RESUMEN
Background: AIDS-related cytomegalovirus (CMV) retinitis is one of the most serious ocular complications in individuals with AIDS. It can progress to blindness, and in some cases, be accompanied by potentially fatal systemic disease.Antiviral compounds including Ganciclovir, Foscarnet and Cidofovir are routinely used in the treatment of CMV infection and disease. However, these agents have a poor oral bioavailability and have the inconvenience and expense of intravenous administration. Aim: The aim of the present study was to evaluate the safety and the effectiveness of oral Valganciclovir in the treatment of CMV retinitis in HIV- infected patients. Methods: A cohort of 12 CMV retinitis patients with HIV was treated with Valganciclovir at the Department of Ophthalmology, JNIMS during the period of Apr 2013 - Mar 2016. The therapy of Valganciclovir was continued until the CMV retinitis was completely inactive, two reports of CD4+ T lymphocyte counts six months apart was > 100 and the patient was on HAART therapy. The clinical profiles of these patients before and after the therapy were compared. Results: On an average the patients received oral Valganciclovir therapy for 9 months. Post- HAART and anti-CMV treatment, Ophthalmology report showed a 1-2 line improvement in Snellens eye chart reading in three patients while among the remaining nine patients, seven had no change in vision and in two patients the eyes went Phthisical and had no perception of light vision (NPL) at the time of last follow up. All the patients had increased CD4 cell counts and remained clinically stable over 8-24 months follow up period. Only minor adverse effects were seen with the treatment. Conclusion: Oral valganciclovir therapy is highly effective for the induction and maintenance of AIDS related CMV retinitis . It’s used significantly improves the quality of life for patients with this disease as it has eliminated the need for chronic intravenous therapy for people with CMV retinitis
RESUMEN
Background: Since the beginning of medical mycology at the turn of the century there has been a continual increase in the discovery of pathogenic fungi. The morbidity and mortality associated with these infections are becoming substantial and is emerging as a public health problem. Determining the rate of infections and determining the emerging pathogen and its potential risk factors will have an important influence on the prevention and control of these fungal diseases. Data regarding these is almost non-existent for the north-eastern part of the country. Aim: The present study was done to study the pattern of fungal infections in the north-eastern India in terms of clinical parameters and required diagnostic techniques. Methods: An observational cross-sectional study was done in which all the patients who attended the Otorhinolaryngology Department of Jawaharlal Nehru Institute of Medical Sciences,Imphal during the period of August 2015 to July 2017 with features suggestive of fungal infections were included. The exclusion criteria consisted of patients suffering from malignancies and receiving radiotherapy or chemotherapy. A detailed history was taken by using a structured, open interview schedule which had sections on socio-demography and case-history. Then, all the patients were given a thorough clinical examination followed by routine laboratory investigations, radiological examination and endoscopic examination wherever indicated. Further, the study subjects underwent mycological investigations. Data collected were analysed and presented descriptively. Results & Conclusion: 80 eligible study-subjects participated in the study (58 ear, 15 throat and 7 nose & PNS cases). Otomycosis was found to be more common in the 2nd to 3rd decades of life (56.9%) and aspergillosis of nose & PNS being more common in the 2nd decade of life (42.85%) whereas oral and oropharyngeal candidiasis was more common in older age-groups (40%). In the overall, there was a male preponderance (M:F=1.15:1). Otomycosis which was mainly due to infection with A. niger had a definite relation with warm and humid climatic condition. A. fumigatus was responsible for majority of nose & PNS infections while C. albicans was the commonest fungus responsible for fungal infection of the throat.