection, the prevalence of actinomycosis in the HIV-infected population has remained low. This article reviews previously reported cases of actinomycosis in HIV-positive and AIDS patients. Microbiological, pathological, diagnostic, clinical and therapeutic aspects of actinomycosis in this population are discussed. Clinicians should be aware of the possibility of actinomycosis as the cause of a persistent inflammatory lesion in these patients and know the correct techniques for collecting and submitting tissue specimens for anaerobic culture.
- Published
- 2000
- Full Text
- View/download PDF
42. Saccharomyces cerevisiae oesophagitis in an HIV-infected patient.
- Author
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Konecny P, Drummond FM, Tish KN, and Tapsall JW
- Subjects
- Humans, Male, Middle Aged, Mycoses complications, Mycoses diagnosis, AIDS-Related Opportunistic Infections microbiology, Esophagitis microbiology, HIV Infections complications, Mycoses microbiology, Saccharomyces cerevisiae isolation & purification
- Published
- 1999
- Full Text
- View/download PDF
43. Acid-alcohol fast bacilli in sputa of HIV-infected patients.
- Author
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Sullivan AK, Hannan MM, Azadian BS, Easterbrook PJ, Gazzard BG, and Nelson MR
- Subjects
- AIDS-Related Opportunistic Infections pathology, Adult, Female, Humans, Male, Mycobacterium Infections, Nontuberculous pathology, Mycobacterium avium Complex genetics, Mycobacterium avium Complex isolation & purification, Mycobacterium avium-intracellulare Infection pathology, Mycobacterium fortuitum genetics, Mycobacterium fortuitum isolation & purification, Mycobacterium kansasii genetics, Mycobacterium kansasii isolation & purification, Mycobacterium tuberculosis genetics, Mycobacterium tuberculosis isolation & purification, Predictive Value of Tests, Retrospective Studies, Tuberculosis pathology, AIDS-Related Opportunistic Infections microbiology, Mycobacterium Infections, Nontuberculous microbiology, Mycobacterium avium-intracellulare Infection microbiology, Sputum microbiology, Tuberculosis microbiology
- Abstract
We identified 34 HIV-infected patients with sputum smear positive for acid-alcohol fast bacilli (AAFB) to determine any factors predictive of subsequent species identification. There were 20 cases of Mycobacterium tuberculosis (MTB), 9 cases of Mycobacterium avium-intracellulare (MAI), 3 cases of Mycobacterium kansasii and one each of Mycobacterium malmoense and Mycobacterium fortuitum. Factors associated with isolation of MAI were lower CD4 cell count, a higher incidence of previous AIDS diagnosis, a history of dyspnoea and a normal chest X-ray. The organism was isolated from blood cultures in 58% of patients with MTB and 78% of patients with MAI infection. Disseminated disease was diagnosed in 45% of MTB patients and 33% of MAI patients.
- Published
- 1999
- Full Text
- View/download PDF
44. Diagnosis of disseminated Mycobacterium scrofulaceum infection in an AIDS patient using a continuously monitored culture system.
- Author
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Shay WE and LaBombardi VJ
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, Adult, Humans, Male, Mycobacterium Infections, Nontuberculous diagnosis, AIDS-Related Opportunistic Infections microbiology, Mycobacterium Infections, Nontuberculous microbiology, Mycobacterium scrofulaceum growth & development
- Published
- 1999
45. An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in HIV-seropositive persons.
- Author
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Smith NP, Nelson MR, Azadian B, and Gazzard BG
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections microbiology, Adult, Disease Outbreaks, Female, Humans, London, Middle Aged, Staphylococcal Infections epidemiology, HIV Seropositivity microbiology, Methicillin Resistance, Staphylococcal Infections drug therapy
- Abstract
Staphylococcus aureus is a cause of considerable morbidity and mortality in HIV-seropositive persons. Although methicillin-resistant S. aureus (MRSA) is encountered worldwide and in many areas of medical care, little has been reported on clinical infection with MRSA in patients with HIV. We report on an outbreak of MRSA infection in HIV antibody positive patients, using case reports to describe an outbreak of MRSA infection in HIV-seropositive persons. Six cases of clinical MRSA infection were reported over a 4-week period on patients on an HIV dedicated ward. All cases had previous AIDS diagnoses and low CD4 cell counts (median 8 x 10(6)/l; range 0 to 238). Two cases had infected skin lesions and 2 cases had infected indwelling central venous catheters with septicaemia. Two cases had pneumonia, one with concurrent infection at the entry site of a percutaneous endoscopic gastrostomy (PEG) feeding tube. Isolates of MRSA from the 6 cases were compared by pulsed-field gel electrophoresis of Sma1 chromosomal digests. The resultant banding pattern showed the same strain was responsible for all the infections. A seventh inpatient, the index case, had positive carriage with the same strain of MRSA. To define ongoing MRSA carriage after the outbreak, 29 consecutive ward patients were swabbed for MRSA: all were negative. All patients identified with MRSA infection responded to treatment with intravenous teicoplanin, although carriage was unaltered. Four of the 6 cases died within 7 weeks of diagnosis of MRSA. MRSA can cause severe morbidity in patients with end-stage HIV disease. A small outbreak of MRSA was controlled by simple precautionary measures with no subsequent ongoing transmission of MRSA.
