Neurocysticercosis and HIV Infection: what can we learn from the published literature? / Neurocisticercosis e infección por VIH: ¿Qué se puede aprender de la literatura reportada?

ABSTRACT Infections caused by the human immunodeficiency virus (HIV) and by the larvae of Taenia solium (i.e., cysticercosis) are still widespread in many developing countries. Both pathologies modify host immune status and it is possible that HIV infection may modulate the frequency and pathogeny of cysticercosis of the central nervous system (i.e., neurocysticercosis [NCC]). Objective: To describe published cases of NCC among HIV-positive patients and to evaluate whether the characteristics of NCC, including frequency, symptoms, radiological appearance, and response to treatment differed between HIV-positive and HIV-negative patients. Methods: Forty cases of NCC/HIV co-infected patients were identified in the literature. Clinical and radiological characteristics, as well as response to treatment, were compared with non-matching historical series of NCC patients without HIV infection. Results: Most of these patients had seizures and multiple vesicular parasites located in parenchyma. Clinical and radiological characteristics were similar between HIV-positive and HIV-negative patients with NCC, as well as between immunocompromised and non-immunocompromised HIV-positive patients. Conclusion: Our review did not reveal clear interactions between HIV and NCC. This may be partially due to the small number of cases and reliance on published research. A systematic, multi-institutional effort aiming to report all the cases of this dual pathology is needed to confirm this finding and to clarify the possible relationship between both pathogens.

RESUMO Las infecciones causadas por el virus de inmunodeficiencia humana (VIH) y la larva de la Tenia solium siguen estando diseminadas en países en vías de desarrollo. Ambas patologías modifican el estado inmune y es posible que la infección por el VIH module la frecuencia y la patología de la neurocisticercosis (NCC). Objetivo: Describir los casos publicados de NCC en los pacientes VIH positivos y evaluar si las características de la NCC, incluyendo frecuencia, síntomas, presentación radiológica, respuesta a tratamiento, difieren entre los sujetos VIH positivos y VIH negativos. Métodos: Cuarenta casos con coinfección NCC/VIH fueron identificados en la literatura. Se compararon sus características clínico-radiológicas, así como su respuesta al tratamiento con diferentes series de casos históricos no pareados. Resultados: La mayoría de los pacientes NCC/VIH tenían epilepsia y múltiples parásitos vesiculares en el parénquima. Las características clínico-radiológicas de la NCC así como la evolución de los pacientes fueron similares entre pacientes VIH positivos y negativos, así como entre pacientes VIH inmunocomprometidos y no inmunocomprometidos. Conclusión: No encontramos interacciones claras entre VIH y NCC. Este resultado puede haber sido influenciado por el pequeño número de casos y la parcialidad de la información publicada. Un esfuerzo multiinstitucional, sistemático encaminado a reportar todos los casos de esta patología dual es necesario para confirmar estos resultados y esclarecer la relación entre patógenos.

Secondary Infections in Swine Flu.

Swine influenza is respiratory disease of pigs caused by type A influenza virus that causes regular outbreak in pigs. Human to human transmission occurs. Some people develop severe respiratory symptoms and need ventilator. Patients can get secondary bacterial infections in form of pneumonia if viral infections persist. Death of swine flu occurs due to secondary bacterial infections leading to bacterial pneumonias. Method : 369 patients having acute respiratory illness suspected to be suffering from swine flu were included. Real time reverse transcriptase polymerase chain reaction (RT-PCR) was performed on sputum samples or tracheal aspirates of 134 patients admitted in Hospital due to pneumonia. 90 of these patients were positive for swine flu by RT-PCR. Result : Among 90 patients 55 patients’ shows bacterial growth and 35 patients did not show any growth. Maximum patients 17 shows Klebseilla pneumoniae,17 show Staphylococcus aureus ,10 show Escherichia coli,8 show Pseudomonas aeruginosa and 3 patients show Streptococccus pneumoniae. Even after treatment, death of 36 patients occurred. Among these 36 patients, 19 had both, bacterial as well as swine flu infection and 17 patients had only swine flu infection. Conclusion : Secondary bacterial infections in swine flu patients were multiresistant to antibiotics were noted. Pneumonia caused by co-infection contributes to a severe rapidly progressive illness.

Tuberculosis in HIV co-infected patients- a study at tertiary care hospital, Amritsar (India).

Background: The dual epidemic of tuberculosis and HIV is a significant problem in the developed and developing countries. Tuberculosis is the most common human immunodeficiency virus related opportunistic infection in India and caring for patients with both diseases is a major public health challenge. Aim: The aim of the present study was to record the different clinical patterns of tuberculosis in HIV co-infected patients as a function of CD4+T cell count. Material and Methods: The study was a retrospective analysis of the HIV-TB co-infected patients admitted in the Chest and TB Hospital, Government Medical College, Amritsar (Punjab) during the calender year 2011. Results: Out of total 47 HIV sero-positive patients (n=47), 36 were males (76.59%) and 11 females (23.41%) of age group 14 to 51 years. Cough was the most common presenting symptom (72.34%).A large number of patients were diagnosed as having pulmonary tuberculosis (48.94%). The other diagnoses were tubercular meningitis (n=4), pleural effusion (n=4), tubercular lymphadenopathy (n=2), pneumothorax (n=2), hydropneumothorax (n=2) and abdominal tuberculosis (n=2). A total of 34 (72.34%) patients were having a CD4+T cell count of < 200. Conclusion: The manifestations of tuberculosis in HIV infected patients are quite varied and generally show a different pattern as a function of CD4+ T cell count. Co-infection with HIV infection leads to difficulties in both diagnosis and treatment of tuberculosis. High degree of suspicion of tuberculosis, with astute clinical and laboratory evaluation is the key for early diagnosis and management.