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Invasive aspergillosis is an uncommon but increasingly reported complication of AIDS. Sinusitis, usually bacterial in etiology, is frequently seen among human immunodeficiency virus (HIV)—infected patients. We discuss the cases of three patients with AIDS and invasive aspergillus sinusitis seen at our institutions and those of 15 patients who are described in the literature. Seven of the 18 had brain involvement, 3 had orbital involvement, and 7 had mastoid or other bony disease. Three had evidence of concomitant invasive pulmonary aspergillosis. Of 15 patients with evaluable histories, 11 had recognized risks for invasive aspergillosis; 6 had previous sinusitis, otitis, or polyposis; and 11 had prior conditions indicative of advanced HIV-related disease. Despite aggressive surgical intervention and systemic antifungal therapy, nearly all patients died as a result of aspergillosis. [ABSTRACT FROM PUBLISHER]

Invasive aspergillosis is a rare complication of AIDS. We discuss the cases of 18 patients with AIDS and invasive aspergillosis who were identified at our institution and 19 patients who are described in the literature. Twenty-one patients were either homosexual or bisexual, eight were intravenous drug users, three were hemophiliacs, two attributed their disease to a heterosexual contact, and one was a transfusion recipient; risk factors for AIDS were unknown for two patients. Twenty-eight of the 37 patients had pulmonary aspergillosis; for 18 of these 28, the lung was the sole site of disease. Aspergillosis involved the brain in 12 cases, the heart in five cases, and the kidney, sinuses, or skin in six other cases. Eleven patients had multiple sites of disease, and eight patients had extrapulmonary disease alone. Possible risk factors for aspergillosis included leukopenia (7 patients, of whom 5 were also neutropenic) and use of corticosteroids (8 patients), alcohol (6 patients), broad-spectrum antibiotics (5 patients), and antineoplastic agents (4 patients); 14 patients had no identifiable risk. Death was the usual outcome, despite treatment of patients with amphotericin B. In cases of AIDS and invasive aspergillosis, early diagnosis may lead to improved outcome. [ABSTRACT FROM PUBLISHER]

Presents a case report of the use of ceftriaxone and minocycline in the treatment of presumptive cerebral Nocardia asteroides. Computed tomography (CT) scan of the brain showing a right frontal lobe abscess with surrounding edema and mass effect; CT scan of the brain obtained after 5 weeks of therapy; Amenability of nocardial brain abscesses in patients with AIDS to medical therapy.

Background: Patients with human immunodeficiency virus (HIV) infection on antiretroviral (ARV) therapy are at increased risk for medication errors during transitions of care between the outpatient and inpatient settings. This can lead to treatment failure or toxicity. Previous studies have emphasized the prevalence of medication errors in such patients, but few have reported initiatives to prevent errors from occurring., Methods: The study was conducted in a 1,400-bed health care center with a state-designated Acquired Immunodeficiency Syndrome (AIDS) Center in the Bronx, New York. The antimicrobial stewardship team and HIV specialists developed customized order-entry sets (COES) to guide ARV prescribing and retrospectively reviewed their effect on error rates of initial ARV orders for inpatients before reconciliation. Patient records were reviewed in six-month periods before and after intervention. The student's t-test or Mann-Whitney U test was used to compare continuous variables; chi-square or Fisher's exact test was used for categorical variables., Results: A total of 723 and 661 admissions were included in the pre-intervention and post-intervention periods, respectively. Overall, error rates decreased by 35% (38.0% to 24.8%, P < 0.01) with COES. Wrong doses and drug interactions decreased by more than 40% (P < 0.005). Error reductions were observed in protease inhibitor (PI)-based (43.6% versus 28.7%, P < 0.01) and non-PI-based (38.0% versus 24.4%, P = 0.02) regimens with COES. A shift in predominant drug-class errors was observed as there was a trend toward increased usage of non-PI regimens post-intervention. Admission in the pre-intervention period (adjusted odds ratio [AOR], 1.79; 95% confidence interval [CI], 1.39-2.31) and use of PI-based regimens (AOR, 2.03; 95% CI, 1.53-2.70) remained significantly associated with ARV prescribing errors after controlling for confounding factors., Conclusion: Detailed COES improved ARV prescribing habits, reduced the potential for prescribing incorrect regimens, and can prove useful and cost-effective where HIV-specific medication reconciliation is unavailable.

A case of a severely immunosuppressed HIV-infected man with meningitis caused by Enterococcus faecalis is presented. E faecalis is a distinctly unusual cause of bacterial meningitis in patients with HIV infection and should be considered in the differential diagnosis of purulent meningitis in such patients to ensure optimal empiric treatment.