Diagnosis and treatment of upper urinary tract calculi complicated with dual infection (report of 3 cases) / 中华泌尿外科杂志

Upper urinary tract calculi combined with dual infections is rare, and the antimicrobial therapy is complicated. This retrospective study analyzed the clinical data of 3 patients with upper urinary tract calculi combined with dual infection who were admitted to our hospital. Three patients were treated with piperacillin sulbactam combined with fluconazole for 1 week, according to the preoperative urine culture and drug sensitivity results. Endoscopic surgery was performed after the efficacy was determined by routine urine examination. After surgery, fluconazole was administered until the removal of the double-J tube for 2 weeks, and fluconazole was discontinued when no white blood cells or fungus were found. No recurrence of stones or infection was observed at a follow-up of 11 months to 2 years. The rational choice of antimicrobial drugs to treat upper urinary tract calculi combined with dual infection could create good conditions for endoscopic surgical intervention, thus achieving satisfactory clinical outcomes.

Analysis on status quo of TB/HIV dual infection screening and diagnosis and treatment management in Guangxi / 重庆医学

Objective To analyze the data of TB/HIV dual infection screening and treatment monitoring in Guangxi during 2010-2015 and to evaluate the prevention and treatment status quo and development trend.Methods The annual monitoring report forms of TB/HIV dual infection during 2010-2015 were collected for deriving the special data of AIDS in corresponding years.Then the data were conducted the comparison and trend analysis.Results The acceptance rates of HIV detection among Guangxi TB patients and the acceptance rate of TB related screening detection in patients with HIV infection/AIDS showed the increasing trend year by year (P＜0.05);the positive detection rate of two-way showed the decreasing trend year by year (P＜0.05).The patients with TB/HIV dual infection were mainly concentrated in the central area of Guangxi.The annual monitoring report table data in annual monitoring TB/HIV dual infection prevention and treatment work trended to be consistent with the twoway registration and screening data in the special report system,but the errors still existed;the rate of receiving anti-TB and anti-viral combined therapy in the patients with TB/HIV dual infection was lower,which was fluctuated from 20％ to 60％;the treatment success rate was still elevated year by year,but which was affected by death,lose and other outcomes.Conclusion The TB/HIV dual epidemic situation has already obtained a certain effect along with comprehensively promoting the dual infection prevention and control work in Guangxi area.

CD4 cell count recovery in HIV/TB co-infected patients versus TB uninfected HIV patients.

Background: There is lack of data comparing the improvement in CD4 count following antitubercular (ATT) and antiretroviral therapy (ART) in patients presenting with Human Immunodeficiency Virus/Tuberculosis (HIV/TB) dual infection compared with CD4 matched cohort of TB uninfected HIV patients initiated on ART. We sought to test the hypothesis; TB additionally contributes to reduction in CD4 count in HIV/TB co-infected patients and this would result in greater improvement in count following treatment compared with CD4 matched TB uninfected individuals. Materials and Methods: In a retrospective cohort study design we studied the change in CD4 cell counts in two groups of patients - those with CD4 cell count >100 cells / mm 3 (Group 1) and <100/mm 3 (Group 2) at presentation. In each group the change in CD4 cell count in dually infected patients following six-month ATT and ART was compared to cohorts of CD4 matched TB uninfected patients initiated on ART. Results: In Group 1 (52 patients) dually infected subjects' CD4 count improved from 150 cells/ mm 3 to 345 cells/mm 3 (P=0.001). In the control TB uninfected patients, the change was from 159 cells/mm 3 to 317 cells/mm 3 (P=0.001). Additional improvement in dually infected patients compared to the control group was not statistically significant (P=0.24). In Group 2 (65 patients) dually infected subjects count improved from 49 cells/mm3 to 249 cells/mm 3 (P=0.001) where as in control TB uninfected patients improvement was from 50 cells/ mm 3 to 205 cells/mm 3 (P=0.001), there being statistically significant additional improvement in dually infected subjects (P=0.01). Conclusion: Greater increment in CD4 counts with ATT and ART in dually infected patients suggests that TB additionally influences the reduction of CD4 counts in HIV patients.

Mycobacterium avium bacteremia and dual infection with mycobacterium avium and mycobacterium wolinskyi in the gut of an aids patient – First case report.

An AIDS patient was admitted to a tertiary care hospital in central India with fever, weight loss, breathlessness, night sweats, diarrhoea, BMI 14kg/m2, Hemoglobin 8gm% and CD4 counts 120 cells/cumm. His blood culture by BACTEC 460 TB system revealed Mycobacterium avium bacteremia and stool culture grew Mycobacterium avium and mycobacterium wolinskyi.

Concurrent Capillaria and Heterakis Infections in Zoo Rock Partridges, Alectoris graeca

Two adult rock partridges raised in a city zoo were examined parasitologically and pathologically. Two distinctive eggs resembling those of Capillaria and Heterakis were detected in the feces. At necropsy, a markedly-dilated duodenum with severe catarrhal exudates, containing adult worms of Capillaria sp. and Heterakis sp. in the cecum, was observed. Male Capillaria had the cloacal aperture extended almost terminally with a small bursal lobe and an unsheathed spicule with transverse folds without spines. Female Capillaria had a vulva that was slightly prominent and slightly posterior to the union of the esophagus and intestine. The esophagus of the adult Capillaria was more than a half as long as the body in the male, but was much shorter in the female. Based on these morphological features, the capillarid nematode was identified as Capillaria obsignata. The male adult worms of Heterakis was identifiable by 2 dissimilar spicules, a unique morphological feature where the right spicule was considerably longer than the left, which is also a characteristic feature of Heterakis gallinarum. This is the first report of concurrent infections with C. obsignata and H. gallinarium in rock partridges.

Experimental evidence for dual infection with two genetically distinguishable mycobacterium tuberculosis strains using a guinea pig model.

Background: Infection with Mycobacterium tuberculosis is thought to be induced by a single strain, and the presence of two strains within the same tuberculosis (TB) patient can rarely be considered. Aims: The present experimental study was done to investigate the phenomenon of mixed infection with the H37Rv and Kurono strains of Mycobacterium tuberculosis, which can be distinguished genetically from each other by IS6110 restriction fragment length polymorphism (RFLP). Methods: The guinea pigs were infected with the two strains simultaneously, or initially with H37Rv or Kurono followed by the other strain seven days later or 30 days later, via the airborne route. Results: Two strains were recognized in individual guinea pigs only when the guinea pigs were infected initially with H37Rv and later infected with Kurono strain. The coinfecting strains were unequally distributed in the lung, liver, spleen and lymph nodes depending on number of the colony-forming unit (CFU) and order of infection. Although pulmonary lesions were diminished significantly (incomplete protection against M. tuberculosis) 7 weeks after guinea pigs were infected with H37Rv initially and with Kurono strain 30days later, Kurono strain was recognized in the lungs and H37Rv was recognized in the liver, spleen and pulmonary hilar lymph nodes. Conclusions: These results suggest that prior exposure with a particular strain may lead to partial protection or altered immunity which affects the subsequent exposure and that multiple infections may not be so rare clinically and occur in high-incidence regions of tuberculosis.