[HIV infection and cervical cancer: a note of caution for clinicians and health planners]. / Infección por VIH y cáncer de cérvix: una llamada de atención para clínicos y planificadores.

BACKGROUND: To estimate the association between HIV infection and cervical intraepithelial neoplasia (CIN). PATIENTS AND METHODS: Cross-sectional study based on data from 251 women from a Sexually Transmitted Diseases clinic. Patients with CIN were compared with those without CIN in terms of HIV infection and exposure to other risk factors, calculating the corresponding adjusted odds ratio (ORA) by logistic regression. RESULTS: HIV infection (ORA = 7.5; CI 95%: 2.5-22.1), having previous cytologies with cellular changes associated with human papillomavirus infection (ORA = 3.6; CI 95%: 1.3-10.2) and history of condylomas (ORA = 3.2; CI 95%: 1.2-8.4) were associated with CIN. CONCLUSIONS: The strong association observed between HIV and CIN, shows that it is necessary for health services planners and clinicians caring for HIV infected women to ensure that the latter receive the appropriate care to guarantee its early detection.

Isoniazid preventive therapy in human immunodeficiency virus-infected persons. Long-term effect on development of tuberculosis and survival.

BACKGROUND: Although the short-term benefit of isoniazid prophylaxis in patients coinfected with human immunodeficiency virus (HIV) and tuberculosis has been shown, long-term benefits are unknown. METHODS: Historical cohort study in an acquired immunodeficiency syndrome unit at a tertiary referral hospital. A sample of 121 HIV-infected patients with positive results on a purified protein derivative test were followed up for development of active tuberculosis and survival. Patients who received isoniazid prophylaxis were compared with patients who did not receive prophylaxis. RESULTS: Of the 121 patients examined, 29 (24%) completed a 9- to 12-month course of isoniazid prophylaxis (median follow-up, 89 months), and 92 (76%) did not receive the drug (median follow-up, 60 months). Active tuberculosis developed in 46 patients (38%). The incidence of tuberculosis was higher among patients with no prophylaxis (9.4 per 100 patient-years) than among patients with isoniazid prophylaxis (1.6 per 100 patient-years) (P = .006). Risk for development of tuberculosis was associated with the absence of isoniazid prophylaxis (relative risk [RR], 6.55; 95% confidence interval [CI], 2.02-21.19). Death during the period of study was more frequent in patients who did not receive isoniazid (50/92 or 54%) than in patients who received isoniazid (7/29 or 24%) (P = .008). Median survival was more than 111 months in patients who received isoniazid compared with 75 months in patients who did not receive isoniazid (P < .001). In a proportional hazards analysis, the development of tuberculosis (RR, 1.88; 95% CI, 1.09-3.27), the absence of isoniazid prophylaxis (RR, 2.68; 95% CI, 1.16-6.17), and a CD4+ cell count lower than 0.20 x 10(9)/L (RR, 3.03; 95% CI, 1.39-6.61) were independently associated with death. Patients who received isoniazid had a longer survival after stratifying for the CD4+ cell count. CONCLUSIONS: Preventive therapy with isoniazid confers long-term protection against tuberculosis and significantly increases survival in patients dually infected with HIV and Mycobacterium tuberculosis.

Cutaneous mucormycosis in a heart transplant patient associated with a peripheral catheter.

The first known case of an intravascular catheter-related primary cutaneous mucormycosis in a heart transplant patient is reported. The patient had corticosteroid-induced hyperglycemia and experienced an acute tissue rejection episode. A necrotic lesion appeared around the insertion site of a peripheral venous catheter. A biopsy revealed typical mucorales hyphae. The lesion continued to spread during the following 24 hours and necessitated amputation of the forearm. The organism was identified as a Mucor species.

[Fever evolution after treatment in patients with tuberculosis and HIV infection]. / Evolución de la fiebre tras el tratamiento en pacientes con tuberculosis e infección por VIH.

OBJECTIVES: To compare the fever course after starting therapy in patients diagnosed of active tuberculosis with and without HIV infection and evaluate the usefulness of empiric antituberculous therapy in diagnosing the disease. METHODS: Review of clinical records from all patients meeting the following criteria for three years: recovery of Mycobacterium tuberculosis from any clinical sample, knowledge of serological status to HIV, initial therapy of tuberculosis, absence of ther causes of fever identified, and not being treated with drugs which potentially could interfere with the course of fever during their hospital stay. RESULTS: At admission HIV-positive patients with tuberculosis were afebrile in a significantly lower proportion than HIV-negative patients (17% vs. 54%, respectively; p < 0.001). After initiating antituberculous therapy, the median time to fever resolution was similar in both HIV-positive and HIV-negative patients (6 and 4 days, respectively). After two weeks of therapy, 25% of HIV-positive patients and 23% HIV-negative patients still had fever. No factor was identified which could predict the delay in resolution of fever. CONCLUSIONS: The course of fever was similar in both HIV-positive and HIV-negative patients after initiating antituberculous therapy. This empirical therapy may be useful in diagnosing tuberculosis, as fever resolved in the first two weeks of therapy in most patients.

Group-C beta-hemolytic streptococcal bacteremia.

Group-C beta-hemolytic streptococci (GCBHS) is an uncommon cause of bacteremia. In a 5-year period, GCBHS accounted for 0.28% of positive blood cultures and 0.35% of bacteremias documented at our hospital. The incidence of GCBHS bacteremia was 0.05 episodes per 1000 admissions. We were able to analyze clinical data of 10 of the 13 patients with GCBHS bacteremias. All but one were adults with significant underlying diseases, and seven episodes were community acquired. The skin was the portal of entry in only one case. Clinical syndromes included primary bacteremia (four cases), pneumonia (two cases), endocarditis (two cases), and meningitis, intraabdominal infection, and metastatic suppurative pericarditis (one episode each). Of 13 isolates, 12 were identified to species level: six, Streptococcus equisimilis; three S. equi; two S. dysgalactiae; and one S. zooepidemicus. Resistance to penicillin was detected in one isolate and none of our isolates displayed penicillin tolerance, Four patients died (40%) despite appropriate antimicrobial therapy.