51 results on '"AIDS-Related Opportunistic Infections diagnosis"'
Search Results
2. [Tuberculosis Guideline for Adults - Guideline for Diagnosis and Treatment of Tuberculosis including LTBI Testing and Treatment of the German Central Committee (DZK) and the German Respiratory Society (DGP)].
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Schaberg T, Bauer T, Brinkmann F, Diel R, Feiterna-Sperling C, Haas W, Hartmann P, Hauer B, Heyckendorf J, Lange C, Nienhaus A, Otto-Knapp R, Priwitzer M, Richter E, Rumetshofer R, Schenkel K, Schoch OD, Schönfeld N, and Stahlmann R
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections prevention & control, Adult, Antitubercular Agents adverse effects, Bacteriological Techniques, Cross-Sectional Studies, Emigrants and Immigrants statistics & numerical data, Germany, Humans, Refugees statistics & numerical data, Societies, Medical, Tuberculosis, Multidrug-Resistant diagnosis, Tuberculosis, Multidrug-Resistant drug therapy, Tuberculosis, Multidrug-Resistant epidemiology, Tuberculosis, Multidrug-Resistant prevention & control, Tuberculosis, Pulmonary drug therapy, Tuberculosis, Pulmonary epidemiology, Tuberculosis, Pulmonary prevention & control, Antitubercular Agents therapeutic use, Tuberculosis, Pulmonary diagnosis
- Abstract
Since 2015 a significant increase in tuberculosis cases is notified in Germany, mostly due to rising numbers of migrants connected to the recent refugee crisis. Because of the low incidence in previous years, knowledge on tuberculosis is more and more limited to specialized centers. However, lung specialist and healthcare workers of other fields have contact to an increasing number of tuberculosis patients. In this situation, guidance for the management of standard therapy and especially for uncommon situations will be essential. This new guideline on tuberculosis in adults gives recommendations on diagnosis, treatment, prevention and prophylaxis. It provides a comprehensive overview over the current knowledge, adapted to the specific situation in Germany. The German Central Committee against Tuberculosis (DZK e. V.) realized this guideline on behalf of the German Respiratory Society (DGP). A specific guideline for tuberculosis in the pediatrics field will be published separately. Compared to the former recommendations of the year 2012, microbiological diagnostics and therapeutic drug management were given own sections. Chapters about the treatment of drug-resistant tuberculosis, tuberculosis in people living with HIV and pharmacological management were extended. This revised guideline aims to be a useful tool for practitioners and other health care providers to deal with the recent challenges of tuberculosis treatment in Germany., Competing Interests: Interessenkonflikt: Siehe Interessenkonflikterklärung auf www.awmf.org, (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2017
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3. [This far it can go without HIV therapy!].
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Bogner JR, Steinert D, and Coppenrath E
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- Disease Progression, Drug Therapy, Combination, Germany, Humans, Male, Middle Aged, Nigeria ethnology, Prednisolone therapeutic use, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections drug therapy, Anti-HIV Agents therapeutic use, Emigrants and Immigrants, HIV Infections diagnosis, HIV Infections drug therapy, Medication Adherence, Pneumonia, Pneumocystis diagnosis, Pneumonia, Pneumocystis drug therapy
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- 2016
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4. Neuroimaging of HIV-associated cryptococcal meningitis: comparison of magnetic resonance imaging findings in patients with and without immune reconstitution.
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Katchanov J, Branding G, Jefferys L, Arastéh K, Stocker H, and Siebert E
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- AIDS-Related Opportunistic Infections complications, AIDS-Related Opportunistic Infections drug therapy, Adult, Anti-HIV Agents therapeutic use, Antifungal Agents therapeutic use, Arachnoid Cysts pathology, Female, Fluconazole therapeutic use, Germany, HIV Infections complications, HIV Infections drug therapy, Humans, Immune Reconstitution Inflammatory Syndrome complications, Immune Reconstitution Inflammatory Syndrome drug therapy, Immunocompromised Host, Magnetic Resonance Imaging, Male, Meningitis, Cryptococcal complications, Meningitis, Cryptococcal drug therapy, Middle Aged, Neuroimaging, AIDS-Related Opportunistic Infections diagnosis, Antiretroviral Therapy, Highly Active adverse effects, Cryptococcus neoformans isolation & purification, HIV Infections diagnosis, Immune Reconstitution Inflammatory Syndrome diagnosis, Meningitis, Cryptococcal diagnosis
- Abstract
To determine the frequency, imaging characteristics, neuroanatomical distribution and dynamics of magnetic resonance imaging findings in HIV-associated cryptococcal meningitis in immunocompromised patients we compared patients without antiretroviral therapy with patients undergoing immune reconstitution. Neuroimaging and clinical data of 21 consecutive patients presenting to a German HIV centre in a 10-year period between 2005 and 2014 were reviewed. We identified eight patients with magnetic resonance imaging findings related to cryptococcal disease: five patients without antiretroviral therapy and three patients receiving effective antiretroviral therapy resulting in immune reconstitution. The pattern of magnetic resonance imaging manifestations was different in the two groups. In patients not on antiretroviral therapy, pseudocysts (n = 3) and lacunar ischaemic lesions (n = 2) were detected. Contrast-enhancing focal leptomeningeal and/or parenchymal lesions were found in all patients under immune reconstitution (n = 3). Magnetic resonance imaging lesions suggestive of leptomeningitis or meningoencephalitis were detected in all patients with a recurrence of cryptococcal meningitis under immune reconstitution, which differs from the classical magnetic resonance imaging findings in patients without antiretroviral therapy. In antiretroviral therapy-treated patients with past medical history of cryptococcal meningitis, detection of contrast-enhancing focal meningeal and/or parenchymal lesions should prompt further investigations for a recurrence of cryptococcal meningitis under immune reconstitution., (© The Author(s) 2015.)
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- 2016
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5. [35-year-old patient with unclear oral finding].
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Schleenvoigt B, Baier M, Lundershausen R, Jäger H, and Pletz M
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- Adult, Diagnosis, Differential, Female, Germany, Humans, Thailand ethnology, AIDS-Related Opportunistic Infections diagnosis, Candidiasis, Oral diagnosis, Cheilitis diagnosis, Emigrants and Immigrants, Mouth Diseases etiology, Pain etiology
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- 2015
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6. 'Time-to-amphotericin B' in cryptococcal meningitis in a European low-prevalence setting: analysis of diagnostic delays.
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Katchanov J, von Kleist M, Arastéh K, and Stocker H
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- AIDS-Related Opportunistic Infections microbiology, Adult, Cryptococcus neoformans, Delayed Diagnosis, Female, Germany epidemiology, Humans, Immunocompromised Host, Male, Middle Aged, Multivariate Analysis, Retrospective Studies, Young Adult, AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections drug therapy, Amphotericin B therapeutic use, Antifungal Agents therapeutic use, Meningitis, Cryptococcal diagnosis, Meningitis, Cryptococcal drug therapy, Time-to-Treatment
- Abstract
Background: Cryptococcal meningitis is a rare disease in Europe, resulting in delayed recognition and slower initiation of specific treatment., Aim: To analyse the time-to-treatment and the factors that delay the diagnosis and treatment in the low-prevalence setting of a European centre., Design: Retrospective review, Methods: We reviewed full medical records of all adult patients with cryptococcal meningitis referred to an HIV centre in Berlin, Germany in 10-year period between 1st of October 2003 and 31st of September 2013. Multivariant statistics with bootstrap-resampling were performed., Results: We identified 19 patients with a diagnosis of HIV-related cryptococcal meningitis (0.55% of all consecutive HIV-infected patients). In almost half of our patients the diagnosis was not considered initially on admission to the secondary care centre and the first diagnostic clue being an accidental positive blood, cerebrospinal fluid or bronchoalveolar lavage culture growing Cryptococcus neoformans. The median time-to-treatment was 5 days (range: 1-16). Known positive HIV status accelerated the time-to-diagnosis (p < 0.05) by a median of 1.89 days, whereas the CSF cell count ≤ 10/µl delayed diagnosis by a median time of 1.93 days (p < 0.1)., Conclusions: Diagnostic delays could be avoided by encouraging practising physicians (i) to consider cryptococcal meningitis in immunosuppressed HIV-infected patients irrespective of neurological symptoms; (ii) to test for India ink, cryptococcal antigen and fungal cultures in immunosuppressed HIV-infected patients with normal CSF; (iii) to consider a possibility of underlying HIV infection in patients with unknown HIV status presenting with meningitis; and (iv) to consider early targeted HIV testing in persons at risk according to locally validated criteria., (© The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
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- 2014
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7. Characteristics and coinfection with syphilis in newly HIV-infected patients at the University Hospital Dresden 1987-2012.
