Clinical profile and factors associated with mortality in hospitalized patients with HIV/AIDS: a retrospective analysis from Tripoli Medical Centre, Libya, 2013.

In Libya, little is known about HIV-related hospitalizations and in-hospital mortality. This was a retrospective analysis of HIV-related hospitalizations at Tripoli Medical Centre in 2013. Of 227 cases analysed, 82.4% were males who were significantly older (40.0 versus 36.5 years), reported injection drug use (58.3% versus 0%) and were hepatitis C virus co-infected (65.8% versus 0%) compared with females. Severe immunosuppression was prevalent (median CD4 count = 42 cell/µL). Candidiasis was the most common diagnosis (26.0%); Pneumocystis pneumonia was the most common respiratory disease (8.8%), while cerebral toxoplasmosis was diagnosed in 8.4% of patients. Current HAART use was independently associated with low risk of in-hospital mortality (OR 0.33), while central nervous system symptoms (OR 4.12), sepsis (OR 6.98) and low total lymphocyte counts (OR 3.60) were associated with increased risk. In this study, late presentation with severe immunosuppression was common, and was associated with significant in-hospital mortality.

Clinical profile and factors associated with mortality in hospitalized patients with HIV/AIDS: a retrospective analysis from tripoli medical centre, Libya, 2013

In Libya, little is known about HIV-related hospitalizations and in-hospital mortality. This was a retrospective analysis of HIV-related hospitalizations at Tripoli Medical Centre in 2013. Of 227 cases analysed, 82.4% were males who were significantly older [40.0 versus 36.5 years], reported injection drug use [58.3% versus 0%] and were hepatitis C virus co-infected [65.8% versus 0%] compared with females. Severe immunosuppression was prevalent [median CD4 count = 42 cell/micro L]. Candidiasis was the most common diagnosis [26.0%]; Pneumocystis pneumonia was the most common respiratory disease [8.8%], while cerebral toxoplasmosis was diagnosed in 8.4% of patients.Current HAART use was independently associated with low risk of in-hospital mortality [OR 0.33], while central nervous system symptoms [OR 4.12], sepsis [OR 6.98]and low total lymphocyte counts [OR 3.60]were associated with increased risk.In this study, late presentation with severe immunosuppression was common, and was associated with significant in-hospital mortality

En Libye, les connaissances sur les hospitalisations et la mortalite en milieu hospitalier liees au VIH sont rares. Nous avons procede a une analyse retrospective des hospitalisations liees au VIH au centre medical de Tripoli en 2013. Sur 227 cas analyses,82,4 % etaient des hommes nettement plus ages [40,0 contre 36,5 ans], qui declaraient s'injecter des drogues [58,3 % contre 0 %]et qui etaient atteints d'une co-infection par le virus de l'hepatite C [65,8 % contre 0 %] comparativement aux femmes.L'immunosuppression severe etait prevalente [numeration des lymphocytes T-CD4 = 42 cellules/micro L]. Le diagnostic le plus frequent etait la candidose [26,0 %]; la pneumonie a Pneumocystis etait la maladie respiratoire la plus frequente [8,8 %], tandis que la toxoplasmose cerebrale etait diagnostiquee chez 8,4 % des patients]. Un traitement antiretroviral hautement actif en cours etait independamment associe a un faible risque de mortalite en milieu hospitalier [OR 0,33], tandis que les symptomes du systeme nerveux central [OR 4,12], la septicemie [OR 6,98] et les faibles numerations lymphocytaires totales [OR 3,60] etaient associes a un risqué accru.Dans cette etude,une presentation tardive accompagnee d'une immunosuppression severe etait frequente,et etait associee a une mortalite elevee en milieu hospitalier

The effect of wearing the veil by Saudi ladies on the occurrence of respiratory diseases.

It is customary in clinical practice and elsewhere to put on a mask for protection against infection, dust, and so forth. The veil, which is traditionally worn by women in many Muslim countries, especially in Saudi Arabia, may have a similar effect. The study was carried out during 1998-1999 in the eastern province of Saudi Arabia. Adult women were asked to answer a structured questionnaire related to the occurrence of respiratory tract problems and about veil wearing. Veil wearing was practiced by 58% of the sample. Respiratory infections and asthma were significantly more common in veils users (p < 0.00001 and p < 0.0003, respectively). This unexpected finding was probably secondary to infection. More and bigger studies are recommended.

Pyogenic abscesses and parasitic diseases.

