Neurosyphilis with Ocular Involvement in a patient with newly diagnosed Human Immunodeficiency Virus (HIV) Infection: A case report

Introduction@#Syphilis is a chronic systemic infection caused by Treponema pallidum sub-species pallidum. Syphilis, by itself, already has a varied clinical presentation depending on the stage, earning its moniker as “the great imitator”. In a patient without HIV infection, untreated syphilis presents as a chronic infection with primary, secondary, latent, and tertiary stages. With the emergence of the AIDS pandemic, HIV co infection may significantly alter the clinical presentation of syphilis. This is a case of a patient with neurosyphilis with overlapping primary and secondary syphilis.@*Case Presentation@#This is a case of a 34-year-old Filipino male who came in due to blurring of vision. The patient’s illness started six months prior to admission, when he noted the appearance of a painless, non-pruritic, solitary ulcer with erosions on his penis. A month after, he started to have progressive blurring of vision. In the interim, erythematous, scaly plaques appeared on the dorsal aspect of both hands and feet, and on the tip of the nose, with associated thinning of hair on the scalp and eyebrows. The skin and penile lesions eventually increased in size and number. The examination of the pupils showed a 6 mm right pupil, non-reactive to light, and a 2 mm left pupil which was minimally reactive to light and constricts upon accommodation. The diagnosis of syphilis was confirmed by a reactive serum Rapid Plasma Reagin at 1:64 dilution, and a reactive serum Treponemal Enzyme Immunoassay. HIV screening was also reactive, with a CD4+ cell count of 15 cells/μL. Ophthalmologic findings were consistent with panuveitis. Skin punch biopsy revealed lichenoid and interstitial dermatitis with which syphilis was highly considered. Cranial CT imaging showed mild cerebral atrophy. Lumbar tap revealed a colorless, clear cerebrospinal fluid, with lymphocytic pleocytosis, normal protein, decreased glucose, and a reactive CSF RPR. The patient was given intravenous penicillin G 3 million units every 4 hours for 14 days, together with ophthalmic medications (prednisolone, levofloxacin, and atropine ophthalmic drops). He was also started on antiretroviral therapy. Prior to discharge, the patient was noted to have improved vision, skin lesions were significantly improved, and he was advised for close monitoring as outpatient.@*Conclusion@#Through this case, it was elaborated that with HIV co-infection, syphilis may present atypically—with multiple, persistent, primary lesions; with overlapping of the stages, and increased frequency of neurosyphilis presenting early into the infection.

Multicenter study of Candida species in oral mucosa of different patients: analysis of 711 strains and literature review

This study aimed to identify Candida spp. collected from oral mucosa and maintained in culture collections, correlating the findings with the medical history of patients and comparing with data from the literature over the past five years. Seven hundred and eleven oral Candida spp. isolates, collected between 2013 and 2017, were selected and identified using traditional and molecular methods. In addition, a literature review was performed with the key words: "Oral", "Candida" and "Yeast". Seven species of the genus Candida: were identified C. albicans(73.3%); C. tropicalis (9.3%); C. parapsilosis (8.2%); C. glabrata (3.9%); C. guilliermondii(2.8%); C. krusei (1.7%) and C. lusitaniae (0.3%). The strains identified as C. albicans were submitted to molecular methods using specific primers and of these, 5.8% were identified as C. dubliniensis strains. The greatest diversity of strains was found in patients presenting no systemic diseases or HIV +, while the highest percentage of strains of Candidanon-albicanswere observed in cancer patients. This study reports a representative distribution of Candidaspecies among individuals exhibiting distinct clinical conditions, in order to contribute to the design of future research on details of aspects involved in the infections caused by these microorganisms. The correct identification of oral Candida strains contributes to a realistic epidemiological approach and future clinical protocols against these pathogens