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Spornraft-Ragaller P, Schmitt J, Stephan V, Boashie U, and Beissert S
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- AIDS-Related Opportunistic Infections epidemiology, Adolescent, Adult, Aged, Cross-Sectional Studies, Female, Germany, HIV Infections epidemiology, Hospitals, University, Humans, Male, Middle Aged, Young Adult, AIDS-Related Opportunistic Infections diagnosis, HIV Infections diagnosis, Syphilis diagnosis
- Abstract
Background: In Germany, notification data cannot be used to determine HIV and syphilis coinfection. No regional cohort has been studied for this in Eastern Germany. The rising incidence of syphilis from 2010 to 2012, predominantly in men having sex with men (MSM), has been suggested as a cause for recent increases in HIV infection rates in this group., Patients and Methods: Characteristics of 355 consecutive patients newly diagnosed with HIV infection at the University Hospital Dresden 1987-2012 were retrospectively compared to German surveillance data from the region of Dresden. Additionally, coinfection with syphilis was determined., Results: Compared to German surveillance data, we observed higher proportions of persons originating from high prevalence countries and of AIDS cases. In the age group of up to 25 years, the proportion of MSM has risen 3-fold since 2001. At time of HIV diagnosis, seroprevalence of syphilis was 20.3 %. Active syphilis (VDRL ≥ 1: 8) occurred in 6.7 % of patients, predominantly MSM, who also exhibited a significantly higher HIV viral load., Conclusions: Our findings suggest a causative relationship between recently rising incidences of syphilis and HIV infection in MSM. Early diagnosis of syphilis may promote earlier diagnosis of HIV infection; therefore, HIV prevention measures should also include other sexually transmitted infections., (© 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)
- Published
- 2014
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8. [Increase of N. gonorrhoeae, Chlamydia trachomatis and Ureaplasma in HIV infected individuals].
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Fuchs W and Brockmeyer NH
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- AIDS-Related Opportunistic Infections epidemiology, Anti-Infective Agents adverse effects, Chlamydia Infections epidemiology, Cross-Sectional Studies, Female, Germany, Gonorrhea epidemiology, Humans, Incidence, Male, Pregnancy, Ureaplasma Infections epidemiology, AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections drug therapy, Anti-Infective Agents therapeutic use, Chlamydia Infections diagnosis, Chlamydia Infections drug therapy, Chlamydia trachomatis drug effects, Gonorrhea diagnosis, Gonorrhea drug therapy, Ureaplasma Infections diagnosis, Ureaplasma Infections drug therapy
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- 2014
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9. [Syphilis: the new epidemic among MSM].
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Spornraft-Ragaller P
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- AIDS-Related Opportunistic Infections diagnosis, Cross-Sectional Studies, Disease Notification, Female, Germany, Humans, Incidence, Infant, Newborn, Male, Neurosyphilis diagnosis, Neurosyphilis epidemiology, Pregnancy, Recurrence, Syphilis diagnosis, Syphilis, Cutaneous diagnosis, Syphilis, Cutaneous epidemiology, AIDS-Related Opportunistic Infections epidemiology, Epidemics, Homosexuality, Male statistics & numerical data, Syphilis epidemiology
- Published
- 2014
10. [Laboratory survey on the incidence of Pneumocystis jirovecii - obviously a peculiar fungus, but also a rare pathogen?].
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Hof H, Oberdorfer K, Mertes T, Miller B, Schwarz R, Regnath T, Schmidt-Wieland T, Wellinghausen N, and Holfelder M
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- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections epidemiology, Child, Preschool, Cross-Sectional Studies, Germany, Humans, Incidence, Infant, Infant, Newborn, Infant, Premature, Diseases diagnosis, Infant, Premature, Diseases epidemiology, Middle Aged, Opportunistic Infections diagnosis, Opportunistic Infections epidemiology, Pneumonia, Pneumocystis diagnosis, Polymerase Chain Reaction, Health Surveys, Pneumocystis carinii, Pneumonia, Pneumocystis epidemiology, Rare Diseases
- Abstract
Pneumocystsis jirovecii is a peculiar fungus for a variety of reasons. This opportunistic pathogen multiplies in humans only under certain conditions; a defect in the T-cell defense system creates a predisposition to this infection. In 2010 a data survey (IFT as well as PCR) from a few laboratories in Germany revealed 412 positive individuals. Even if only a few patients test positive for the colonization stage of this pathogen, the sheer number of individuals testing positive for other stages of infection indicate that the incidence of pneumocystosis in immunocompromised patients in Germany is underestimated., (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2012
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11. [Extrapulmonary tuberculosis: radiological imaging of an almost forgotten transformation artist].
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Heye T, Stoijkovic M, Kauczor HU, Junghanss T, and Hosch W
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- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections epidemiology, Adolescent, Adult, Age Factors, Aged, Child, Child, Preschool, Cross-Cultural Comparison, Cross-Sectional Studies, Diagnosis, Differential, Emigrants and Immigrants statistics & numerical data, Female, Germany, Humans, Incidence, Magnetic Resonance Imaging, Male, Middle Aged, Radiography, Tomography, X-Ray Computed, Tuberculosis epidemiology, Tuberculosis prevention & control, Tuberculosis, Pulmonary diagnosis, Tuberculosis, Pulmonary epidemiology, Tuberculosis, Pulmonary prevention & control, Young Adult, Diagnostic Imaging, Tuberculosis diagnosis
- Abstract
Tuberculosis (TB) continues to be one of the infectious diseases with the world's highest rates of avoidable morbidity and mortality. A continuing downward trend has only been observed in highly industrialized countries, including Germany with 4,400 cases in the year 2009 representing an incidence of 5.5 per 100,000 persons. At the same time, the exposure to this patient group and the clinical experience are decreasing. Tuberculosis may affect any organ. The lung was the manifestation site in 80% of cases, and extrapulmonary manifestations were recorded in 20% of cases in Germany in the year 2008. Lymph node involvement is most common with a rate of approximately 50% of all extrapulmonary cases followed by the pleura in 18% of cases, genitourinary tract in 13% of cases, bones and joints in 6% of cases, gastrointestinal tract in 6% of cases, the central nervous system in 3% of cases and the spine in 3% of cases. Symptoms like fever, night sweats and weight loss are non-specific and may be absent. The aim of the review is to raise awareness of this disease, which is increasingly falling into oblivion, with its various radiological manifestations and to point out clinical-epidemiological and demographic factors that raise suspicion of tuberculosis., (© Georg Thieme Verlag KG Stuttgart · New York.)
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- 2011
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12. [Influenza : clinical symptoms, diagnostics and therapy].
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Rohde GG
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- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections mortality, AIDS-Related Opportunistic Infections therapy, Adamantane therapeutic use, Adult, Age Factors, Aged, Antiviral Agents therapeutic use, Child, Child, Preschool, Female, Germany, Humans, Infant, Influenza A Virus, H1N1 Subtype, Influenza Vaccines administration & dosage, Influenza, Human mortality, Influenza, Human therapy, Male, Neuraminidase antagonists & inhibitors, Pandemics, Pneumonia, Viral diagnosis, Pneumonia, Viral mortality, Pneumonia, Viral therapy, Population Surveillance, Pregnancy, Rimantadine therapeutic use, Survival Rate, Influenza, Human diagnosis
- Abstract
Influenza infections have important socio-economic consequences. Risk groups identified so far include small children and elderly adults with comorbidities. In recent years in addition to seasonal influenza an outbreak of avian influenza occurred in 2005 and the new H1N1 pandemic occurred in 2009. For the latter other at risk groups were affected and a different clinical course has been documented. The focus of this article is to give an overview on the epidemiology, clinical characteristics, diagnosis and therapy of influenza infections.
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- 2011
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13. [New recommendations for contact tracing in tuberculosis. German Central Committee against Tuberculosis].
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Diel R, Loytved G, Nienhaus A, Castell S, Detjen A, Geerdes-Fenge H, Haas W, Hauer B, Königstein B, Maffei D, Magdorf K, Priwitzer M, Zellweger JP, and Loddenkemper R
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- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections prevention & control, AIDS-Related Opportunistic Infections transmission, Adolescent, Adult, Age Factors, Antitubercular Agents administration & dosage, BCG Vaccine administration & dosage, Child, Child, Preschool, Germany, Humans, Latent Tuberculosis diagnosis, Predictive Value of Tests, Risk Factors, Tuberculin Test, Tuberculosis diagnosis, Tuberculosis transmission, Young Adult, Contact Tracing methods, Interferon-gamma Release Tests, Tuberculosis prevention & control
- Abstract
In 2007, the German Central Committee against Tuberculosis (DZK) published recommendations for contact tracing that introduced the new interferon gamma release assays (IGRAs). Meanwhile, substantial progress has been made in documenting the utility of IGRAs. Because IGRAs are usually superior to the tuberculin skin test (TST) in detecting latent TB infection (LTBI) with respect to sensitivity and specificity in adult contact populations that are at least partially BCG vaccinated, it is now recommended that instead of two-step testing only IGRAs be used.[nl]As the literature does not yet provide sufficient data on the accuracy of IGRAs in children younger than 5 years, the TST remains the method of choice in that age group. To date, also, no clear body of data exists to substantiate better performance for IGRAs than for the TST in older children, thus in this age group using of either test is recommended. The new recommendations also underscore the importance of a diligent preselection of close contacts in order to achieve a high probability that positive test results represent recent infection and to thus increase the benefit of chemopreventive treatment for those identified as requiring it. In a third point of update, it is noted that re-testing of contacts individuals found positive for LTBI may produce a considerable number of false-negative results and should thus be avoided in case of documented exposure., (© Georg Thieme Verlag KG Stuttgart · New York.)
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- 2011
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14. [Suspicion of HIV-infection: which symptoms should be warning lights?].