Parasitic diseases which during their course in the host switch the immune system from a T helper 1 to a T helper 2 response may be detrimental to the host, contributing to granuloma formation, eosinophilia, hyper-IgE, and increased susceptibility to bacterial and fungal infections. Patients and animals with acute schistosomiasis and hyper-IgE in their serum develop pyogenic liver abscess in the presence of bacteremia caused by Staphylococcus aureus. The Salmonella-S. mansoni association has also been well documented. The association of tropical pyomyositis (pyogenic muscle abscess) and pyogenic liver abscess with Toxocara infection has recently been described in the same context. In tropical countries that may be an interesting explanation for the great morbidity of bacterial diseases. If the association of parasitic infections and pyogenic abscesses and/or fungal diseases are confirmed, there will be a strong case in favor of universal treatment for parasitic diseases to prevent or decrease the morbidity of superinfection with bacteria and fungi.

Human toxocariasis and pyogenic liver abscess: a possible association.

OBJECTIVES: To study the role of human toxocariasis in the pathogenesis of pyogenic liver abscess. METHODS: We compared the serology for toxocariasis and serum levels of IgE in 16 patients with pyogenic liver abscess to those in 32 matched (age and gender) controls to define the possible association between these two entities. RESULTS: The serology for toxocariasis was positive in 10 of 16 patients compared with 4 of 32 controls. The relative odds and 95% confidence interval (conditional logistic regression), comparing cases and matched controls, was significant (1.4; 95% confidence interval, 1.1-1.7) for Toxocara serology. Regarding IgE serum levels, there was no difference between cases and controls. CONCLUSIONS: Human toxocariasis can be one of the predisposing causes of pyogenic liver abscess, especially in tropical countries in which this parasitic disease is common. Treatment of human toxocariasis may prevent morbid complications like hepatic abscess and should be considered in patients with clinical and/or serological evidence of Toxocara infection.

Schistosoma mansoni: assessment of morbidity before and after control.

The literature on the assessment of morbidity due to Schistosoma mansoni infection is updated. Imaging techniques such as ultrasonography, echodoppler cardiography, computerized tomography (CT scan) and magnetic resonance imaging (MRI) introduced a new perspective, and expanded our knowledge on morbidity. Three well-defined syndromes caused by schistosomiasis mansoni have been described: the stage of invasion, acute schistosomiasis (Katayama fever), and chronic schistosomiasis. Complications of the acute and chronic syndromes have also been reported: pulmonary hypertension, neuroschistosomiasis, association with Salmonella, association with Staphylococci, viral hepatitis B, glomerulonephritis. In most individuals with hepatosplenic schistosomiasis the spleen is increased in size. Hepatosplenic schistosomiasis can, however, occur without splenomegaly. The definition of hepatosplenic schistosomiasis in endemic areas as the finding of S. mansoni eggs in the stools in an individual with hepatosplenomegaly is not satisfactory anymore. Many aspects of morbidity are expected to change after schistosomiasis control. Some are expected to change quickly (worm burden, Salmonella bacteremia, hepatosplenic schistosomiasis in children) whereas others shall remain for years (pulmonary hypertension, glomerulonephritis, neuroschistosomiasis). Intestinal schistosomiasis in individuals with low worm burdens is very difficult to diagnose and therefore laborious to control.

[The association between human toxocariasis and pyogenic abscesses]. / A associação entre a toxocaríase humana e os abscessos piogênicos.

The association between hepatic abscesses and schistosomiasis mansoni was confirmed by clinical and experimental studies. Other parasites may cause systemic immunologic changes and local structural alterations in the affected organs that can facilitate the seeding of these areas by bacteria. Tropical pyomyositis, pyogenic liver and renal abscesses are frequent diseases in tropical areas. The visceral larva migrans syndrome is caused by the presence, in the human body, of larvae of worms that have other animals as their definitive host, most commonly being caused by Toxocara canis. The larvae migrate to various body organs leading to many inflammatory reactions in the form of granuloma and tissue necrosis. In this review we discuss the possible host-parasite-bacteria interactions that would favour the formation of abscesses in the organs involved by the larva of T. canis and present preliminary results of a clinical and experimental study undertaken during the last four years to define the role of this parasite in the pathogenesis of the abscesses.

Fever of undetermined origin in patients with the acquired immunodeficiency syndrome in Brazil: report on 55 cases.

