ABSTRACT
La fasciolosis es una parasitosis hepática zoonótica. La enfermedad en los seres humanos transcurre en tres períodos: agudo o invasivo, latente y crónico u obstructivo. En la mayoría de los casos, el diagnóstico de fasciolosis es difícil por la sitomatología inespecífica y la eliminación intermitente de huevos del parásito con las heces. Los hallazgos radiológicos, las alteraciones bioquímicas y, en especial, la serología por el método de ELISA, contribuyen al diagnóstico, tanto en la etapa aguda como en la crónica. La tríada de fiebre prolongada, dolor en hipocondrio derecho y eosinofilia persistente, deben hacer sospechar la enfermedad. Se presenta el caso de un paciente con diagnóstico de fasciolosis hepática, haciendo especial mención de los hallazgos radiológicos (ecografía y tomografía computada). La paciente fue tratada con una dosis única de triclabendazol, con excelente respuesta clínica.
Subject(s)
Humans , Fasciola hepatica , Ultrasonography , Diagnostic Imaging , Tomography, X-Ray ComputedABSTRACT
Tuberculosis and other mycobacterial diseases are frequent coinfections in AIDS patients with an increased related mortality. In this review we have updated the treatment of the main mycobacterial diseases (tuberculosis and Mycobacterium avium disease), under the scope of pharmacological interactions between antimycobacterial drugs, specially rifampicin and clarithromycin, and anti-retroviral drugs. Antimycobacterial treatment schemes, their duration, primary and secondary chemoprophylaxis and the optimal time to start the anti-retroviral therapy are analized. Finally, the immnune reconstitution inflammatory syndrome and its treatment are discussed.
Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Acquired Immunodeficiency Syndrome/drug therapy , Anti-Bacterial Agents/therapeutic use , Anti-Retroviral Agents/therapeutic use , Mycobacterium Infections/drug therapy , Acquired Immunodeficiency Syndrome/diagnosis , Clarithromycin/therapeutic use , Drug Interactions , Humans , Mycobacterium Infections/diagnosis , Rifampin/therapeutic use , Tuberculosis/diagnosis , Tuberculosis/drug therapySubject(s)
Acquired Immunodeficiency Syndrome/complications , Brain Abscess/etiology , Tuberculosis, Central Nervous System/etiology , Adult , Antitubercular Agents/therapeutic use , Brain Abscess/drug therapy , Brain Abscess/microbiology , Humans , Male , Tuberculosis, Central Nervous System/drug therapyABSTRACT
Tuberculosis and other mycobacterial diseases are frequent coinfections in AIDS patients with an increased related mortality. In this review we have updated the treatment of the main mycobacterial diseases (tuberculosis and Mycobacterium avium disease), under the scope of pharmacological interactions between antimycobacterial drugs, specially rifampicin and clarithromycin, and anti-retroviral drugs. Antimycobacterial treatment schemes, their duration, primary and secondary chemoprophylaxis and the optimal time to start the anti-retroviral therapy are analized. Finally, the immnune reconstitution inflammatory syndrome and its treatment are discussed.
ABSTRACT
In the last years, new techniques of neuroimages and histopathological methods have been added to the management of cerebral mass lesions in patients with AIDS. Stereotactic biopsy is necessary when after 14 days of empirical treatment for Toxoplasma gondii encephalitis there is no clinical or neuroradiologic improvement. We report a woman with AIDS who developed a single focal brain lesion on the right frontal lobe. She presented a long history of headache and seizures. After two weeks of empirical treatment for toxoplasma encephalitis without response, a magnetic resonance image with spectroscopy was performed and showed a tumoral pattern with a choline peak, diminished of N-acetyl-aspartate and presence of lactate. A stereotactic biopsy was performed. Histopathological diagnosis was a diffuse oligodendroglioma type A. A microsurgical resection of the tumor was carried out and antiretroviral treatment was started. To date she is in good clinical condition, with undetectable plasma viral load and CD4 T cell count > 200 cell/uL.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Brain Neoplasms/pathology , Oligodendroglioma/pathology , Adult , Brain Neoplasms/complications , Female , Humans , Magnetic Resonance Imaging , Oligodendroglioma/complications , Stereotaxic TechniquesABSTRACT
En los últimos a¤os, las nuevas técnicas de neuroimágenes y diversos métodos de diagnóstico histopatológico se han agregado al manejo clínico de las lesiones de masa cerebral ocupante en los pacientes con sida. La biopsia estereotáxica es necesaria cuando, luego de dos semanas de tratamiento empírico para toxoplasmosis cerebral, no se comprueba mejoría clínica ni neurorradiológica. Presentamos una paciente con sida que desarrolló una lesión cerebral a nivel del lóbulo frontal derecho. Como antecedente refirió una larga historia de cefalea y convulsiones. La resonancia nuclear magnética con espectroscopia de voxel único ubicado a nivel de la lesión mostró un patrón de lesión tumoral con pico de colina, déficit de N-acetil-aspartato y presencia de ácido láctico. La biopsia estereotáxica y el estudio histopatológico permitieron arribar al diagnóstico de oligodendroglioma difuso de tipo A. Se le efectuó resección por microcirugía y tratamiento antirretroviral de alta eficacia. Actualmente la paciente se encuentra en buen estado clínico, con carga viral indetectable y recuento de linfocitos T CD4 + > de 200 cél/uL.