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Härter G
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- AIDS Serodiagnosis, Diagnosis, Differential, Early Diagnosis, Germany, Humans, Male, Middle Aged, AIDS-Related Opportunistic Infections diagnosis, Candidiasis, Oral diagnosis, Diarrhea diagnosis, HIV Infections diagnosis, Leukopenia diagnosis
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- 2011
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15. The treatment of patients with HIV.
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Vogel M, Schwarze-Zander C, Wasmuth JC, Spengler U, Sauerbruch T, and Rockstroh JK
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- AIDS Serodiagnosis, AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections epidemiology, Acquired Immunodeficiency Syndrome diagnosis, Acquired Immunodeficiency Syndrome drug therapy, Acquired Immunodeficiency Syndrome epidemiology, Acquired Immunodeficiency Syndrome transmission, Adult, Aged, CD4 Lymphocyte Count, Cross-Sectional Studies, Early Diagnosis, Female, Germany, HIV Infections diagnosis, HIV Infections epidemiology, HIV Infections transmission, Humans, Life Expectancy, Male, Middle Aged, Practice Guidelines as Topic, RNA, Viral blood, Risk Factors, Young Adult, Antiretroviral Therapy, Highly Active, HIV Infections drug therapy
- Abstract
Background: Infection with the human immunodeficiency virus (HIV) remains a major medical challenge., Methods: Selective literature review, including the current German/Austrian, European, and American guidelines on the treatment of HIV infection in adults., Results: In Germany, 3000 persons become infected with HIV each year; in 2009, 67,000 persons in Germany were living with HIV. When highly active antiretroviral therapy (HAART) is initiated in time, patients can achieve a nearly normal life expectancy. Nonetheless, in Germany as elsewhere, 30% of patients receive the diagnosis of HIV infection only when they have reached the AIDS stage of the disease or are suffering from advanced immunodeficiency. HAART should be started, at the latest, when the CD4-positive helper cell count drops below 350/microL. Primary drug resistances, accompanying illnesses, and the patient's living circumstances must all be taken into account in the selection of antiretroviral drugs. The goal of treatment is lasting suppression of HIV-RNA to below 50 copies per milliliter of plasma., Conclusions: HIV testing should be offered to all patients at high risk for HIV infection and all persons newly diagnosed with a sexually transmitted disease. As persons with HIV grow older, their treatment is complicated by increasing comorbidity and requires increased vigilance for possible drug interactions.
- Published
- 2010
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16. False economies.
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Mütterlein R
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- AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections transmission, Cross-Sectional Studies, Developing Countries, Drug Therapy, Combination, Germany, Humans, Microbial Sensitivity Tests, Tuberculosis, Multidrug-Resistant diagnosis, Tuberculosis, Multidrug-Resistant epidemiology, Tuberculosis, Multidrug-Resistant transmission, AIDS-Related Opportunistic Infections diagnosis, Antitubercular Agents therapeutic use, Tuberculosis, Multidrug-Resistant drug therapy
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- 2010
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17. Historical background.
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Hundeiker M
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- AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections transmission, Cross-Sectional Studies, Developing Countries, Drug Therapy, Combination, Germany, History, 20th Century, Humans, Microbial Sensitivity Tests, Tuberculosis, Multidrug-Resistant epidemiology, United States, AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections history, Antitubercular Agents therapeutic use, Tuberculosis, Multidrug-Resistant drug therapy, Tuberculosis, Multidrug-Resistant history
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- 2010
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18. What about existing databases?
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Herzmann C, Günther G, Eker B, Lange C, and Migliori GB
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- AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections transmission, Cross-Sectional Studies, Developing Countries, Drug Therapy, Combination, Germany, Humans, Microbial Sensitivity Tests, Tuberculosis, Multidrug-Resistant diagnosis, Tuberculosis, Multidrug-Resistant epidemiology, Tuberculosis, Multidrug-Resistant transmission, AIDS-Related Opportunistic Infections diagnosis, Antitubercular Agents therapeutic use, Databases, Factual, Registries, Tuberculosis, Multidrug-Resistant drug therapy
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- 2010
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19. Drug-resistant tuberculosis: a worldwide epidemic poses a new challenge.
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Loddenkemper R and Hauer B
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- AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections transmission, Cross-Sectional Studies, Developing Countries, Drug Therapy, Combination, Germany, Humans, Microbial Sensitivity Tests, Tuberculosis, Multidrug-Resistant diagnosis, Tuberculosis, Multidrug-Resistant epidemiology, Tuberculosis, Multidrug-Resistant transmission, AIDS-Related Opportunistic Infections diagnosis, Antitubercular Agents therapeutic use, Tuberculosis, Multidrug-Resistant drug therapy
- Abstract
Background: Although the incidence of tuberculosis (TB) in Germany is now declining, the world as a whole faces the threat of a catastrophe that will also affect the industrialized nations. The main reason, aside from TB/HIV co-infection, is the increase of resistant TB strains. The situation is already serious because of the spread of multidrug-resistant TB, i.e., TB that is resistant to the two most important antituberculous drugs, and is being further aggravated by resistance to second-line drugs as well., Method: Selective review of the literature., Results: There are an estimated half a million cases of multidrug-resistant TB worldwide, and so-called extensively resistant TB (XDR-TB), with additional resistance to defined second-line drugs, is now prevalent in more than 45 countries. An accurate assessment of the situation is hampered by a widespread lack of laboratory capacity and/or proper surveillance. The problem is mainly due to inappropriate treatment, which may have many causes, but is theoretically avoidable. Aside from programmatic weaknesses, a lack of diagnostic and therapeutic tools causes difficulties in many countries., Discussion: Only rapid and internationally concerted action, combined with intensified research efforts and the support of the affected nations, will be able to prevent the development of a situation that will no longer be manageable even with 21(st)-century technology.
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- 2010
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20. Knowledge and attitude regarding human immunodeficiency virus/acquired immunodeficiency syndrome in dermatological outpatients.
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Kouznetsov L, Kuznetsov AV, Ruzicka T, Matterne U, Wienecke R, and Zippel SA
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- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections etiology, Acquired Immunodeficiency Syndrome complications, Adolescent, Adult, Aged, Blood Transfusion, Cross-Sectional Studies, Educational Status, Female, Germany, HIV Infections complications, Humans, Male, Marital Status, Middle Aged, Patient Education as Topic, Sexual Behavior, Skin Diseases, Viral diagnosis, Skin Diseases, Viral etiology, Socioeconomic Factors, Surveys and Questionnaires, Young Adult, Acquired Immunodeficiency Syndrome prevention & control, Acquired Immunodeficiency Syndrome transmission, Ambulatory Care Facilities, HIV Infections prevention & control, HIV Infections transmission, Health Knowledge, Attitudes, Practice
- Abstract
Background: Dermatologists are often the first-line specialists who recognize and diagnose human immunodeficiency virus (HIV) infection because of pathognomic skin signs. It is therefore important to investigate attitudes and knowledge regarding HIV/acquired immunodeficiency syndrome (AIDS) amongst dermatological patients in order to provide information for dermatologists and to draw their attention to the issues., Objectives: Awareness of HIV/AIDS, its prevention, and hypothetical behaviour were surveyed in dermatological outpatients., Patients/method: The anonymous cross-sectional survey was conducted with consecutive German-speaking outpatients aged 18-65 years, who registered at the dermatological outpatient's clinic (excluding venereology, genitourinary or HIV medicine) of the University of Munich (Germany)., Results: Three hundred forty-seven (77.5%) questionnaires were accepted for analysis. Most of the patients knew about HIV incurability (89.4%), HIV transmissibility during needle sharing (95.3%), or vaginal (87.4%) and anal intercourse (79.5%), as well as about HIV prevention by condom use (97.8%), and use of single needles (76.2%). However, knowledge gaps and misconceptions were detected regarding the risk of HIV transmission during oral sex, and the efficacy of sexual fidelity and avoidance of blood transfusions in HIV prevention. The lowest knowledge level (< 50% correct answers) was detected in patients aged 50-59 years, in unemployed, divorced/widowed, and in those without or with incomplete school education., Conclusions: Patient education about HIV/AIDS in dermatological ambulant settings should be performed differentially with regard to socio-demographic factors, and focused on the topic of oral sexual HIV transmission and on some other specific misconceptions.
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- 2009
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21. [Non-AIDS-defining malignancies].
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Hoffmann C
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- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections mortality, Acquired Immunodeficiency Syndrome diagnosis, Anus Neoplasms diagnosis, Anus Neoplasms mortality, Carcinoma, Bronchogenic diagnosis, Carcinoma, Bronchogenic mortality, Cause of Death, Cross-Sectional Studies, Germany, Humans, Lung Neoplasms diagnosis, Lung Neoplasms mortality, Neoplasms diagnosis, Papillomavirus Infections diagnosis, Papillomavirus Infections mortality, Survival Rate, Acquired Immunodeficiency Syndrome mortality, Neoplasms mortality
- Published
- 2008
22. [HIV-infection].
