Gastrointestinal opportunistic infections in human immunodeficiency virus disease

Gastrointestinal [GI] opportunistic infections [OIs] are commonly encountered at various stages of human immunodeficiency virus [HIV] disease. In view of the suppressive nature of the virus and the direct contact with the environment, the GI tract is readily accessible and is a common site for clinical expression of HIV. The subject is presented based on information obtained by electronic searches of peer-reviewed articles in medical journals, Cochrane reviews and PubMed sources. The spectrum of GI OIs ranges from oral lesions of Candidiasis, various lesions of viral infections, hepatobiliary lesions, pancreatitis and anorectal lesions. The manifestations of the disease depend on the level of immunosuppression, as determined by the CD4 counts. The advent of highly active antiretroviral therapy has altered the pattern of presentation, resorting mainly to features of antimicrobial-associated colitis and side effects of antiretroviral drugs. The diagnosis of GI OIs in HIV/ acquired immunodeficiency syndrome patients is usually straightforward. However, subtle presentations require that the physicians should have a high index of suspicion when given the setting of HIV infection

Brucellosis: Haemorrhagic pleural effusion. A case report

To describe haemorrhagic pleural effusion as a rare complication of brucellosis that finally needed lung decortication. Clinical Presentation and Intervention: A 37-year-old female presented with a 1-week history of fever, dry cough and pleuritic chest pain. Physical examination showed signs of right pleural effusion and hepatosplenomegaly. Complete blood count showed pancytopenia, white blood cells 2.9/mm3, haemoglobin 10 g/dl, platelets 131/mm3. Chest X-ray confirmed a moderate right pleural effusion, that was found to be exudative biochemically. Culture of pleural fluid and blood grew Brucella species. Fever subsided with Brucella chemotherapy, but pleural effusion persisted. Computed tomographic [CT] chest scan showed a large loculated pleural effusion, which failed to resolve despite repeated aspirations under CT guidance. Fluid was always found to be haemorrhagic. Finally, lung decortication was done with successful outcome. This case showed that brucellosis can cause haemorrhagic pleural effusion that needs lung decortication