ABSTRACT
Objective To investigate the clinical features and prognostic factors in patients with acquired immunodeficiency syndrome (AIDS) and liver abscess.Methods The clinical data of AIDS patients with liver abscess admitted in Beijing You-an Hospital during January 2013 to December 2017 were retrospective analyzed to reveal the clinical manifestations,etiologies,imaging features,therapeutic effects and prognostic factors.T test,x2 test or Fisher exact test were used for statistical analyses.Results A total of 76 patients were recruited.The most common clinical manifestations were fever (72 cases),chills (48 cases),anorexia (42 cases) and abdominal pain (35 cases).Liver abscesses were mainly located in right lobe (57 cases),then in left lobe (11 cases),in both right and left lobes (6 cases) and in caudate lobe (2 cases).Lobulation or division was seen in 19 cases and gas formation was seen in 5 cases.Single abscess was identified in 56 cases.Positive culture results were obtained in 15.5％ (9/58) from liver pus and 6.0％ (4/67) from blood samples.Thirteen strains of pathogens were detected by liver pus culture,including 9 strains of Staphylococcus,3 strains of Candida and 1 strain of Mycobacterium.Six strains of pathogens were detected by blood culture,including 5 strains of Staphylococcus and 1 strain of Corynebacterium.The main complications included acute kidney injury (10 cases) and septic shock (6 cases).Sixty-one cases were treated with antibiotics plus imaging-guided percutaneous aspiration,drainage or surgery,of whom 57 cases were effective.Fifteen cases were treated with antibiotics alone,of whom 12 cases were effective.Septic shock (OR =70.16,95％ CI:4.77-1 032.06,P ＜0.01),respiratory failure (OR =68.41,95％ CI:2.40-1 946.53,P =0.01) and gas formation (OR =23.36,95％ CI:1.30-420.16,P =0.03) were independent risk factors for poor prognosis.Conclusions The clinical features of AIDS patients with liver abscess are uncharacteristic.Bacteria are the main pathogens.Septic shock,respiratory failure and gas formation are independent risk factors for poor prognosis.Imagingguided percutaneous aspiration,drainage combined with antibiotic therapy is safe and effective.
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Objective To investigate the influence of interferon-a therapy on CD8 T memory subsets in patients with chronic hepatitis B(CHB) and correlation between the effect of IFN-α and CD8 T memory subsets. Methods Blood samples from 57 patients with CHB were collected before treatment (0 week), at 12 weeks and 24 weeks of treatment with pegylated IFN-α. Assays were performed on freshly isolated peripheral blood mononuclear cells ( PBMCs). For phenotype analysis, All data were acquired on a flow cytometer instrument and prepared for analysis. Results A significantly higher frequency of CD8+ TEM and lower frequency of CD8+ TCM in inactive HBsAg carriers than that in CHB patients prior to treatment was observed (P <0.05). The proportion of CD8 + TCM was higher in group nonresponders than in group respond-ers, and the proportion of CD8 + TEM was lower in group nonresponders than in group responders (P < 0.05 ). The average dosage of IFN-α applied to patients with response was significantly higher than nonresponders. Conclusion The dominance of circulating effector memory T cells may be associated with elimination of viral infection, and possibly benefit for response to therapy with IFN-α.
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Objective To study the clinical characteristics, the laboratory profile (CD4+ and CD8+ counts and CD4+/CD8+ ratio) and the efficacy of antifungal treatment in HIV/AIDS patients with oropharyngeal candidiasis. Methods Oral lesions were evaluated among 20 HIV/AIDS patients with oropharyngeal candidiasis and the controls who were HIV-negative patients with oropharyngeal candidiasis. Samples were obtained from the lesions for fungal examination by microscopy and culture. The flow cytometry was used for detection of CD4+ and CD8+ counts in peripheral blood. Treatment efficacy of itraconazole was assessed among study group and the control group after treatment for one week, two weeks, at the end of treatment, as well as two weeks after treatment. Results Out of 20 HIV/AIDS patients, 19 were infected with Candida albicans and one with Candida parapsilosis. Six cases had infection on the tongue and 14 on the mucous membrane of oral cavity. CD4+ and CD8+ counts, and CD4/CD8 ratio were 119.40?127.43, 652.50?338.57 and 0.163?0.13, respectively. Mycologic clearance rates were 16.67%, 50.00%, 61.11% and 66.67%, respectively, after treatment with itraconazole for one week, two weeks, at the end of treatment, and two weeks after treatment. Conclusions Oropharyngeal candidiasis is a complication occurred in HIV/AIDS patients, and Candida albicans is the most common pathogen of the infection. The tongue and mucous membrane of oral cavity are usually involved in the patients. The therapeutic efficacy is related to the status of immunity.