Improving survival with tuberculosis & HIV treatment integration: A mini-review

Tuberculosis (TB) is a leading cause of morbidity and mortality among HIV-infected patients while HIV remains a key risk factor for the development of active TB infection. Treatment integration is a key in reducing mortality in patients with HIV-TB co-infection. However, this opportunity to improve outcomes of both infections is often missed or poorly implemented. Challenges in TB-HIV treatment integration range from complexities involving clinical management of co-infected patients to obstacles in health service-organization and prioritization. This is evident in high prevalence settings such as in sub-Saharan Africa where TB-HIV co-infection rates reach up to 80 per cent. This review discusses published literature on clinical trials and cohort studies of strategies for TB-HIV treatment integration aimed at reducing co-infection mortality. Studies published since 2009, when several treatment guidelines recommended treatment integration, were included. A total of 43 articles were identified, of which a total of 23 observational studies and nine clinical trials were informative on TB-HIV treatment integration. The data show that the survival benefit of AIDS therapy in patients infected with TB can be maximized among patients with advanced immunosuppression by starting antiretroviral therapy (ART) soon after TB treatment initiation, i.e. in patients with CD4+ cell counts <50 cells/?l. However, patients with greater CD4+ cell counts should defer initiation of ART to no less than eight weeks after initiation of TB treatment to reduce the occurrence and extent of immune reconstitution disease and subsequent hospitalization. Addressing operational challenges in integrating TB-HIV care can significantly improve patient outcomes, generate substantial public health impact by decreasing morbidity and death in settings with a high burden of HIV and TB.

Accelerated decline in anti-HCV antibody levels in spontaneous HCV seroconverters with HIV co-in-fection / 中华微生物学和免疫学杂志

Objective To investigate the influence on anti-HCV antibody levels in spontaneous HCV seroconverters co-infected with HIV. Methods A retrospective study was conducted on people with a history of blood donation in Wangying Village,Shangcai County,Henan Province in 2009 and 2017. Accord-ing to the infection status in 2009,patients who were positive for anti-HCV antibody were divided into four groups:HIV-negative chronic HCV infection group (HCVc),HIV-negative spontaneous HCV clearance group (HCVr),HIV-positive chronic HCV infection group (HIV+HCVc),HIV-positive spontaneous HCV clear-ance group ( HIV+HCVr). All patients were followed up in 2017 and those who were lost to follow-up, received HCV treatment or were reinfected with HCV (only for those of HCV seroconverters) were excluded from this study. Altogether 167 patients met the inclusion criteria (HCVc:n=65;HCVr:n=34;HIV+HCVc:n=44;HIV+HCVr:n=24). A horizontal comparison of anti-HCV antibody levels among the above four groups in 2009 and a longitudinal comparison of changes in anti-HCV antibody in each group from 2009 to 2017 were respectively conducted. Results The horizontal comparison indicated that the levels of anti-HCV antibody were higher in chronic HCV-infected patients than in HCV seroconverters no matter whether they were co-infected with HIV or not (both P<0. 000 1). After comparison of anti-HCV antibody titers in 2017 and 2009,no significant changes were found in HCVc or HIV+HCVc group. The levels of anti-HCV antibody in HCVr and HIV+HCVr groups decreased significantly from 2009 to 2017 ( both P<0. 000 1). HIV+HCVr group showed a faster decline in anti-HCV antibody level than HCVr group (P=0. 003 9). Significant nega-tive correlations between the decline speed in anti-HCV antibody sample/cut-off ( S/CO) values and the initial anti-HCV antibody S/CO values (in 2009) were found in both HCVr (r=-0. 517 7, P=0. 001 7) and HIV+HCVr groups (r=-0. 753 2, P<0. 000 1). The decline speed in anti-HCV antibody in HIV+HCVr patients was found to be negatively correlated with their CD4+T cell counts in 2009 ( r=-0. 563 8, P=0. 004 1). Moreover,the seroreversion rate of anti-HCV antibody in patients of the HIV+HCVr group was higher than that of HCVr group (P=0. 027 5). Conclusion HIV co-infection can accelerate the decline of anti-HCV antibody in spontaneous HCV seroconverters. This study indicates that in a large-scale retrospective epidemiological investigation especially for HIV-infected populations, the prevalence of anti-HCV antibody may be underestimated.

