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The objective of this study was to identify prognostic factors of death in patients with tuberculous meningitis (TM) and show the impact of infection by multidrug-resistant strains on the outcome of this disease. We retrospectively analysed clinical charts of HIV-infected patients with culture-confirmed TM attending our institution during 1996-2004. The following variables were associated with death during hospitalization: neurological signs at admission, a CD4 T-cell count less than 50 cells/microl and infection by multidrug-resistant strains.

A 21 year old man, previously healthy, presented with subcutaneous nodes consistent with gummas. Ultrasonography disclosed multiple subcutaneous abscesses and images suitable with piomiositis, pleural and pericardium effusion. A puncture-aspirate with fine-needle was performed and produced purulent material, with isolate of Staphylococcus aureus. Antimicrobial susceptibility testing by disk diffusion showed resistant to cefalotin, erythromycin and clindamycin, and susceptibility to trimethoprim-sulfamethoxazole, ciprofloxacin and rifampicin. Methicilin-resistance was confirmed by Staphyslide agglutination testing (Biomérieux). The patient was treated with ciprofloxacin and rifampicin during four weeks, with a good clinical response. The frequency of CA-MRSA infections is increasing, and these are reported in patients without identified predisposing risks leading to failure on empiric therapy for community infections presumed to be due to staphylococcal agents.

Trichinellosis is a parasitic zoonosis caused by ingestion of infected meat containing cysts of Trichinella spp.To analyze the epidemiological, clinical and laboratory findings of trichinellosis patients in our center and compare the results with those from published series. To analyze the relationship between the clinical symptoms and laboratory findings.The clinical records of 127 patients were retrospectively analyzed.Epidemiological: 61% were male and mean age was 32 years; 95% were associated with other cases. The food implicated was always pork. Clinical: 45% presented gastrointestinal symptoms and 98% systemic symptoms. Three patients required intensive care unit hospitalization and one died. In 53%, treatment consisted of associated antiparasitic and anti-inflammatory drugs. Laboratory: 59% presented leukocytosis and 72% absolute eosinophilia. Creatine phosphokinase was elevated in 62%, lactic dehydrogenase in 56% and glutamic-oxaloacetic transaminase (GOT) in 30%. Among 52 patients, 65% had positive serology; trichinoscopy of food samples was positive in three outbreaks. The population studied had a mean of 5 signs and/or symptoms. The patient group with more than 5 signs and/or symptoms presented higher white blood cell counts and GOT levels (p0.05)Our results were comparable to those of other series; however, there was a low rate of complications. An association was found between a larger number of signs and symptoms and higher leukocyte counts and GOT levels. The relevance of these findings should be assessed in future studies. There is no agreement as to the best therapeutic option, a fact reflected in the various treatment modalities seen in our study.

Nocardiosis is a bacterial disease that occurs in immunocompromised patients, including those infected by the human immunodeficiency virus (HIV).We retrospectively analyzed the clinical records of 27 HIV-positive patients with nocardiosis seen during the period of 1993 to 2004. Clinical presentations, diagnostic methods, predominant species, antimicrobial therapy and outcome were analyzed.Among the total, 81% were males and the median age was 30 years. There was an elevated percentage of alcoholism (89%), smoking (80%) and intravenous drug use (82%). A previous positive serology for HIV infection was present in 85% of the patients. Plasma CD4+ T cell count at the time of diagnosis in 15 of 17 patients (88%) was below 50 cells/microl (median 15 cells/microl). The most frequent clinical onset was pulmonary in 70%, followed by cutaneous in 11% and disseminated in 11%. The main specimens for diagnostic bacterial isolation were sputum (54%), skin and soft tissues (22%) and bronchoalveolar lavage (19%). The predominant pulmonary radiological pattern was alveolar infiltration (74%), followed by cavitations (32%). The species was identified in 13 patients (48%); Nocardia asteroides was isolated in 84% (n = 11). The main antimicrobial drugs prescribed were cotrimoxazole (78%), amikacin (59%) and ciprofloxacin (33%). Dual therapy was used in 78% of the cases, with cotrimoxazole-amikacin being the most frequent. Overall mortality was 37%.Nocardiosis is an unusual infection among HIV-infected patients. The diagnosis should be considered in patients with CD4+ T cell counts below 50/microL and lung or pericardial involvement.