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Wasmuth JC and Rockstroh JK
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- AIDS-Related Opportunistic Infections diagnosis, Acquired Immunodeficiency Syndrome diagnosis, Acquired Immunodeficiency Syndrome drug therapy, Acquired Immunodeficiency Syndrome epidemiology, Acquired Immunodeficiency Syndrome prevention & control, Adult, Anti-Retroviral Agents administration & dosage, Anti-Retroviral Agents adverse effects, Anti-Retroviral Agents therapeutic use, Drug Interactions, Drug Resistance, Viral genetics, Drug Therapy, Combination, Female, Germany epidemiology, HIV-Associated Lipodystrophy Syndrome chemically induced, Homosexuality, Male, Humans, Infant, Newborn, Infectious Disease Transmission, Vertical, Male, Pregnancy, Pregnancy Complications, Infectious etiology, Prognosis, Reverse Transcriptase Inhibitors administration & dosage, Reverse Transcriptase Inhibitors adverse effects, Reverse Transcriptase Inhibitors therapeutic use, Time Factors, Antiretroviral Therapy, Highly Active, HIV Infections classification, HIV Infections diagnosis, HIV Infections drug therapy, HIV Infections epidemiology, HIV Infections prevention & control, HIV Infections transmission
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- 2007
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23. [Syphilis. Guideline of the German Sexually Transmitted Diseases Society fo diagnosis and therapy of syphilis].
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Schöfer H, Brockmeyer NH, Hagedorn HJ, Hamouda O, Handrick W, Krause W, Marcus U, Münstermann D, Petry KU, Prange H, Potthoff A, and Gross G
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- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections epidemiology, Cross-Sectional Studies, Evidence-Based Medicine, Female, Germany, Humans, Infant, Newborn, Male, Neurosyphilis diagnosis, Neurosyphilis drug therapy, Neurosyphilis epidemiology, Penicillins therapeutic use, Pregnancy, Syphilis drug therapy, Syphilis epidemiology, Syphilis Serodiagnosis, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology, Syphilis, Cutaneous diagnosis, Syphilis, Cutaneous drug therapy, Syphilis, Cutaneous epidemiology, Disease Notification, Syphilis diagnosis
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- 2006
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24. Incidence and prognosis of CMV disease in HIV-infected patients before and after introduction of combination antiretroviral therapy.
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Salzberger B, Hartmann P, Hanses F, Uyanik B, Cornely OA, Wöhrmann A, and Fätkenheuer G
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- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections mortality, Adult, CD4 Lymphocyte Count, Cohort Studies, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections mortality, Female, Germany epidemiology, HIV Infections mortality, Humans, Incidence, Male, Middle Aged, Prognosis, Risk Factors, Survival Rate, AIDS-Related Opportunistic Infections epidemiology, Antiretroviral Therapy, Highly Active, Cytomegalovirus Infections epidemiology, HIV Infections complications, HIV Infections drug therapy
- Abstract
Background: Highly active antiretroviral therapy (HAART) has improved the prognosis of HIV-infected patients. We studied the changes in the incidence and prognosis of cytomegalovirus (CMV) disease preceding and during the first few years of HAART in a clinic cohort., Patients and Methods: All patients with CMV disease diagnosed between 1993 and 1999 from a clinic cohort in Cologne, Germany, were included. The patients were followed until death or until December 31, 2001. The time period from 1993-1996 was classified as pre-HAART, the period from 1997-1999 as the HAART era. Survival was analyzed with a Cox-proportional hazard model., Results: From a total of 1,279 HIV-infected patients, 127 patients with CMV disease were enrolled. The incidence of CMV disease declined rapidly and significantly from 7.34 cases per 100 patient years (py) in the pre-HAART era to 0.75 cases per 100 py in the HAART era. The median survival time in the pre-HAART era was 9.5 months; the median survival was not yet reached at 4 years of follow-up in the HAART era. The only risk factors influencing survival were CD4-cell count and antiretroviral therapy before and after diagnosis of CMV disease. Treatment naive patients had a better prognosis than pretreated patients and patients treated with triple combination therapy survived longer than patients with other treatment modalities., Conclusion: A rapid decline in the incidence of new CMV manifestations and a better prognosis of patients with CMV disease, especially if they were treatment naive and treated with triple combination therapy, were observed in the HAART era.
- Published
- 2005
- Full Text
- View/download PDF
25. [Diagnostics of the HIV infection].
- Author
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Jablonowski H
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, Diagnosis, Differential, Early Diagnosis, Germany, HIV Seroprevalence, Humans, AIDS Serodiagnosis, HIV Infections diagnosis
- Abstract
Diagnostics of the HIV Infection The clinical picture of an acute HIV infection resembles that of mononucleosis with lymphadenopathy, fatigue and fever. In this phase, the infection can be diagnosed with certainty only through direct virus detection. During the subsequent latent phase, recurring or serious progressive skin manifestations from different illnesses, prominent candidiasis of the oral cavity and community acquired pneumonia frequently occur. Ulcerations in atypical locations of the gastrointestinal tract could also indicate an HIV infection. For cases of clear lymphopenia, an HIV infection should be definitely considered. Above all, the presence of non-Hodgkin's lymphoma is characteristic of the complete clinical picture of AIDS. An appropriate diagnostic test (antibody test or detection of HIV) is urgently indicated in situations that carry a high risk for HIV transmission. This applies, above all, to patients whose partner is HIV positive, to patients who frequently change sex partners, to prostitutes and to intravenous drug users.
- Published
- 2005
26. [Syphilis and HIV infection. Characteristic features of diagnosis, clinical assessment, and treatment].
- Author
-
Potthoff A and Brockmeyer NH
- Subjects
- AIDS Serodiagnosis trends, AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections epidemiology, Cross-Cultural Comparison, Cross-Sectional Studies, Diagnosis, Differential, Disease Notification, Female, Germany, Humans, Male, Neurosyphilis diagnosis, Neurosyphilis drug therapy, Neurosyphilis epidemiology, Penicillins therapeutic use, Population Surveillance, Sexual Behavior, Syphilis drug therapy, Syphilis epidemiology, Syphilis, Cutaneous diagnosis, Syphilis, Cutaneous drug therapy, Syphilis, Cutaneous epidemiology, AIDS-Related Opportunistic Infections diagnosis, Syphilis diagnosis
- Abstract
The incidence of syphilis has increased dramatically in Germany since 2001. Homosexual men have been particularly afflicted. Several characteristic features should be taken into account in the diagnosis and treatment of HIV patients with concomitant syphilis. Since laboratory analyses are frequently unreliable, the experienced physician must pay special attention to the clinical picture. The stages in the clinical course of syphilis do not differ essentially between HIV-positive and HIV-negative patients. However, atypical and serious courses with rapid progression and CNS involvement are observed more frequently. Moreover, incorrect diagnoses are often reached. Treatment requires particular diligence. Penicillin is the agent of choice for all stages of syphilis in patients infected with HIV. Because the stages are often difficult to differentiate, the choice of which penicillin derivative should be administered is the subject of controversy. There is no safe alternative for patients allergic to penicillin.
- Published
- 2005
- Full Text
- View/download PDF
27. [Syphilis in pregnancy].
- Author
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Enders M and Hagedorn HJ
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections epidemiology, Cross-Sectional Studies, Female, Germany epidemiology, Humans, Incidence, Infant, Newborn, Penicillins adverse effects, Penicillins therapeutic use, Pregnancy, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious epidemiology, Syphilis drug therapy, Syphilis epidemiology, AIDS-Related Opportunistic Infections diagnosis, Pregnancy Complications, Infectious diagnosis, Syphilis diagnosis
- Abstract
Syphilis, a sexually transmitted infection, has a major impact on the disease burden worldwide. Globally, an estimated 12 million new cases of sexually acquired syphilis occurred in 1997. Developing countries in Africa, Southeast Asia and regions of the former Soviet Union are mainly affected. With rising numbers of human immunodeficiency virus-infected pregnant women and an increase in gonorrhoea in some areas, the incidence of syphilis is expected to increase again. As a consequence of migration from Eastern bloc countries to Europe after the breakdown of the former Soviet Union, the resurgence of syphilis will also affect Germany. Therefore, we present the clinical picture of syphilis as well as review the current recommendations of the German STD Society, the Centers of Disease Control (CDC), USA, and the Clinical Effectiveness Group (CEG), England, for diagnosis and treatment of syphilis with special emphasis on pregnancy. Considering the current epidemiological situation, physicians should include syphilis in their differential diagnosis. Although recommended therapy regimens differ, penicillin is the treatment of choice. Pregnant patients who are allergic to penicillin should be desensitized and treated with penicillin. Early recognition and timely treatment of syphilis are essential to prevent or treat potentially fatal fetal infection.
- Published
- 2002
- Full Text
- View/download PDF
28. [Primary diagnosis of syphilis by the ophthalmologist].