- Published
- 1998
- Full Text
- View/download PDF
46. A proposal for basic management of HIV disease in west Africa: use of clinical staging and haemogram data.
- Author
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Ledru E, Diagbouga S, Meda N, Sanou PT, Dahourou H, Ledru S, Dembelé A, Zoubga A, and Durand G
- Subjects
- AIDS-Related Opportunistic Infections microbiology, Adult, Burkina Faso, CD4 Lymphocyte Count, Cross-Sectional Studies, Eosinophils, HIV Infections blood, Hemoglobins analysis, Humans, Lymphocyte Count, Platelet Count, Tuberculosis, Pulmonary etiology, HIV Infections therapy
- Abstract
Our objective was to propose a strategy to screen HIV-infected African people for biological immunodeficiency easily. In a cross-sectional study, we analysed the patterns of diseases and of CD4 counts among 266 HIV-infected adults. Peripheral facial paralysis and chronic cutaneo-mucous diseases were the earlier B-stage diseases. Pulmonary tuberculosis was close to B-stage diseases, and chronic diarrhoea was borderline between B and C stages. Cachexia was the most frequent C-stage symptom (47.8%). Ninety per cent of CDC-C stage people had CD4 counts below 350/microliter, whereas only 75% had CD4 counts below 200/microliter. Regression analysis identified the lymphocyte count, clinical stage and platelet count as predictors of CD4 count below 350/microliter. A simple score (lymphocyte count < or = 2500/microliter and clinical stage > or = B) is proposed to determine this CD4 threshold (positive predictive value: 83%) and to determine those patients needing treatment to prevent wasting and opportunistic infections.
- Published
- 1998
- Full Text
- View/download PDF
47. Xanthomonas maltophilia: an emerging pathogen in patients with HIV disease.
- Author
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Manfredi R, Nanetti A, Ferri M, and Chiodo F
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections microbiology, Adult, Anti-Bacterial Agents, Bacteremia drug therapy, Bacteremia microbiology, Drug Therapy, Combination therapeutic use, Female, Gram-Negative Bacterial Infections drug therapy, Gram-Negative Bacterial Infections microbiology, Humans, Male, Middle Aged, Retrospective Studies, AIDS-Related Opportunistic Infections epidemiology, Bacteremia epidemiology, Gram-Negative Bacterial Infections epidemiology, Xanthomonas
- Abstract
Fifty-four episodes of Xanthomonas maltophilia infection were observed in 52 HIV-infected patients out of 2062 assessed (2.52%) over a 6-year period: sepsis/bacteraemia in 44 cases, lower airways infection in 5 cases, urinary tract infection and pharyngitis in 2 cases each, and lymph node involvement in one patient. X. maltophilia represented the fourth most common non-mycobacterial bacterial pathogen responsible for bacteraemia in HIV-infected patients: 44 cases out of 721 diagnosed (6.1%). When compared with non-typhoid Salmonella spp. bacteraemia, an increased risk to develop X. maltophilia disseminated infection was seen according to the progression of HIV-related immunodeficiency, the occurrence of leukopenia-neutropenia, central venous catheterization, previous antibiotic and/or corticosteroid treatment, and hospitalization. In 3 patients suffering from concurrent AIDS-related disorders, X. maltophilia infection contributed to death, while a recurrence occurred in 2 cases only. Due to the poor antimicrobial susceptibility of this pathogen (also confirmed in our series), X. maltophilia bacteraemia associated with advanced HIV infection and concurrent risk factors, may represent a potentially severe disease.
- Published
- 1998
- Full Text
- View/download PDF
48. An unusual aural presentation of Pneumocystis carinii.
- Author
-
Khaksar S, Sullivan A, Francis N, and Nelson M
- Subjects
- AIDS-Related Opportunistic Infections pathology, Adult, Ear Neoplasms complications, Ear Neoplasms pathology, Humans, Male, Pneumocystis Infections microbiology, Pneumocystis Infections pathology, Polyps complications, Polyps pathology, Tomography, X-Ray Computed, AIDS-Related Opportunistic Infections microbiology, Ear Neoplasms microbiology, Pneumocystis Infections complications, Polyps microbiology
- Published
- 1998
- Full Text
- View/download PDF
49. Cerebral abscesses in a patient with AIDS caused by methicillin-resistant Staphylococcus aureus.
- Author
-
Brook G
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections microbiology, Brain Abscess diagnosis, Brain Abscess microbiology, Humans, Staphylococcal Infections diagnosis, Staphylococcal Infections microbiology, AIDS-Related Opportunistic Infections etiology, Brain Abscess etiology, Methicillin Resistance, Staphylococcal Infections etiology
- Published
- 1998
50. Hypothyroidism and hypoparathyroidism associated with Pneumocystis carinii infection in a patient with AIDS.
- Author
-
Siddiqi A, Goh BT, Brown CL, Hillman RJ, and Monson JP
- Subjects
- AIDS-Related Opportunistic Infections microbiology, AIDS-Related Opportunistic Infections physiopathology, Adult, Humans, Hypoparathyroidism microbiology, Hypoparathyroidism physiopathology, Hypothyroidism microbiology, Hypothyroidism physiopathology, Male, Pneumocystis Infections microbiology, Pneumocystis Infections physiopathology, AIDS-Related Opportunistic Infections complications, Hypoparathyroidism etiology, Hypothyroidism etiology, Pneumocystis Infections complications
- Published
- 1998
- Full Text
- View/download PDF
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