ABSTRACT
Histoplasma capsulatum es un hongo dismórfico de distribución geográfica, que reside en la tierra. Su presencia se favorece en la deposición de pájaros y murciélagos. La infección en humanos es por inhalación de un alto inóculo de esporas. Se presenta el curso clínico de un paciente de 43 años, inmunocompetente, geólogo, quien adquirió la infección al recorrer minas subterráneas en Centroamérica y Perú. El 90 por ciento de las infecciones por Histoplasma spp son asintomáticas, el resto cursa con infección pulmonar o diseminada, aguda o crónica. Su diagnóstico se basa en tests de reacción cutánea, detección de antígenos en sangre u orina, visión directa del agente en muestras clínicas y cultivo. Estos pacientes deben ser tratados con itraconazol o anfotericina B, de acuerdo a la gravedad clínica
Subject(s)
Humans , Male , Adult , Histoplasmosis , Lung Diseases, Fungal , HistoplasmaABSTRACT
Se presenta el caso de una paciente boliviana quien acude con el diagnóstico de una osteomielitis de cadera, décima costilla y techo del etmoides, posiblemente secundario a una infección por bacterias anaerobias. Se revisa la evolución y tratamiento y se efectúa una revisión de las etiologías infectológicas que podrían explicar un cuadro de estas características
Subject(s)
Humans , Female , Adolescent , Osteomyelitis , Sinusitis , Drainage , Hip , Anti-Bacterial Agents/therapeutic use , Osteolysis/microbiologyABSTRACT
We report two male patients with AlDS, aged 23 and 30 years old respectively. One was admitted due to a progressive weakness of the left leg and urinary and fecal incontinence. The other was admitted due to a progressive paraparesia without incontinence, but with a severe lumbar pain. In both patients polymerase chain reactions for cytomegalovirus in cerebrospinal fluid were positive. Treatment with ganciclovir, for 21 and 14 days respectively and highly active antiretroviral therapy was started. Both patients experienced recovery of their neurological deficits after 98 and 88 days of therapy, respectively
Subject(s)
Humans , Male , Adult , Polyradiculopathy , AIDS-Related Opportunistic Infections , Paresis , Polyradiculopathy , Ganciclovir , AIDS-Related Opportunistic Infections , Cytomegalovirus InfectionsABSTRACT
Type B lactic acidosis occurs without any evidence of cellular hypoxia and is associated with the use of drugs or toxins. We report a 36 years old woman with acquired immunodeficiency syndrome that was admitted to the hospital with a severe lactic acidosis. She had been treated with didanosine, stavudine and efavirenz for four months prior to admission. Despite the use of high bicarbonate doses and vasoactive drugs, the patient had a catastrophic evolution and died in shock and multiple organ failure, 68 hours after admission
Subject(s)
Humans , Female , Adult , Anti-HIV Agents/adverse effects , Acidosis, Lactic/chemically induced , Acquired Immunodeficiency Syndrome/complications , Antiviral Agents/pharmacology , Didanosine/adverse effects , Stavudine/adverse effects , Anti-HIV Agents/pharmacology , Lactic Acid/biosynthesis , Lactic Acid/metabolism , Acidosis, Lactic/diagnosis , Acidosis, Lactic/drug therapy , Acquired Immunodeficiency Syndrome/drug therapyABSTRACT
Objetivo: Evaluar la eficacia y seguridad de las inyecciones intravítreas de ganciclovir en el tratamiento de mantención de la retinitis por citomegalovirus en pacientes con SIDA. Método: Entre 1995 y 1997 se administraron 319 inyecciones intravítreas de 200 ug de ganciclovir a los 13 ojos de 10 pacientes. Se efectuó un tratamiento de inducción de 2 semanas con ganciclovir intravenoso, seguido de inyecciones intravítreas semanales. Resultados: Se obtuvo estabilización de la retinitis con inyecciones consecutivas en todos los ojos. De los 13 ojos, 2 desarrollaron desprendimiento de retina (15,3 por ciento), uno asociado a un desgarro periférico y el otro sin agujeros visibles. Un ojo desarrolló endoftalmitis (7,6 por ciento). No se observó hemorragia vítrea. La agudeza visual inicial se mantuvo o mejoró en 11 ojos (84,6 por ciento). Conclusiones: Las inyecciones intravítreas de ganciclovir son efectivas para suprimir la retinitis por CMV y para prevenir las recurrencias. Aunque pueden ocurrir complicaciones severas, la visión generalmente se conserva
Subject(s)
Humans , Male , Adult , Female , AIDS-Related Opportunistic Infections , Cytomegalovirus Retinitis , Ganciclovir , AIDS-Related Opportunistic Infections , Cytomegalovirus Retinitis , Endophthalmitis , Ganciclovir , Ocular Hypertension/etiology , Retinal DetachmentSubject(s)
Humans , Candidiasis/etiology , Multiple Organ Failure/nursing , Systemic Inflammatory Response Syndrome/nursing , Candidiasis/diagnosis , Candidiasis/drug therapy , Diarrhea/physiopathology , Critical Illness/therapy , Ethics, Medical , Cross Infection/etiology , Cross Infection/drug therapy , Intensive Care Units , Internet , PrognosisABSTRACT