- Author
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Porstmann AU, Marcus U, and Pleyer U
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections transmission, Adult, Chorioretinitis diagnosis, Chorioretinitis drug therapy, Chorioretinitis epidemiology, Cross-Sectional Studies, Diagnosis, Differential, Eye Diseases drug therapy, Eye Diseases epidemiology, Female, Fluorescein Angiography, Germany, Humans, Male, Middle Aged, Ophthalmoscopy, Papilledema diagnosis, Papilledema drug therapy, Papilledema epidemiology, Penicillins therapeutic use, Syphilis drug therapy, Syphilis epidemiology, Syphilis transmission, Syphilis Serodiagnosis, Urban Population statistics & numerical data, Uveitis, Anterior diagnosis, Uveitis, Anterior drug therapy, Uveitis, Anterior epidemiology, Eye Diseases diagnosis, Patient Care Team, Syphilis diagnosis
- Abstract
Background: Throughout the developed world the reported incidence of sexually transmitted diseases is rising with previously unreported cases at rates of 40 - 70 %. According to German sources, recent epidemiological data show a considerable increase of syphilis especially among homosexual men in larger cities., Patients: We report on 4 patients (age 38 - 54) who were referred to our outpatient department because of vision loss of unknown origin. All were subsequently tested positive for syphilis. None of the patients (3 men, 1 woman) belonged to a risk group, only one described systemic symptoms (urethritis and arthritis). The ocular manifestations of syphilis were broad: granulomatous and non-granulomatous anterior uveitis, papillitis, and chorioretinitis. Two patients also tested positive for HIV. After systemic antibiotic therapy, the ocular diseases stabilized., Conclusion: Diagnosis and therapy of syphilis is cost-effective. The rise of syphilis especially in urban areas necessitates a high level of suspicion dealing with patients with intraocular inflammation of unknown origin. Lues serology should be incorporated into routine lab diagnostics to aid in the detection of such cases.
- Published
- 2002
- Full Text
- View/download PDF
29. Assessment of lymph node tuberculosis in northern Germany: a clinical review.
- Author
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Geldmacher H, Taube C, Kroeger C, Magnussen H, and Kirsten DK
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections pathology, Adolescent, Adult, Aged, Antitubercular Agents therapeutic use, Bacteriological Techniques, Biopsy, Needle, Cross-Sectional Studies, Drug Therapy, Combination, Female, Germany epidemiology, Humans, Lymph Nodes pathology, Male, Middle Aged, Retrospective Studies, Tuberculin Test, Tuberculosis, Lymph Node diagnosis, Tuberculosis, Lymph Node drug therapy, AIDS-Related Opportunistic Infections epidemiology, Tuberculosis, Lymph Node epidemiology
- Abstract
Aim of Study: To evaluate patient profiles, diagnostic approaches, and treatment strategies in patients with lymph node tuberculosis., Methods: Demographic data, diagnostic findings, and therapies were retrospectively analyzed in 60 patients with lymph node tuberculosis who were hospitalized between 1992 and 1999., Results: Thirty percent (n = 18) of patients were natives, and 70% were immigrants (n = 42). The cervical lymph nodes were most frequently involved (63.3%), followed by the mediastinal lymph nodes (26.7%) and the axillary lymph nodes (8.3%). All patients (except one patient who was HIV-positive) showed a positive response to tuberculin skin testing. Lymph node excision and fine-needle aspiration (FNA) were similarly effective in obtaining sufficient material for histologic and microbiological analysis. Mycobacterium tuberculosis was identified in 43.3% of patients by microbiological testing, and culture methods showed the highest sensitivity. Despite standard treatment, the initial enlargement of the lymph nodes occurred in 20% of patients and local complications occurred in 10%., Conclusion: Lymph node tuberculosis is still an important issue in developed countries and has to be considered in differential diagnosis. The best approach appears to be a combination of skin testing and FNA. Negative results in the identification of M tuberculosis do not exclude the diagnosis of lymph node tuberculosis.
- Published
- 2002
- Full Text
- View/download PDF
30. Decreased prevalence of Helicobacter pylori infection in HIV patients with AIDS defining diseases.
- Author
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Lichterfeld M, Lorenz C, Nischalke HD, Scheurlen C, Sauerbruch T, and Rockstroh JK
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, Adult, Aged, Cohort Studies, Comorbidity, Cross-Sectional Studies, Female, Germany, HIV Seropositivity diagnosis, Helicobacter Infections diagnosis, Humans, Male, Middle Aged, AIDS-Related Opportunistic Infections epidemiology, HIV Seropositivity epidemiology, Helicobacter Infections epidemiology, Helicobacter pylori
- Abstract
Various clinical studies indicated a lower prevalence of HP infection in HIV patients. The present study was initiated to determine whether the decreased frequency of HP infections in HIV patients might be associated with the stage of the underlying HIV disease or concomitant drug regimens the patients had received. 60 randomly selected HIV outpatients were stratified according to the stage of their HIV infection (CDC classification), their CD4 cell count and to the drug regimens they were given. Within these subgroups of patients, HP infection prevalence was separately investigated by serological and C13 breath testing. Data were compared to a reference population of 30 healthy volunteers. No difference in HP infection prevalence was found between the HIV infected patients in general and the reference cohort. A significantly lower proportion of HP infected individuals was observed among those HIV patients who had AIDS-defining diseases. Furthermore, a substantial but insignificant decrease of HP infection prevalence was noted in HIV patients with an extensive decline of CD4 cell count (< 100/microl). HIV patients who had received antimicrobial or H2-antagonizing drugs within 12 months prior to the study commencement also were found to have a remarkably decreased frequency of HP infections independently of their CD4 cell count. No association between HP infection prevalence and patients age, sex, risk group and the type of their antiretroviral treatment was found.We concluded from these results that the decreased HP infection prevalence in HIV patients may, apart from frequent antibiotic treatment, be correlated to the stage of HIV-mediated immune suppression.
- Published
- 2002
- Full Text
- View/download PDF
31. [Primary central nervous system lymphoma as a neurological manifestation of AIDS stage].
- Author
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Happe S, Milbradt O, Heese C, Rickert CH, Oelerich M, Schul C, Reichelt D, and Husstedt IW
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, Adult, Brain pathology, Brain virology, Brain Neoplasms pathology, Brain Neoplasms therapy, Brain Neoplasms virology, Diagnosis, Differential, Female, Germany epidemiology, Humans, Lymphoma, AIDS-Related epidemiology, Lymphoma, AIDS-Related pathology, Lymphoma, AIDS-Related therapy, Lymphoma, AIDS-Related virology, Male, Middle Aged, Prevalence, Prognosis, Retrospective Studies, Risk Factors, Survival Analysis, Brain Neoplasms diagnosis, Herpesvirus 4, Human isolation & purification, Lymphoma, AIDS-Related diagnosis
- Abstract
In patients infected with human immunodeficiency virus (HIV), the risk of developing non-Hodgkin's lymphoma is over 100 times greater than with noninfected persons. Primary central nervous system lymphoma as a complication of the acquired immunodeficiency syndrome (AIDS) occurs in up to 2.4% of all cases and is strongly associated with the Epstein-Barr virus. The prognosis is very poor, with a mean survival time of 21 to 27 days without therapy and up to 119 days with radiation therapy. We describe the course of seven AIDS patients with histologically proven primary central nervous system lymphoma and present a review of clinical symptoms, diagnosis, and therapy. The main criteria for differential diagnosis from other secondary neuromanifestations such as cerebral toxoplasmosis, progressive multifocal leukoencephalopathy, abscesses, and infarctions are described.
- Published
- 2001
- Full Text
- View/download PDF
32. [AIDS in otorhinolaryngology].
- Author
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Weidauer H
- Subjects
- Acquired Immunodeficiency Syndrome prevention & control, Acquired Immunodeficiency Syndrome transmission, Germany, Humans, Infectious Disease Transmission, Patient-to-Professional prevention & control, Risk Factors, AIDS-Related Opportunistic Infections diagnosis, Acquired Immunodeficiency Syndrome diagnosis, Otorhinolaryngologic Diseases diagnosis
- Published
- 2000
- Full Text
- View/download PDF
33. Hepatitis C in the patient with human immunodeficiency virus infection.
- Author
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Spengler U and Rockstroh JK
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections epidemiology, Anti-HIV Agents therapeutic use, Antiviral Agents therapeutic use, Clinical Laboratory Techniques, Germany epidemiology, HIV Infections complications, HIV Infections drug therapy, HIV Infections epidemiology, Hepatitis C complications, Hepatitis C drug therapy, Hepatitis C epidemiology, Humans, Interferons therapeutic use, AIDS-Related Opportunistic Infections diagnosis, HIV Infections diagnosis, Hepatitis C diagnosis
- Published
- 1998
- Full Text
- View/download PDF
34. Comparison of different DNA fingerprinting techniques for molecular typing of Bartonella henselae isolates.
- Author
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Sander A, Ruess M, Bereswill S, Schuppler M, and Steinbrueckner B
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections microbiology, Angiomatosis, Bacillary diagnosis, Animals, Bartonella henselae isolation & purification, Base Sequence, Cat-Scratch Disease blood, Cats, Consensus Sequence, DNA, Ribosomal genetics, Germany, Humans, Introns, Molecular Sequence Data, Polymerase Chain Reaction methods, RNA, Ribosomal, 16S genetics, Serotyping methods, Bartonella henselae classification, Bartonella henselae genetics, Cat-Scratch Disease diagnosis, Cat-Scratch Disease microbiology, DNA Fingerprinting methods, Phylogeny
- Abstract
Seventeen isolates of Bartonella henselae from the region of Freiburg, Germany, obtained from blood cultures of domestic cats, were examined for their genetic heterogeneity. On the basis of different DNA fingerprinting methods, including pulsed-field gel electrophoresis (PFGE), enterobacterial repetitive intergenic consensus (ERIC)-PCR, repetitive extragenic palindromic (REP) PCR, and arbitrarily primed (AP)-PCR, three different variants were identified among the isolates (variants I to III). Variant I included 6 strains, variant II included 10 strains, and variant III included only one strain. By all methods used, the isolates could be clearly distinguished from the type strain, Houston-1, which was designated variant IV. A previously published type-specific amplification of 16S rDNA differentiated two types of the B. henselae isolates (16S rRNA types 1 and 2). The majority of the isolates (16 of 17), including all variants I and II, were 16S rRNA type 2. Only one isolate (variant III) and the Houston-1 strain (variant IV) comprised the 16S rRNA type 1. Comparison of the 16S rDNA sequences from one representative strain from each of the three variants (I to III) confirmed the results obtained by 16S rRNA type-specific PCR. The sequences from variant I and variant II were identical, whereas the sequence of variant III differed in three positions. All methods applied in this study allowed subtyping of the isolates. PFGE and ERIC-PCR provided the highest discriminatory potential for subtyping B. henselae strains, whereas AP-PCR with the M13 primer showed a very clear differentiation between the four variants. Our results suggest that the genetic heterogeneity of B. henselae strains is high. The methods applied were found useful for typing B. henselae isolates, providing tools for epidemiological and clinical follow-up studies.