Leishmaniasis in a patient with HIV co‑infection: Diagnosis on fine needle aspiration cytology.

Leishmaniasis is a vector borne parasitic disease caused by obligate intracellular protozoa Leishmania and is transmitted by the bite of sand fly. The disease typically presents in visceral, cutaneous and mucocutaneous forms and is endemic in some states of India. Cases with atypical presentation are seen when patient has co- infection with HIV. We report a case of Leishmaniasis occurring in a HIV seropositive expectant mother diagnosed initially on fine needle aspiration cytology. The patient was resident of non endemic area and had presented with isolated cervical lymphadenopathy and fever without spleenomegaly. Characteristic morphological features of Leishmania seen in the fine needle aspiration smears from the neck nodes were identified and definitive diagnosis of Leishmaniasis could be given. Cytological features were not suggestive of any other disease. Timely diagnosis of the disease facilitated proper management in our patient.

Chest Radiograhic Patterns of Smear Positive Tuberculosis in Relation to HIV: A Cross-Sectional Study in a Population with a High Burden of HIV and Tuberculosis.

Aim: The purpose of this study was to investigate the chest radiographic patterns of smear positive pulmonary tuberculosis patients in relation to HIV co-infection. Study Deign: Cross-sectional descriptive study Place and Duration of the Study: The study was conducted at Gondar University hospital between May 2004–December 2007. Methodology: We studied chest radiographs of 207 (128 HIV negative and 79 HIV positive) consecutive sputum smear positive pulmonary tuberculosis patients according to the standard classification. Mean and percentages/ proportions were used for descriptive analysis. Chi square test was used to measure association. Results: The prevalence of HIV in patients with smear positive pulmonary tuberculosis was 38.2%. The most common chest radiographic patterns were fibronodular (83.1%), cavity (60.4%), lobar consolidation (49.8%), and brochopnemonic consolidation (9.2%). Lymphadenopthy and pleural effusion were more common in HIV co infected patients (p<0.01). Cavities, upper lobe disease and increased mean number of lung lobes involved were more prominent in HIV negative patients (P<0.05). Despite a higher rate of patients with far advanced CXR patterns in HIV negative TBC patients compared to HIV positive (p<0.026), there was no significant difference in the radiographic, sputum smear conversion or clinical response in terms of increased body mass index after 8 weeks of anti TBC treatment between HIV negative and HIV positive patients. Conclusion: Post primary pulmonary tuberculosis was the commonest chest radiographic pattern at presentation in both HIV positive and HIV negative patients, but atypical chest radiographic presentations were associated with co-infection. It was more common for HIV negative tuberculosis patients to have a radiologically far advanced pattern which did not correspond to the clinical and radiological response. This may prompt a need for revision of the current radiological classification.

High magnitude of diabetes mellitus among Active Pulmonary Tuberculosis Patients in Ethiopia.