Introduction : An increasing number of treatment-experienced perinatally HIV-infected adolescents (PHA) are being transitioned from paediatric centres to adult HIV-care [1]. Most of them had been heavily exposed to antiretroviral drugs (ARVs), harbour drug-resistant viruses and require non-antiretroviral medication due to comorbidities [2]. This may predispose for clinically significant drug–drug interactions (CSDDIs) [3]. There are no studies concerning CSDDIs in PHA. We aimed to evaluate the prevalence of concomitant medications and CSDDIs in PHA who were transitioned for adult HIV-care to the Infectious Diseases Unit, Cosme Argerich Hospital, Buenos Aires City, Argentina. Material and Methods : Descriptive pilot cross-sectional study (March to June 2014). PHA under ARVs at the time of the study were assessed for concomitant medication. CSDDIs were screened and categorized using the University of Liverpool Drug Interactions Program (www.hiv-druginteractions.org) [4]. Results : Forty-five patients were included. Female sex: 53%. Median (IQR) age: 20 years (18–22). CDC-stage C was observed in 27 (79%); 50% had ≥1 comorbidities including 3 with HCV co-infection. Drug abuse was observed in 6 (13%). The median of prior ARV regimens was 3 (3–5). Current ARV regimen included: PI: 87%, NNRTI: 27%, INSTI: 20%, enfuvirtide: 7% and CCR5 inhibitor: 4%. Median CD4 T-cell count: 568 cells/mL (279–771). Viral load

Background The central nervous system is considered a sanctuary site for HIV-1 replication. Variables associated with HIV cerebrospinal fluid (CSF) viral load in the context of opportunistic CNS infections are poorly understood. Our objective was to evaluate the relation between: (1) CSF HIV-1 viral load and CSF cytological and biochemical characteristics (leukocyte count, protein concentration, cryptococcal antigen titer); (2) CSF HIV-1 viral load and HIV-1 plasma viral load; and (3) CSF leukocyte count and the peripheral blood CD4+ T lymphocyte count. Methods Our approach was to use a prospective collection and analysis of pre-treatment, paired CSF and plasma samples from antiretroviral-naive HIV-positive patients with cryptococcal meningitis and assisted at the Francisco J Muñiz Hospital, Buenos Aires, Argentina (period: 2004 to 2006). We measured HIV CSF and plasma levels by polymerase chain reaction using the Cobas Amplicor HIV-1 Monitor Test version 1.5 (Roche). Data were processed with Statistix 7.0 software (linear regression analysis). Results Samples from 34 patients were analyzed. CSF leukocyte count showed statistically significant correlation with CSF HIV-1 viral load (r = 0.4, 95% CI = 0.13-0.63, p = 0.01). No correlation was found with the plasma viral load, CSF protein concentration and cryptococcal antigen titer. A positive correlation was found between peripheral blood CD4+ T lymphocyte count and the CSF leukocyte count (r = 0.44, 95% CI = 0.125-0.674, p = 0.0123). Conclusion Our study suggests that CSF leukocyte count influences CSF HIV-1 viral load in patients with meningitis caused by Cryptococcus neoformans.

Purpose of the study Cerebrospinal fluid (CSF) leukocyte count in asymptomatic HIV-infected patients without central nervous system (CNS) opportunistic diseases has a positive correlation with peripheral blood CD4+ T-lymphocyte count. However, previous communications showed that this correlation is lost in patients with CNS opportunistic infections. This fact has been attributed to the low CD4 Tcell counts found in this population. These studies were undertaken in a low number of patients with different CNS opportunistic infections (cerebral toxoplasmosis, cryptococcal meningitis, Cytomegalovirus encephalitis, progressive multifocal leukoencephalopathy, tuberculous meningitis) considered altogether for the analysis. To date, no study has evaluated correlation between CSF leukocyte count and peripheral CD4+ T-lymphocyte count in a cohort of patients with a single CNS opportunistic infection. The objective of this study was to address this issue in patients with cryptococcal meningitis.