- Published
- 1998
- Full Text
- View/download PDF
35. Prevalence and clinical significance of intestinal microsporidiosis in human immunodeficiency virus-infected patients with and without diarrhea in Germany: a prospective coprodiagnostic study.
- Author
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Sobottka I, Schwartz DA, Schottelius J, Visvesvara GS, Pieniazek NJ, Schmetz C, Kock NP, Laufs R, and Albrecht H
- Subjects
- Cohort Studies, Germany, Humans, Intestinal Diseases, Parasitic diagnosis, Intestinal Diseases, Parasitic epidemiology, Intestinal Diseases, Parasitic physiopathology, Prevalence, Prospective Studies, AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections physiopathology, Diarrhea complications, Microsporidiosis diagnosis, Microsporidiosis epidemiology, Microsporidiosis physiopathology
- Abstract
The prevalence of intestinal microsporidiosis among human immunodefiency virus (HIV)-infected persons with chronic diarrhea varies from 7% to 50%; thus, microsporidia are a significant source of morbidity and, occasionally, mortality among these patients. Anecdotal reports suggest that intestinal microsporidiosis is also an important infection in patients with AIDS in Germany. To determine the prevalence of microsporidiosis among HIV-infected patients in Germany, we performed a prospective coprodiagnostic study of 97 consecutive HIV-infected patients. Microsporidia were the most common enteropathogen identified in 18 (36.0%) of 50 patients with diarrhea and 2 (4.3%) of 47 patients without diarrhea (P < .001; chi2 test). Microsporidia were present in 60% of patients with chronic diarrhea and 5.9% of patients with acute diarrhea. The etiologic agent was Enterocytozoon bieneusi in 18 patients and Encephalitozoon intestinalis in two patients. The prevalence of intestinal microsporidiosis in this cohort of German patients with AIDS and diarrhea is one of the highest to be reported anywhere in the world. Microsporidiosis seems to represent one of the most important causes of diarrhea in HIV-infected patients in Germany and thus must be considered in the differential diagnosis for all AIDS patients presenting with diarrhea.
- Published
- 1998
- Full Text
- View/download PDF
36. [Changes in the spectrum of the causative agents of community-acquired pneumonias (1982-1992)].
- Author
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Allewelt M, Steinhoff D, Rahlwes M, Vogel-Hartmann H, Höffken G, Schaberg T, and Lode H
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections microbiology, AIDS-Related Opportunistic Infections mortality, Adolescent, Adult, Aged, Aged, 80 and over, Bacteria isolation & purification, Community-Acquired Infections diagnosis, Community-Acquired Infections microbiology, Community-Acquired Infections mortality, Female, Germany epidemiology, HIV-1, Hospital Mortality, Humans, Immunocompromised Host, Male, Middle Aged, Pneumonia, Bacterial diagnosis, Pneumonia, Bacterial mortality, Prospective Studies, Pneumonia, Bacterial microbiology
- Abstract
Background and Objective: The picture of pneumonia acquired out of hospital is continually changing. Microbial aetiology as well as predisposing factors, course and prognosis of this disease were prospectively analysed over a period of 10 years., Patients and Methods: In three prospective studies, undertaken between 1982 and 1992, data from 448 patients with out-of-hospital acquired pneumonia were analysed. Microbiological evidence was obtained through blood cultures, from purulent sputum or bronchial secretions, as well as by determining serum antibodies or antigens in urine., Results: Proof of causative organism was achieved in 282 patients (64.1%), with identification of 337 different ones. The spectrum of causative microbes shifted during the study period from predominantly gram-positive bacteria to largely atypical organisms (from 12.5% during 1982/1983, to 36.7% in 1991/1992). Although pneumococci continued to dominate, Chlamydia pneumoniae appeared as an important cause of pneumonia, at 11.4% the most important atypical organism in 1991/1992. -Most patients (74.3%) had a chronic underlying disease. The death rate remained relatively constant at 12.9% during the 10-year period., Conclusion: The observed changes in microbial spectrum should be taken into account when specific antibiotic treatment is given. History as well as clinical, radiological and laboratory findings are of only limited value as pointers to the possible microbial cause.
- Published
- 1997
- Full Text
- View/download PDF
37. [HIV-associated skin diseases. 1: Follow-up and epidemiology of HIV infection, pathogen-induced HIV-associated dermatoses].
- Author
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Ramsauer J, Plettenberg A, and Meigel W
- Subjects
- AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections therapy, Adolescent, Adult, Aged, Anti-Infective Agents therapeutic use, Child, Child, Preschool, Female, Follow-Up Studies, Germany epidemiology, HIV Infections epidemiology, HIV Infections therapy, HIV Seroprevalence trends, Humans, Infant, Infant, Newborn, Male, Middle Aged, Pregnancy, Skin Diseases, Infectious epidemiology, Skin Diseases, Infectious therapy, AIDS-Related Opportunistic Infections diagnosis, HIV Infections diagnosis, Skin Diseases, Infectious diagnosis
- Published
- 1996
38. [Tuberculosis].
- Author
-
Kirsten D
- Subjects
- AIDS-Related Opportunistic Infections mortality, AIDS-Related Opportunistic Infections therapy, Adolescent, Adult, Aged, Cause of Death, Child, Child, Preschool, Cross-Sectional Studies, Female, Germany epidemiology, Humans, Infant, Male, Middle Aged, Tuberculosis, Pulmonary mortality, Tuberculosis, Pulmonary therapy, AIDS-Related Opportunistic Infections diagnosis, Tuberculosis, Pulmonary diagnosis
- Published
- 1996
39. [Indications for eye examination of HIV patients--screening parameters for cytomegalovirus retinitis].
- Author
-
Gellrich MM, Lagrèze WD, Rump JA, and Hansen LL
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, Adolescent, Adult, Aged, Ambulatory Care, CD4 Lymphocyte Count, Cytomegalovirus Retinitis diagnosis, Female, Germany, HIV Seropositivity diagnosis, Humans, Male, Middle Aged, Risk Factors, AIDS-Related Opportunistic Infections epidemiology, Cytomegalovirus Retinitis epidemiology, HIV Seropositivity epidemiology, Mass Screening
- Abstract
Background: To reduce the burden of frequent visits at the physician we have checked (I) for which ocular manifestations in HIV-infection screening of asymptomatic patients is worthwhile and (II) which parameters may indicate patients at risk for CMV-retinitis., Patients and Methods: The clinical data of 215 HIV-infected patients were analyzed retrospectively. Only those ocular manifestations were considered suitable for screening that (a) endanger vision, (b) are treatable, (c) can be diagnosed sufficiently early and (d) are common. Furthermore (1) CDC-stage, (2) CD4+ count, (3) HIV-retinopathy, (4) CMV-uria and (5) CMV-antibodies were checked for their usefulness in indicating patients at risk for CMV-retinitis., Results: Ophthalmological screening of asymptomatic HIV-patients should focus on cytomegalovirus (CMV)-retinitis because early diagnosis of this common blinding disease improves the visual outcome. 85 of 215 HIV-infected patients had a CD4+ count less than 50 cells/microliters 25% of these patients developed CMV-retinitis (21/85). The risk for CMV-retinitis rose to 38% (13/34) when the low CD4+ count was accompanied by CMV-uria. The proportion of patients with CMV-retinitis did not increase when HIV-retinopathy had been diagnosed earlier (12/48 = 25%). CMV-serology and CDC-classification were not helpful in screening for CMV-retinitis., Conclusions: We recommend the following ophthalmological screening scheme for HIV-patients without ocular symptoms: (1) patients with a CD4+ count < 100 cells/microliters should be checked every third month and (2) those with a CD4+ count < 50 cells/microliters and CMV-uria every sixth week.
- Published
- 1996
- Full Text
- View/download PDF
40. [Current aspects of lymph node tuberculosis of the neck].