Background: Resistance of HIV to AZT is the result of mutations in the pol gene that codifies the enzyme reverse transcriptase. Aim: To asses the resistance to antiretroviral drugs in Chhilean patients infected with HIV. Material and methods: The presence of mutations was searched in 22 patients infected with HIV. The emergence or persistence of these mutations was studiend in sequential samples of 19 patients. The presence of the mutation that confers resistance to didanosine (ddi) was studied in those subjects exposed to the drug. Polymerase chain reaction techniques were used to analyze mutations in codons 41, 70 and 215 of the pol gene (resistance to AZT) and the mutation in codon 71 (resistance to DDI). Results: On admission, none of the patients without previous exposure to AZT had drug resistance mutations. Seven of 12 patients (58.3 percent) that had received AZT had mutations in codon 215. In two, they were associated to a mutation in codon 41 and in two, to a mutation in codon 70. After a mean follow up of 14 months, 13 of 15 patients (86 percent) that received AZT had viral strains genotypically resistant to the drug. In nine of these, the resistance was associated with disease progression. None of the 10 patients that received DDI had the mutation in codon 74 that confers resistance to the drug. However, in one of these patients, that never receided AZT, virus with a mutation in codon 215 was detected. Conclusions: A high percentage of patients that have received monotheraphy with AZT have genotypic resistance to the drug. This resistance is associated with clinical and immunological derangement in 70 percent of these subjects
Subject(s)
Humans , Drug Resistance/immunology , Zidovudine/pharmacokinetics , HIV Infections/drug therapy , HIV/drug effects , Codon/genetics , Zidovudine/immunology , Didanosine/immunology , CD4 Lymphocyte Count , Immunity, Innate/physiology , DNA Mutational Analysis/methodsABSTRACT
We characterized clinical manifestations and the risk to develop AIDS in a cohort of 32 patients infected with human immunodeficiency virus without AIDS. A multivariate analysis was performed to determine association between the progression of infection and control variables (socioeconomic level, age, sex and sexual preferences) and causal variables (psychosocial changes, significant clinical events, stress scoring and sexual activity). The cumulative AIDS incidence, defined as CD4 lymphocyte count below 200 cells/cmü was 50 percent at 6.5 years and 82 percent at 8 years. Using clinical criteria to define AIDS, 50 percent developed tha disease at 8 years of follow up. Among studied factors, only age (faster progression at higher age) and time of evolution were associated with progression. In stages before AIDS, the most frequent diseases were acute diarrhea, sexual transmission diseases, oral candidiasis, sinusitis and varicella zoster infections. The reduction of CD4 lymphocytes below 200 cells/cmü always preceded the symptoms of the disease. Two patients have remained more than eight years without clinical or immunological deterioration
Subject(s)
Humans , Male , Female , Adult , Adolescent , Middle Aged , HIV Infections/epidemiology , Natural History of Diseases , Cohort Studies , AIDS-Related Opportunistic Infections/epidemiology , Disease-Free Survival , Substance-Related Disorders/epidemiology , Survival Analysis , Acquired Immunodeficiency Syndrome/epidemiologySubject(s)
Humans , Male , Female , Adult , Pneumonia/drug therapy , Anti-Bacterial Agents/therapeutic use , Chlamydophila pneumoniae/drug effects , Chlamydophila psittaci/drug effects , Legionella pneumophila/drug effects , Mycoplasma pneumoniae/drug effects , Quinolones/therapeutic use , Tetracycline/therapeutic useABSTRACT
Nocardia asteroide infections, an aerobic actinomycete, have several forms and lungs, skin and brain are the organs most frequently involved. When the infection suspected, special staining methods must be ordered to identify the agent. We report three immunocompetent patients with disseminated nocardiosis, 2 presenting with nodular lesions of skin and lungs and one presenting with pulmonary involvement and brain abscesses. The importance of clinical suspicion and early diagnosis of nocardiosis is emphasized
Subject(s)
Humans , Male , Female , Adolescent , Adult , Immunocompetence/physiology , Nocardia Infections/diagnosis , Nocardia asteroides/pathogenicity , Tomography, X-Ray Computed/methodsABSTRACT
La tuberculosis es una enfermedad de alta prevalencia. Sería de gran utilidad disponer de un método serológico principalmente en los casos que son positivos sólo por cultivo que demora 30 a 60 días. El inconveniente de la serología radica en la interpretación de los resultados, por lo que se requiere una cuidadosa evaluación de la utilidad clínica del test en un área determinada. Con el objetivo de implementar y determinar la utilidad clínica del diagnóstico serológico de TBC, se estudiaron los sueros de 101 pacientes divididos en 4 grupos; grupo 1: 26 controles sanos, grupo 2: 25 pacientes con patología pulmonar no TBC, grupo 3: 27 tuberculosos baciloscopia (+) y grupo 4: 2 tuberculosos sólo cultivo (+). Se determinó IgG, IgM y IgA anti antígeno A60 por un ELISA indirecto cenocial. Se calculó para cada suero la sumatoria de las 3 clases de inmunoglobulinas y se estableció un punto de corte de 0,45 absorvancia. La sensibilidad para grupo 4 fue de 78 por ciento y la específidad para grupo 2 fue de 88 por ciento. Con estos resultados la aplicación del test como screening de TBC resulta no recomendable con un alto número de falsos (+) que lleva a tratamientos prolongados e innecesarios. En cambio, el test sería de gran utilidad si se emplea en pacientes hospitalizados, en los que se descarten patologías de diagnóstico diferencial de TBC (cáncer, neumonías, cavitarias, etc). A medida que se va descartando otras patologías, (probabilidad pre-test) va aumentando con lo cual el valor predictivo positivo del examen mejora significativamente: si la probabilidad pre-test es 0,3, el valor predictivo positivo es de 74 por ciento y si la probabilidad pre-test es de 0,7, el valor predictivo positivo aumenta a 94 por ciento. En conclusión, el test de ELISA anti-antígeno A60 sería de gran utilidad como otro elemento de apoyo en pacientes con alta probabilidad clínica de TBC y microbiología negativa