Subject(s)
Humans , Female , Adult , Acquired Immunodeficiency Syndrome/complications , Brain Neoplasms , Oligodendroglioma , Brain Neoplasms , Magnetic Resonance Imaging , Oligodendroglioma , Stereotaxic TechniquesABSTRACT
La enfermedad de las glándulas salivales asociada al HIV es definida como la presencia de aumento del tamaño de la glándula asociado o no a xerostomía. Esta patología es más habitual en niños que en adultos. La enfermedad de las glándulas salivales asociada al HIV incluye lesiones linfoepiteliales y quistes que comprometen el tejido glandulas y/o los ganglios linfáticos, síndrome símil-Sjogren, síndrome de linfocitosis T CD8 difuso y neoplasias. Este artículo incluye una revisión de la epidemiología, la fisiopatología, las manifestaciones clínicas, la metodololgía diagnóstica y los diagnósticos diferenciales de la enfermedad de las glándulas salivales asociada al HIV (AU)
Subject(s)
Humans , Male , Adult , Female , Child , Salivary Gland Diseases/diagnosis , Salivary Gland Diseases/etiology , HIV Infections/complications , Acquired Immunodeficiency Syndrome/complications , /etiology , Lymphocytosis/classification , Lymphocytosis/etiology , T-Lymphocytes , Salivary Gland Diseases/epidemiology , Salivary Gland Diseases/physiopathology , Diagnosis, Differential , Lymphocele/diagnosis , Tomography, X-Ray Computed/methods , Magnetic Resonance Imaging/methodsABSTRACT
La enfermedad de las glándulas salivales asociada al HIV es definida como la presencia de aumento del tamaño de la glándula asociado o no a xerostomía. Esta patología es más habitual en niños que en adultos. La enfermedad de las glándulas salivales asociada al HIV incluye lesiones linfoepiteliales y quistes que comprometen el tejido glandulas y/o los ganglios linfáticos, síndrome símil-Sjogren, síndrome de linfocitosis T CD8 difuso y neoplasias. Este artículo incluye una revisión de la epidemiología, la fisiopatología, las manifestaciones clínicas, la metodololgía diagnóstica y los diagnósticos diferenciales de la enfermedad de las glándulas salivales asociada al HIV
Subject(s)
Humans , Male , Adult , Female , Child , Salivary Gland Diseases/diagnosis , Salivary Gland Diseases/etiology , HIV Infections , Acquired Immunodeficiency Syndrome/complications , Diagnosis, Differential , Salivary Gland Diseases/epidemiology , Salivary Gland Diseases/physiopathology , Magnetic Resonance Imaging/methods , Lymphocele , Lymphocytosis , Sjogren's Syndrome/etiology , T-Lymphocytes , Tomography, X-Ray Computed/methodsABSTRACT
Avascular osteonecrosis (AON) has increased in the last few years in patients infected with the human immunodeficiency virus type-1 (HIV-1). The most commonly affected bone is the femoral head and neck. Frequently these bilateral and clinical findings include moderate to severe pain and functional impotence of the affected joints. The etiology is multifactorial and highly active antiretroviral therapy (HAART) with protease inhibitors (PI) is probably related to its development. In the evolution, a total hip replacement may be needed. We present an hemophilic patient with AIDS, who developed a bilateral AON of the femoral head and neck during HAART.