- Author
-
Lenci G and Gartenschläger M
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections epidemiology, Antitubercular Agents therapeutic use, Combined Modality Therapy, Cross-Sectional Studies, Developing Countries, Drug Therapy, Combination, Germany epidemiology, Humans, Incidence, Tuberculosis, Lymph Node drug therapy, Tuberculosis, Lymph Node epidemiology, Tuberculosis, Lymph Node diagnosis
- Abstract
In 1994, the incidence of tuberculosis (Tb) in Germany is 16/ 100,000, and the incidence of extrapulmonary Tb is 2,3/100,000. The peripheral lymph nodes represent with 41% the most commonly involved extrapulmonary organ system. At present, cervical lymph node Tb is of clinical relevance on one hand in patients from endemic areas of Tb in the developing countries and on the other hand in immunocompromised patients, particularly in course of HIV infection. Diagnostic methods are discussed with special attention to fine needle biopsy; modalities and indications of imaging methods are described. The microbiological examination allows the definitive diagnostic clarification. Cervical lymph node Tb responds well to antituberculous chemotherapy. Regimens of drug combination and the duration of treatment are discussed; generally chemotherapy should be continued for at least 9 months. Indications to surgical intervention are explained. The different aspects of adenopathies caused by atypical mycobacteria are considered.
- Published
- 1996
41. [Illnesses caused by ubiquitous mycobacteria. Clinical, therapeutic and microbiological aspects].
- Author
-
Schütt-Gerowitt H
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections epidemiology, Antitubercular Agents therapeutic use, Bacteriological Techniques, Cross-Sectional Studies, Diagnosis, Differential, Drug Resistance, Microbial, Germany epidemiology, Humans, Incidence, Mycobacterium Infections, Nontuberculous drug therapy, Mycobacterium Infections, Nontuberculous epidemiology, AIDS-Related Opportunistic Infections diagnosis, Mycobacterium Infections, Nontuberculous diagnosis
- Abstract
Over the last ten years, opportunistic infections with ubiquitous mycobacteria have increased greatly in importance. In particular immunosuppressed patients are affected. Given that present methods of detection are much improved, there has still been a "real" increase in such diseases. For the interpretation of findings in HIV-positive patients, special criteria apply. In the case of AIDS patients, virtually all the organs may be affected, while in HIV-negative patients, chronic diseases of the lungs, lymphadenopathies and infections of the skin and soft tissues predominate. The differentiation between tuberculosis pathogens and ubiquitous mycobacteria is the all-important task of the diagnostic laboratory. Owing to the high resistance of the pathogens, treatment is often problematic.
- Published
- 1996
42. [Human herpesviruses 6 and 7. Basic principles and possible significance for dermatology].
- Author
-
Lasch JA, Klussmann JP, and Krueger GR
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections virology, Adult, Autoimmune Diseases diagnosis, Autoimmune Diseases epidemiology, Autoimmune Diseases virology, Blood Donors statistics & numerical data, Child, Child, Preschool, Cross-Cultural Comparison, Cross-Sectional Studies, Exanthema Subitum diagnosis, Exanthema Subitum epidemiology, Female, Germany epidemiology, Herpesviridae Infections diagnosis, Herpesviridae Infections epidemiology, Hodgkin Disease diagnosis, Hodgkin Disease epidemiology, Hodgkin Disease virology, Humans, Incidence, Infant, Lupus Erythematosus, Systemic diagnosis, Lupus Erythematosus, Systemic epidemiology, Lupus Erythematosus, Systemic virology, Male, Opportunistic Infections diagnosis, Opportunistic Infections epidemiology, Opportunistic Infections virology, Tissue Donors statistics & numerical data, Virus Activation physiology, Exanthema Subitum virology, Herpesviridae Infections virology, Herpesvirus 6, Human pathogenicity, Herpesvirus 7, Human pathogenicity
- Abstract
Primary infection with human herpesviruses 6 and 7 (HHV-6 and HHV-7) during early childhood causes permanent latent infection, usually without any ill effects; only a small percentage of primary infections will lead to exanthem subitum. Like other herpesviruses. HHV-6 and HHV-7 can be reactivated at any time if host defence mechanisms become defective (e.g. in transplant recipients, AIDS, tumour patients). HHV-6 can be reactivated under such conditions and cause a variety of clinical problems, such as exanthems along with interstitial pneumonia or hepatitis for example. In addition, the reactivated virus may influence the course of autoimmune and proliferative diseases such as systemic lupus erythematosus and Hodgkin's disease. While, HHV-7 may be associated with similar disorder, more systematic studies are needed to clarify the clinical implications and the pathogeetic mechanisms of both viruses.
- Published
- 1996
- Full Text
- View/download PDF
43. [Invasive mold infections in the university clinics of Leipzig in the period from 1992-1994].
- Author
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Nenoff P, Horn LC, Schwenke H, Mierzwa M, Rieske K, and Haustein UF
- Subjects
- AIDS-Related Opportunistic Infections epidemiology, Adolescent, Adult, Aged, Aspergillosis epidemiology, Aspergillosis etiology, Female, Germany, Hospitals, University, Humans, Male, Middle Aged, Mycoses epidemiology, Mycoses etiology, Retrospective Studies, AIDS-Related Opportunistic Infections diagnosis, Aspergillosis diagnosis, Mitosporic Fungi, Mycoses diagnosis
- Abstract
Invasive mould infection, e. g. aspergillosis in the first place, is a common infection in immunocompromised patients. The diagnosis of invasive mould infection is difficult in the absence of confirmation by tissue biopsy and histological studies. Therefore, prevalence of invasive mould infections at the School of Medicine of the Leipzig University between 1992 and 1994 was investigated. The diagnosis of invasive mould infection was suspected on clinical, mycological, and radiological findings. The definitive diagnosis was obtained by identification of characteristic mould hyphae on stained smears, and/or positive culture, and/or the detection of Aspergillus antigen (Pastorex) in serum, bronchial secretion, or bronchoalveolar fluid, and confirmed by histopathology. In altogether 21 patients the definitive diagnosis invasive mould infection was recorded, among them 20 invasive aspergilloses. Underlying diseases were leukaemia (n = 11), aplastic anaemia (n = 2), non-Hodgkin-lymphoma (n = 1), systemic lupus erythematosus (n = 1), kidney transplantation (n = 1), peritonitis after Billroth II anastomosis (n = 1), Polymyalgia rheumatica (n = 1), AIDS plus Burkitt lymphoma (n = 1), glioblastoma (n = 1), and subarachnoid haemorrhage (n = 1). As causative fungi were isolated: Aspergillus fumigatus (n = 13), Aspergillus terreus (n = 1), Aspergillus flavus as rare simultaneous injection with the basidiomycete Coprinus spec. in a leukaemic patient (n = 1), and the dematiaceous fungus Scedosporium prolificans in an AIDS patient with Burkitt lymphoma (n = 1). In four patients the invasive mould infection was confirmed histopathologically without isolation and differentiation of the causative agent. Nineteen of the 21 patients with invasive mould infections died corresponding to a mortality rate of 90%.
- Published
- 1996
- Full Text
- View/download PDF
44. [HIV infections in Germany].
- Author
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Goebel FD
- Subjects
- AIDS-Related Opportunistic Infections epidemiology, Acquired Immunodeficiency Syndrome epidemiology, Germany epidemiology, HIV Infections epidemiology, Humans, Patient Care Team, AIDS-Related Opportunistic Infections diagnosis, Acquired Immunodeficiency Syndrome diagnosis, Diagnostic Imaging, HIV Infections diagnosis
- Published
- 1995
45. [HIV infection and tuberculosis].
- Author
-
Brodt HR
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections drug therapy, Anti-Bacterial Agents, Antibiotics, Antitubercular adverse effects, Antibiotics, Antitubercular therapeutic use, Cross-Cultural Comparison, Cross-Sectional Studies, Drug Therapy, Combination adverse effects, Drug Therapy, Combination therapeutic use, Germany epidemiology, Humans, Incidence, Internal Medicine statistics & numerical data, Risk Factors, Tuberculosis, Multidrug-Resistant diagnosis, Tuberculosis, Multidrug-Resistant drug therapy, Tuberculosis, Multidrug-Resistant epidemiology, Tuberculosis, Pulmonary diagnosis, Tuberculosis, Pulmonary drug therapy, AIDS-Related Opportunistic Infections epidemiology, Tuberculosis, Pulmonary epidemiology
- Published
- 1995
46. [Epidemiology of tuberculosis].
- Author
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Schlegel J, Ferlinz C, and Ferlinz R
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections prevention & control, Adolescent, Adult, Aged, Child, Child, Preschool, Cross-Cultural Comparison, Cross-Sectional Studies, Female, Germany epidemiology, Humans, Incidence, Infant, Internal Medicine statistics & numerical data, Male, Middle Aged, Tuberculosis, Pulmonary diagnosis, Tuberculosis, Pulmonary prevention & control, AIDS-Related Opportunistic Infections epidemiology, Tuberculosis, Pulmonary epidemiology
- Published
- 1995
47. [Have the incidence and resistance of tuberculosis increased? Epidemiologic follow-up based on diseases confirmed by culture].