Aim: The main aim of this study was to determine the prevalence of diabetes mellitus in patients with active pulmonary tuberculosis at the University of Gondar Teaching Referral Hospital, northwest Ethiopia. Study Design: A cross-sectional hospital-based study was performed using the WHO structured diabetic assessment protocol. Place and Duration: The study included all active pulmonary tuberculosis patients visiting the University of Gondar Teaching Referral Hospital during the study period (October 2011 to November, 2012). Methodology: We included 199 consecutive active pulmonary tuberculosis patients; 117 of these were male and 108 were urban dwellers. Analyses of fasting blood glucose level were carried out using blood samples collected by finger puncture. For testing significance, categorical data were compared using a chi-square test and expressed as proportion with a 95% confidence interval. Result: The prevalence of diabetes was found to be 8.5 % [95%CI: 4.6– 12.5], which was higher (11.1%) among male than female participants (4.9%). Likewise, 10.2% of the patients were from urban and 6.6% from rural areas. The proportion of newly diagnosed diabetic cases was 52.9%, and all of them were between 25-44 years of age. The Prevalence of impaired fasting glucose was 29.6%. The prevalence of HIV co-infection in the study population was 28.6% [95%CI: 22.3 34.9] and Diabetes was 4 times higher among HIV co-infected patients than among HIV-negative tuberculosis patients. Of all patients with active tuberculosis, 146 (73.7%) were sputum smear negative for acid fast bacilli. The proportion of diabetes was 9.6% among smear positive and 8.2% among smear negative cases. Conclusion: The prevalence of diabetes mellitus and pre-diabetes among active pulmonary tuberculosis cases was higher compared to the published prevalence of DM in the general population. Therefore, it is important to implement an active case detection of diabetes among tuberculosis patients.

Presentation of tuberculosis in TB-HIV co-infection patients and the treatment outcome with directly observed short course therapy

Objective:To investigate different presentations of tuberculosis in HIV positive patients and their treatment outcome with directly observed short course therapy (DOTS). Methods: All patients having tuberculosis-HIV (TB-HIV) co-infection were taken. Different manifestations of tuberculosis in HIV positive patients were analyzed. Outcome of the treatment was observed in 14 patients. The rest of the patients were either transferred to other districts or still continuing their DOTS therapy according to the revised national tuberculosis control programme (RNTCP). Results:A total of 901 patients were diagnosed as tuberculosis. Out of these, 227 had positive pulmonary tuberculosis smear, 212 had negative smear and 462 had extra pulmonary tuberculosis. A total of 65 patients suffered from TB-HIV co-infection (7%). Result showed that the incidence of TB-HIV coinfection was the highest in productive age group of 16-45 years old (75%). Treatment completion rate was only 57%and the rate was higher in extra pulmonary tuberculosis patients (83%). Out of 4 sputum positive cases, 3 were declared cured (75%). Conclusions:TB-HIV co-infection in wardha (Cental India) is around 7%. Pattern of tuberculosis in HIV positive patient is the same as in HIV negative patient. Pattern of extra-pulmonary tuberculosis in HIV positive patients is mainly in form of tubercular lymphadenitis and pleural effusion. DOTS is the best modality of treatment of tuberculosis.

Estudo clínico-molecular na leishmaniose mucocutânea: diagnóstico e rastreamento de subpopulações de leishmania (Viannia) braziliensis nos níveis inter e intrapacientes / Clinical and molecular study in mucocutaneous leishmaniasis: Diagnoses and screening of subpopulation of leishmania (Viannia) braziliensis in the inter and intrapatient levels

O presente estudo teve como principal objetivo avaliar a diversidade genética de Leishmania (Viannia) braziliensis nos níveis inter e intrapacientes, diretamente em lesões cutâneas e mucosas de indivíduos com leishmanioses mucocutânea (LMC), disseminada (LD) e mucosa (LM), incluindo indivíduos coinfectados pelo vírus da imunodeficiência humana (HIV). Um total de 61 amostras procedentes de 38 pacientes foi analisado pelas técnicas da reação em cadeia da polimerase (PCR), da reação em cadeia da polimerase com primer único em condições de baixa estringência (LSSP-PCR) e da análise fenética, tendo como alvo molecular a região variável do minicírculo do DNA do cinetoplasto (kDNA). Neste estudo, predominaram indivíduos do sexo masculino e com acometimento mucoso nasal. A presença de DNA do parasita foi evidenciada pela banda diagnóstica de 750 pb, em todas as amostras analisadas, possibilitando o diagnóstico específico. Na investigação do perfil genotípico de subpopulações de L. (V.) braziliensis, através da LSSP-PCR, foi revelado o polimorfismo genético intrafragmento traduzido como uma assinatura do kDNA do parasito para cada amostra. Assinaturas de kDNAs similares em amostras de paciente coletadas ao mesmo tempo (mucosa oral e nasal), e a divergência nos perfis genéticos em amostras coletadas em tempos diferentes na mesma localização (mucosa nasal) sugerem a clonalidade do inóculo inicial, como consequência da estrutura populacional clonal de Leishmania. No estudo da variabilidade genética de L. (V.) braziliensis nos níveis inter e intrapacientes foram evidenciadas similaridades genotípicas entre as amostras de lesões cutânea e mucosa intrapacientes. As análises fenética e estatística possibilitaram afirmar que a diversidade genética no nível intrapacientes é menor do que a observada entre os pacientes...