Subject(s)
Antiretroviral Therapy, Highly Active/adverse effects , Femur Head Necrosis/chemically induced , HIV Seropositivity/drug therapy , Adult , CD4 Lymphocyte Count , Humans , MaleABSTRACT
Avascular osteonecrosis (AON) has increased in the last few years in patients infected with the human immunodeficiency virus type-1 (HIV-1). The most commonly affected bone is the femoral head and neck. Frequently these bilateral and clinical findings include moderate to severe pain and functional impotence of the affected joints. The etiology is multifactorial and highly active antiretroviral therapy (HAART) with protease inhibitors (PI) is probably related to its development. In the evolution, a total hip replacement may be needed. We present an hemophilic patient with AIDS, who developed a bilateral AON of the femoral head and neck during HAART.
ABSTRACT
Infections caused by Nocardia species are infrequent but challenging to clinicians. They cause a wide variety of diseases in both normal and immunocompromised patients. In recent years, the number of case reports has been increasing, and this can be attributed to the improvements in diagnostic capabilities and the higher clinical index of suspicion accompanying the increased prevalence of immunosuppressed patients. The treatment of nocardiosis also requires expertise. This report reviews the epidemiology, physiopathology, clinical manifestations, diagnosis and treatment of this aerobic bacterial disease.
Subject(s)
Nocardia Infections , Nocardia , Adult , Anti-Bacterial Agents/therapeutic use , Central Nervous System Bacterial Infections/diagnosis , Central Nervous System Bacterial Infections/microbiology , Central Nervous System Bacterial Infections/pathology , Central Nervous System Bacterial Infections/therapy , Humans , Immunocompromised Host , Middle Aged , Nocardia Infections/diagnosis , Nocardia Infections/pathology , Nocardia Infections/therapy , Opportunistic Infections , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/microbiology , Respiratory Tract Infections/pathology , Respiratory Tract Infections/therapy , Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/microbiology , Skin Diseases, Bacterial/pathology , Skin Diseases, Bacterial/therapyABSTRACT
Thrombocytopenia is an important and common hematological abnormality in patients with HIV-1/HCV coinfection. Splenomegaly is a frequent finding in these patients and usually causes hypersplenism and thrombocytopenia. We analyzed the clinical results of a minimal invasive treatment (splenic artery embolization) for thrombocytopenia secondary to hypersplenism and refractory to other therapies in two hemophiliac patients, HIV seropositive and with cirrhosis due to chronic HCV infection. The results suggest that splenic artery embolization is a safe, relatively atraumatic and effective method for the treatment of splenomegaly and hypersplenism in selected patients with HIV-1/HCV coinfection.
Subject(s)
Embolization, Therapeutic , Hemophilia A/complications , Hypersplenism/therapy , Splenic Artery , Adult , HIV Infections/complications , HIV-1 , Hemophilia A/virology , Hepatitis C/complications , Humans , Hypersplenism/complications , Hypersplenism/surgery , Liver Cirrhosis/complications , Male , Middle Aged , Splenectomy , Thrombocytopenia/etiologyABSTRACT
La trombocitopenia es una anomalía usual e importante en pacientes con coinfección por HIV-1/HCV. La esplenomegalia es un hallazgo frecuente en estos pacientes y, usualmente, causa hiperesplenismo y trombocitopenia. Analizamos los resultados clínicos de un método invasivo mínimo (embolización de la arteria esplénica) para el tratamiento de la trombocitopenia secundaria al hiperesplenismo y refractaria a otras terapias en dos pacientes hemofílicos, infectados por el HIV-1 y con cirrosis causada por la infección crónica por HCV. Estos resultados sugieren que la embolización de la arteria esplénica es un método seguro, poco traumático y efectivo para el tratamiento de la esplenomegalia y el hiperesplenismo en pacientes con coinfección por HIV-1/HCV.(AU)
Subject(s)
Humans , Male , Adult , Middle Aged , Embolization, Therapeutic , Hemophilia A/complications , Hypersplenism/therapy , Hepatitis C/complications , HIV Infections/complications , HIV-1 , Hypersplenism/complications , Hypersplenism/surgery , Liver Cirrhosis/complications , Splenectomy , Splenic Artery , Thrombocytopenia/etiologyABSTRACT
Thrombocytopenia is an important and common hematological abnormality in patients with HIV-1/HCV coinfection. Splenomegaly is a frequent finding in these patients and usually causes hypersplenism and thrombocytopenia. We analyzed the clinical results of a minimal invasive treatment (splenic artery embolization) for thrombocytopenia secondary to hypersplenism and refractory to other therapies in two hemophiliac patients, HIV seropositive and with cirrhosis due to chronic HCV infection. The results suggest that splenic artery embolization is a safe, relatively atraumatic and effective method for the treatment of splenomegaly and hypersplenism in selected patients with HIV-1/HCV coinfection.
