ABSTRACT
La coinfección entre el virus de la inmunodeficiencia humana (VIH) y la Leishmaniosis visceral (LV) ha sido descripta de manera reciente, en especial en Brasil y en ciertas áreas de la Europa del Mediterráneo. Los pacientes VIH positivos con fiebre de origen desconocido y/o citopenias tienen indicación de punción aspirativa de médula ósea para estudios microbiológicos e histopatológicos, estos últimos para descartar un síndrome linfoproliferativo. El diagnóstico de leishmaniosis visceral puede confirmarse por diversas técnicas microbiológicas y serológicas: detección de amastigotes de Leishmania en aspirados de médula ósea con tinción de Giemsa, detección de anticuerpos por aglutinación directa, inmunofluorescencia indirecta, detección del antígeno rK39, reacción en cadena de la polimerasa en extendidos de médula ósea y prueba de aglutinación del látex. La LV puede ser la primera manifestación del sida o ser una complicación grave en pacientes ya diagnosticados con VIH e inmunodeficiencia severa. La LV es una complicación grave y potencialmente fatal y debe sospecharse en todo sujeto VIH positivo con fiebre de etiología desconocida y/o citopenias.
The association between visceral leishmaniasis (VL) and HIV is recent and has an increasing number of cases in Brazil and worldwide - especially in the Mediterranean region of Europe. HIV patients with cytopenias and/or fever of an unknown etiology, have indication of bone marrow aspirate for microbiological cultures and histopathological examination to rule out lymphoproliferative disorders. Diagnosis of VL can be confirmed by the following examinations: Leishmania amastigotes detection in bone marrow aspirate with Giemsa smear, direct agglutination test, indirect immunofluorescence, rK39 dipstick test, polymerase chain reaction and latex agglutination test. VL may be the first infection related with HIV or patients can be diagnosed with VL concomitantly with AIDS. HIV/AIDS-associated VL is an aggressive complication with a potentially fatal evolution in advanced HIV/AIDS patients, without specific symptoms, that should be suspected in all HIV subjects with fever of unknown etiology and cytopenias.
Subject(s)
Humans , Male , Middle Aged , AIDS Serodiagnosis , Leishmaniasis/complications , Punctures , HIV Infections/complications , Endemic Diseases , Leishmaniasis, Visceral/diagnosisABSTRACT
Se presenta un paciente con enfermedad VIH/SIDA avanzada, que desarrolló un cuadro de angiomatosis bacilar por Bartonella henselae, con manifestaciones cutáneas, mucosas, sistémicas y que respondió favorablemente al tratamiento con antibióticos más la terapia antirretroviral.
We report a case of a patient with advanced HIV/AIDS disease who developed a bacillary angiomatosis due to Bartonella henselae with cutaneous, mucosae, systemic compromise and a good response to the antimicrobial therapy plus highly active antiretroviral therapy.
ABSTRACT
We conducted a retrospective evaluation to determine the clinical and microbiological characteristics of 61 episodes of infective endocarditis (IE) in intravenous drug abusers (IDA), HIV seropositive patients. Forty-nine males and 6 females between 15 and 42 years of age were included in the study. All the included patients presented 61 episodes of IE. Fever and cardiac murmur were present in all episodes; 43 (70.4
) presented cough (9 with hemoptysis); 25 (41
) had dyspnea, and 5 (8.2
) had jugular ingurgitation. Fundoscopy showed alterations in 3 patients (4.9
). Bacteriological confirmation was obtained in 41 episodes (67.2
); blood cultures revealed Staphylococcus aureus in 30 cases (73.1
), Streptococcus viridans in 8 (19.5
) patients, Staphylococcus epidermidis in 1 (2.4
), Staphylococcus hominis in 1 (2.4
) and Streptococcus pneumoniae in one case (2.4
). The tricuspid valve was involved in 51 episodes (83.6
), the aorta in 6 (9.8
), the mitral valve in 3 (4.9
) and the pulmonary valve in one (1.6
). There was evidence of right bivalvular involvement in 2 patients (3.2
) and tricuspid and mitral involvement in another (1.6
). Pericardial effusion was detected in 19 episodes (31.1
) died during the acute episode of IE.
ABSTRACT
In the context of HIV infection, cryptococcal meningitis is the most common mycosis threatening the patient's life. We conducted a retrospective evaluation to determine the epidemiological, microbiological, immunological and clinical characteristics of disseminated cryptococcosis in 51 hospitalised HIV seropositive patients. All the individuals (n = 51) presented reactive serology for HIV (ELISA and/or Western blot) and none fulfilled strict HAART treatment, previous to the opportunistic infection. CD4+ lymphocyte T counts showed levels between 361 and 0 cells/microliter (mean = 45). All patients but one had counts lower than 100 cells/microliter. Cryptococcosis presented as unique episode in 35 patients (68.6) and in 16 as relapse (31.3). In all of them we detected central nervous system involvement. The induction treatment was carried out with amphotericin B (AMB), continued with maintenance therapy with fluconazole. Lethality rate was 36.7, slightly superior among patients in relapse (40) compared to those who presented a first episode of the mycosis (35.2). In those individuals for whom data were available, 65.2 of blood cultures, 94.1 of CSF cultures and 79.06 of microscopic CSF examination with India ink were positive. Titers of Cryptococcus neoformans capsular antigen in CSF > or = 1/1000 were found in 36.1 and > or = 1/1000 in 73.6 of serum samples. In conclusion, manifestations and severity of disseminated cryptococcosis continue maintaining the characteristics of half a decade behind, in those patients who are not treated with HAART. Neurological involvement existed in all patients of this cohort. Treatment is not able to modify the parameters of mortality seen in previous communications. Diagnostic methods applied in this study are in accordance with those in the bibliography.
Subject(s)
Humans , Male , Adult , Middle Aged , Cryptococcosis , AIDS-Related Opportunistic Infections/epidemiology , Acute Disease , Amphotericin B , Antigens, Fungal/blood , Antigens, Fungal/cerebrospinal fluid , Antifungal Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Argentina , Cryptococcosis , Cryptococcus neoformans , Fluconazole , HIV Antibodies , HIV-1 , AIDS-Related Opportunistic Infections/immunology , AIDS-Related Opportunistic Infections/microbiology , Inpatients , Meningitis, Cryptococcal/cerebrospinal fluid , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/epidemiology , Meningitis, Cryptococcal/immunology , Meningitis, Cryptococcal/microbiology , Recurrence , Retrospective StudiesABSTRACT
El Strongyloides stercoralis es un nematelminto de distribución universal, que en pacientes con alteraciones de la respuesta inmune celular, puede provocar infecciones diseminadas graves. Las formas extraintestinales de la estrongiloidosis han sido publicadas con poca frecuencia, a pesar de la elevada prevalencia de infección por este parásito en áreas de clima tropical y en países en vías de desarrollo. Existen escasas publicaciones en pacientes con SIDA. La mayoría de los casos presentan compromiso gastrointestinal, respiratorio, cutáneo y del SNC. La radiografía de tóraz revela la existencia de infiltrados intersticiales difusos. El diagnóstico se confirma por el hallazgo de las larvas rhabditoides en las materias fecales o en el esputo e incluso en el LCR. Con frecuencia, las infecciones diseminadas por este helminto se asocian con septicemias o meningitis causadas por bacilos gram negativos, especialmente Escherichia coli. Presentamos 2 casos de estrongiloidosis diseminada en pacientes con SIDA con hallazgo de larvas en materias fecales y esputo.