ABSTRACT
An HIV-1-infected patient with progressive multifocal leukoencephalopathy presented clinical deterioration and contrast-enhancing lesions on brain nuclear MR after the initiation of highly active antiretroviral therapy (HAART). Brain biopsy identified an inflammatory reaction compatible with immune reconstitution inflammatory syndrome. Treatment with corticosteroids and transient suppression of HAART led to marked neurologic improvement.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Antiretroviral Therapy, Highly Active/adverse effects , Brain/drug effects , Encephalitis/chemically induced , Encephalitis/immunology , Leukoencephalopathy, Progressive Multifocal/drug therapy , Adult , Anti-Inflammatory Agents/therapeutic use , Aphasia/chemically induced , Aphasia/immunology , Aphasia/physiopathology , Brain/immunology , Brain/pathology , Chemotaxis, Leukocyte/drug effects , Chemotaxis, Leukocyte/immunology , Dexamethasone/therapeutic use , Encephalitis/physiopathology , Hemiplegia/chemically induced , Hemiplegia/immunology , Hemiplegia/physiopathology , Humans , Inclusion Bodies/immunology , Inclusion Bodies/pathology , Inclusion Bodies/virology , JC Virus/immunology , JC Virus/isolation & purification , Leukoencephalopathy, Progressive Multifocal/physiopathology , Leukoencephalopathy, Progressive Multifocal/virology , Macrophages/drug effects , Macrophages/immunology , Magnetic Resonance Imaging , Male , Oligodendroglia/immunology , Oligodendroglia/pathology , Oligodendroglia/virology , T-Lymphocytes/drug effects , T-Lymphocytes/immunology , Treatment Outcome , Withholding TreatmentABSTRACT
Community-acquired pneumonia (CAP) affects approximately 1% of the population annually. Initial antimicrobial therapy is most often empirical. Guidelines designed in other countries for the empirical management of CAP are not recommended for use in Argentina. Studies from other countries were considered together with unpublished local data to define the potential etiologic microorganisms and their antimicrobial susceptibility. Recommended diagnostic tests, groups of patients for different therapies and hospitalization criteria were defined. Severe CAP requiring intensive care was distinguished from the rest because of its distinct spectrum of etiologic agents and its high mortality, requiring a more focused therapy. Age, coexisting conditions and severity of illness were taken into account in the election of therapy.