- Author
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Schneider C, Lasch C, and Brade V
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections epidemiology, Antitubercular Agents therapeutic use, Bacteriological Techniques, Cross-Sectional Studies, Drug Therapy, Combination, Germany epidemiology, Humans, Incidence, Microbial Sensitivity Tests, Tuberculosis diagnosis, Tuberculosis drug therapy, Tuberculosis, Multidrug-Resistant diagnosis, Tuberculosis, Multidrug-Resistant drug therapy, Tuberculosis, Pulmonary diagnosis, Tuberculosis, Pulmonary drug therapy, Tuberculosis epidemiology, Tuberculosis, Multidrug-Resistant epidemiology, Tuberculosis, Pulmonary epidemiology
- Abstract
The unexpected increase in the incidence of tuberculosis in many industrialized countries, which was recorded in Germany for the first time in 1992, provided the incentive for this retrospective analysis over the past 13 years of the epidemiology and resistance situation for Tbc in the Rhine/Main area. Basis for the evaluation were the data from our laboratory which is the only institution in the region performing type and resistance determinations on mycobacteria. During the period of the investigation, in which 3,738 tuberculoses were confirmed in cultures, the number of cases of the disease among German citizens decreased continuously. However, the still stagnating incidence rates can probably be attributed to the increasing flow of immigrants from countries with a high Tbc prevalence. Extrapulmonary manifestations were detected more often among foreigners than among Germans (19.6% versus 13.3%, p < 0.0001). In 9.5% of the cases, resistance against at least one of the five primordial antituberculosis agents (INH, SM, EMB, RMP, and PZA) was observed; but the rate was almost twice as high among foreigners as among Germans (13.8% versus 7.4%, p < 0.001). An increase in resistance either against individual substances or in regard to combination resistance could not be observed. In spite of the relatively high number of HIV-positive persons in the Frankfurt region, HIV-associated tuberculosis is still too seldom to make a noticeable impression on the total incidence. In the light of the regional incidence and resistance rates determined by us, a special position or even pace-setting function of our conurbation within the epidemiological tuberculosis situation in Germany cannot be recognized at present.
- Published
- 1994
48. [No detection of mycoplasma in 205 conjunctival swabs].
- Author
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Grasbon T, Miño de Kaspar H, and Klauss V
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections epidemiology, Adolescent, Adult, Aged, Aged, 80 and over, Bacteriological Techniques, Child, Conjunctivitis, Bacterial epidemiology, Cross-Sectional Studies, Female, Germany epidemiology, Humans, Incidence, Male, Middle Aged, Mycoplasma Infections epidemiology, Prospective Studies, Conjunctivitis, Bacterial diagnosis, Mycoplasma Infections diagnosis
- Abstract
Mycoplasma is known to cause pulmonary and urogenital infections in humans. A pathogenicity for the human eye never has been assessed, although they have been observed in the peripheral eye in a few cases of acute and non-specific conjunctivitis, in patients with Reiter's disease and in newborns. Due to the absence of cell walls, mycoplasma is only sensitive to a few antibiotics. Therefore, we presume that mycoplasma has a role in non-specific and chronic conjunctivitis. It is conceivable that in HIV-positive patients the risk of opportunistic colonization of the conjunctiva by mycoplasma is increased. PATIENTS AND METHODS. Between January and December 1992, 205 conjunctival swabs of 151 patients were prospectively analyzed for mycoplasma. The group contained 51 HIV-infected patients (94 swabs). A total of 85 swabs were from non-irritated eyes and the remaining (120) from peripherally inflamed eyes, mainly diagnosed as non-specific or chronic conjunctivitis (75 swabs). Specimen were obtained from the inferior fornix conjunctivae by use of a moistened cotton swab, which was directly immersed in culture broth. For subsequent culture, we used a liquid and a solid mycoplasma medium to differentiate Mycoplasma hominis, Mycoplasma fermentans and Ureaplasma urealyticum. In 77 swabs, a second sample was taken, which was investigated at the Institute for Poultry Diseases of the Ludwig Maximilians University, Munich. OUTCOME. None of 205 swabs, including the 77 samples tested in parallel, gave positive results for mycoplasma. Six cases were positive for bacteria and five cases for fungi. CONCLUSION. In adult patients at the Munich University Eye Hospital with either non-irritated eyes or non-specific and chronic conjunctivitis, no mycoplasma could be detected. With regard to HIV infection, there is no indication that mycoplasma plays a role in opportunistic infections of the conjunctiva.
- Published
- 1994
49. [HIV-associated dermatoses and their prevalence in 456 HIV-infected patients. Relation to immune status and its importance as a diagnostic marker].
- Author
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Garbe C, Husak R, and Orfanos CE
- Subjects
- AIDS-Related Opportunistic Infections diagnosis, AIDS-Related Opportunistic Infections immunology, Adult, Blotting, Western, CD4 Lymphocyte Count, Cross-Sectional Studies, Dermatitis diagnosis, Dermatitis immunology, Dermatitis, Seborrheic diagnosis, Dermatitis, Seborrheic epidemiology, Dermatitis, Seborrheic immunology, Enzyme-Linked Immunosorbent Assay, Female, Germany epidemiology, HIV Infections diagnosis, HIV Infections immunology, Humans, Incidence, Male, Sarcoma, Kaposi diagnosis, Sarcoma, Kaposi immunology, Skin Diseases, Infectious diagnosis, Skin Diseases, Infectious immunology, Skin Neoplasms diagnosis, Skin Neoplasms immunology, AIDS-Related Opportunistic Infections epidemiology, Dermatitis epidemiology, HIV Infections epidemiology, Sarcoma, Kaposi epidemiology, Skin Diseases, Infectious epidemiology, Skin Neoplasms epidemiology
- Abstract
Some 456 patients with HIV-associated skin disorders were documented in the HIV follow-up clinics at the Department of Dermatology, University Medical Center Steglitz, Berlin, during the years 1982-1992. Males comprised 91% of the patients. The most important risk groups for HIV infection were homosexual and bisexual men (77.9%) and individuals with intravenous drug abuse (12.7%). The most frequent dermatological diagnoses were oral candidosis (44.5%), seborrhoeic dermatitis (38.6%), folliculitis (32.9%) and Kaposi's sarcoma (23.5%). Altogether, 138 of the patients died during the time of observation. The most frequent cause of death was disseminated Kaposi's sarcoma (26.8%). A significant proportion of the patients developed skin diseases before significant reduction of the circulating CD4+ lymphocytes. In a still satisfactory immune situation, predominantly infections of the skin with dermatophytes (tinea), human papilloma viruses (warts) and bacteria (pyodermas) were observed. A considerable number of the HIV patients who developed zoster were also still in a favourable immune status; another 50% of these cases, however, developed the disease with reduced CD4+ lymphocyte count (< 300/microliters). Skin manifestations that tended to occur later in the course of HIV infection were oral candidosis, oral hairy leukoplakia, herpes genitoanalis, mollusca contagiosa and Kaposi's sarcoma, in spite of their early appearance in some cases. In the large majority of these patients the immunological parameters were already clearly reduced. Fungal, bacterial and viral infections of the skin, especially with extended skin involvement, may manifest themselves during the early phases of HIV infection. The number and severity of the skin manifestations increase with progressing immunosuppression, and treatment is often a difficult challenge for the dermatologist.
- Published
- 1994
- Full Text
- View/download PDF
50. [HIV-associated histoplasmosis with pulmonary manifestation in Europe].
- Author
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Wöckel W, Neher A, and Morresi A
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, AIDS-Related Opportunistic Infections ethnology, AIDS-Related Opportunistic Infections pathology, Adult, Biopsy, Diagnosis, Differential, Drug Therapy, Combination, Germany epidemiology, Histoplasma isolation & purification, Histoplasmosis drug therapy, Histoplasmosis ethnology, Histoplasmosis pathology, Humans, Lung microbiology, Lung pathology, Lung Diseases, Fungal drug therapy, Lung Diseases, Fungal ethnology, Lung Diseases, Fungal pathology, Male, Nebraska ethnology, Pneumonia, Pneumocystis diagnosis, Tuberculosis, Miliary diagnosis, AIDS-Related Opportunistic Infections diagnosis, Histoplasmosis diagnosis, Lung Diseases, Fungal diagnosis
- Abstract
A 35-year-old man developed weight loss, lower abdominal pain, diarrhoea, cough, fever and general deterioration in his health. He had been born and resident in the USA until 1991, when he moved to Germany. Since 1991 he had known that he was HIV-positive. The chest radiograph showed bilateral diffuse spotty marking and a rounded cardiac silhouette, the latter echocardiographically due to pericardial effusion. Tuberculostatic drugs were started because miliary tuberculosis was suspected. But as his condition worsened and he was thought to have Pneumocystis pneumonia high doses of co-trimoxazole were administered. Perbronchial lung biopsy showed nonspecific chronic inflammatory changes. Periodide acid-Schiff reaction and Grocott staining demonstrated numerous histoplasma in alveolar macrophages and connective tissue. The organism was also cultured from bronchial secretions. Treatment was now changed to itraconazole (400 mg daily), 2 weeks later changed to liposomal amphotericin B (100 mg daily) because of renewed fever. After 6 weeks the patient became free of symptoms and the radiological changes had largely regressed. To prevent recurrence, treatment with itraconazole (400 mg daily) is being continued.
- Published
- 1994
- Full Text
- View/download PDF
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