ABSTRACT
La trombocitopenia es una anomalía usual e importante en pacientes con coinfección por HIV-1/HCV. La esplenomegalia es un hallazgo frecuente en estos pacientes y, usualmente, causa hiperesplenismo y trombocitopenia. Analizamos los resultados clínicos de un método invasivo mínimo (embolización de la arteria esplénica) para el tratamiento de la trombocitopenia secundaria al hiperesplenismo y refractaria a otras terapias en dos pacientes hemofílicos, infectados por el HIV-1 y con cirrosis causada por la infección crónica por HCV. Estos resultados sugieren que la embolización de la arteria esplénica es un método seguro, poco traumático y efectivo para el tratamiento de la esplenomegalia y el hiperesplenismo en pacientes con coinfección por HIV-1/HCV.
Subject(s)
Humans , Male , Adult , Middle Aged , Embolization, Therapeutic , Hemophilia A , Hypersplenism , Hepatitis C , HIV Infections , HIV-1 , Hypersplenism , Liver Cirrhosis , Splenectomy , Splenic Artery , ThrombocytopeniaABSTRACT
El compromiso cardíaco en el sida es frecuente aunque puede pasar inadvertido desde el punto de vista clínico. Las patologías más comunes son la miocardiopatía dilatada, la miocarditis infecciosa o tumoral, la pericarditis con derrame o sin él, la endocarditis valvular o parietal y la hipertensión pulmonar con insuficiencia cardíaca derecha.
Subject(s)
Cardiology , Diagnostic Imaging , Epidemiology , Infectious Disease Medicine , Internal MedicineABSTRACT
As HIV seropositive patients with undetectable CSF viral load have a lower likelihood of developing neurologic disease, the determination of CSF viral load levels may be useful to evaluate the efficacy of HAART. We compared plasma viral load levels with HIV-1 RNA CSF levels in 18 hemophilic patients without neurocognitive involvement under HAART. We detected a significant correlation between plasma viral load levels and CSF viral load levels. Fourteen patients with undetectable plasma viral load had undetectable RNA HIV-1 CSF levels as well. Four patients with detectable plasma viral load had detectable HIV-RNA in CSF, but the latter were significantly lower. Viral load is usually lower in non-blood fluids and HAART decreases the viral load in CSF as well as in blood.
Subject(s)
Humans , Antiretroviral Therapy, Highly Active , Hemophilia A , HIV Infections , HIV-1 , RNA, Viral , Viral Load , Acquired Immunodeficiency Syndrome/drug therapy , Central Nervous System Diseases , Hemophilia A , HIV Infections , RNA, ViralABSTRACT
As HIV seropositive patients with undetectable CSF viral load have a lower likelihood of developing neurologic disease, the determination of CSF viral load levels may be useful to evaluate the efficacy of HAART. We compared plasma viral load levels with HIV-1 RNA CSF levels in 18 hemophilic patients without neurocognitive involvement under HAART. We detected a significant correlation between plasma viral load levels and CSF viral load levels. Fourteen patients with undetectable plasma viral load had undetectable RNA HIV-1 CSF levels as well. Four patients with detectable plasma viral load had detectable HIV-RNA in CSF, but the latter were significantly lower. Viral load is usually lower in non-blood fluids and HAART decreases the viral load in CSF as well as in blood. (Au)
Subject(s)
Comparative Study , Humans , Viral Load , Hemophilia A/virology , HIV-1 , RNA, Viral/cerebrospinal fluid , Antiretroviral Therapy, Highly Active/methods , HIV Infections/drug therapy , Hemophilia A/cerebrospinal fluid , Hemophilia A/blood , HIV Infections/complications , Acquired Immunodeficiency Syndrome/drug therapy , RNA, Viral/blood , Central Nervous System Diseases/drug therapy , Central Nervous System Diseases/virologyABSTRACT
En el presente trabajo se analizan los beneficios y limitaciones de la terapia antirretroviral de alta eficacia (HAART). Los objetivos de esta terapia son reducir la carga viral plasmática lo máximo posible y durante el mayor tiempo posible. Esto implica alcanzar niveles de carga viral no detectables con técnicas ultrasensibles. Se evalúan los resultados obtenidos con los principales esquemas de tratamiento asi como sus indicaciones y efectos adversos.