The present study has as its main objective to evaluate the genetic diversity of Leishmania(Viannia) braziliensis in the inter and intrapatient levels, directly from cutaneous and mucosallesions of individuals with mucocutaneous (MCL), disseminated (DL) and mucosal (ML)leishmaniasis, including individuals with the human immunodeficiency virus (HIV) infection.A total of 61 samples recovered from 38 patients was analyzed by the techniques ofpolymerase chain reaction (PCR), low-stringency single-specific-primer PCR (LSSP-PCR)and phenetic analysis, directed to the variable region of the kinetoplast DNA (kDNA)minicircles. In this study, male individuals with nasal mucosa involvement predominated. Thepresence of the parasite’s DNA was revealed by the diagnosis band of 750 bp, in all analyzedsamples, making the specific diagnosis possible. In the investigation of the genotypic profileof the subpopulations of L. (V.) braziliensis, through LSSP-PCR, it was revealed theintrafragment genetic polymorphism translated as a kDNA signature for each sample. SimilarkDNAs signatures in patient’s samples collected simultaneously (oral and nasal mucosa), andthe divergence in the genetic profiles in samples collected at different times on the samelocation (nasal mucosa) suggest the clonality of the initial inoculum, as a consequence of theclonal population structure of Leishmania. In the study of the genetic variability of L. (V.)braziliensis in the inter and intrapatient levels, genotypic similarities were observed amongthe cutaneous and mucosal lesions intrapatients...

Malaria infection in HIV/AIDS patients and its correlation with packed cell volume (PCV).

Background & objectives: The study was designed: (i) to determine the prevalence of malaria parasites; (ii) to determine the relationship between parasitaemia and age/sex; (iii) to correlate the PCV levels with parasitaemia; and (iv) to determine the influence of protection against natural transmission on the prevalence of malaria. Methods: Participants were recruited at the Plateau State Human Virology Research Laboratory (PLASVIREC), Robert Gallo House at the Plateau State Specialist Hospital, Jos and grouped into: (i) Malaria and HIV co-infection group (n = 64); and (ii) HIV infected group without concurrent malaria infection (n = 136). Standard laboratory procedures were used for the HIV and Plasmodium parasites screening, malaria parasite density, and packed cell volume. Results: The results showed a significant difference (p <0.05) among the sexes and age groups. About 64 (32%) of the individuals had Plasmodium infection (30% Plasmodium falciparum, 0.5% P. malariae, and 1.5% mixed infections of P. falciparum and P. malariae). Malaria parasites were more common among the rural dwellers and in the age group of 21–30 yr. Regression analysis showed a negative association of malaria parasitaemia and PCV among the malaria–HIV positive and malaria-HIV negative (r2 = 0.529; p <0.001). Interpretation & conclusion: In the present study, PCV might be of useful indicator and if not monitored could lead to AIDS establishment especially where high malaria parasitaemia is noted. The findings further suggest that the defined stage of HIV infection in the study, malaria coinfection may moderate the impact of HIV infection on PCV.