The medical records of patients with AIDS admitted to a general hospital in Brazil from 1989 to 1997 were reviewed retrospectively with the aim at defining the frequency and etiology of fever of undetermined origin (FUO) in HIV-infected patients of a tropical country and to evaluate the usefulness of the main diagnostic procedures. 188 (58.4%) out of 322 patients reported fever at admission to hospital and 55 (17.1%) had FUO. Those with FUO had a mean CD4+ cell count of 98/ml. A cause of fever was identified for 45 patients (81.8%). Tuberculosis (32.7%), Pneumocystis carinii pneumonia (10.9%), and Mycobacterium avium complex (9.1%) were the most frequent diagnoses. Other infectious diseases are also of note, such as cryptococcal meningitis (5.5%), sinusitis (3.6%), Salmonella-S. mansoni association (3.6%), disseminated histoplasmosis (3.6%), neurosyphilis (1.8%), and isosporiasis (1.8%). Four patients had non-Hodgkin's lymphoma (7.3%). We conclude that an initial aggressive diagnostic approach should be always considered because biopsies (lymph node, liver and bone marrow) produced the highest yield in the diagnosis of FUO and the majority of the diagnosed diseases are treatable. The association of diseases is common and have contributed to delay the final diagnosis of FUO in most cases. In our study area the routine request of hemocultures for Salmonella infection and the investigation of cryptococcal antigen in the serum should be considered.

Schistosomiasis and associated infections.

In hospital-based series viral hepatitis B has been frequently described in association with schistosomiasis whilst in field-based studies the association has not been confirmed. The association between schistosomiasis and Salmonella bacteraemia has been well documented. More recently, acute schistosomiasis has been shown to be a facilitating factor in the genesis of pyogenic liver abscesses caused by Staphylococcus aureus. New evidences indicate an interaction between the acquired immunodeficiency syndrome (AIDS) and schistosomiasis. In this paper, data on the association of schistosomiasis with other infections are updated.

Splenic palpation for the evaluation of morbidity due to schistosomiasis mansoni.

This study was undertaken to determine the accuracy of splenic palpation for the diagnosis of splenomegaly, and to determine whether the frequency of individuals with a palpable spleen in an endemic area can be considered as an index of morbidity of schistosomiasis. For the clinical diagnosis of splenomegaly, two criteria have been tested: (A) presence of a palpable spleen and (B) presence of a palpable spleen whose border could be felt more than 4 cm below the costal margin. In an area of high prevalence of the disease (66.3%) 285 individuals aged 18 years or more have been submitted to abdominal ultrasonography and physical examination. Splenomegaly was defined as a splenic length greater than 120 mm by ultrasound and the sensitivity, specificity, positive and negative predictive values of criterion A were 72.2%, 90.5%, 35.1% and 97.8%. The values for criterion B were 27.8%, 98%, 50% and 95%, respectively. In an non endemic area, 517 individuals were submitted to the same protocol and 22 individuals had a palpable spleen, but no patient fulfilled criterion B for splenomegaly, and only one met the ultrasonographic criterion for splenomegaly. The authors concluded that abdominal palpation is a poor method for the diagnosis of splenomegaly.

Chronic carriers of hepatitis B surface antigen in an endemic area for schistosomiasis mansoni in Brazil.

Data on the association of schistosomiasis and hepatitis B in field-based studies are scarce. Two areas have been selected for this study: i) Queixadinha, endemic for schistosomiasis, with a population of 693 individuals, and ii) Capão, a control non-endemic area, with 515 inhabitants. Sera of all individuals in both areas were tested for hepatitis B infection, yearly, from 1994 to 1997. In the first area hepatitis B was found in 32.1% of children up to one year old and reached a peak of 68.7% in the age range of 15 to 19 years. In the control area the prevalence of hepatitis B was under 5% up to 19 years of age and the highest prevalence was observed in adults over 45. HBsAg was detected in 9.4% of the individuals living in the endemic area for schistosomiasis and in 1.4% of the controls (OR = 4.98; 95% CI = 3.7-6.7). The index of chronicity of HBsAg was not statistically different in the studied areas (8.1% x 7.3%; OR = 1.09; 95% CI = 0.42-3.03), nor was it different for people with and without schistosomiasis in Queixadinha (8.7% x 7.0%). We conclude that the Schistosoma mansoni infection has not altered the course of hepatitis B in the studied area.

Salmonella-S. mansoni association in patients with acquired immunodeficiency syndrome.

Two young men with Salmonella bacteraemia, active schistosomiasis and the acquired immunodeficiency syndrome are reported. The clinical presentation comprised nonspecific signs and symptoms, such as fatigue, malaise, weight loss, diarrhoea, prolonged fever, and hepatosplenomegaly. In one patient, liver biopsy showed poorly formed granulomata around Schistosoma mansoni eggs and hepatitis. Treatment of schistosomiasis alone induced consistent clinical improvement with eventual cure of both Salmonella and S. mansoni infections. Recognition of the Salmonella-S. mansoni association in patients with AIDS is important because treatment of schistosomiasis makes a difference, improving the prognosis of this otherwise, recurrent, potentially fatal bacteraemia.

Acute schistosomiasis: report on five singular cases

The cases of five patients with unusual manifestation of acute schistosomiasis mansoni are described in this paper. One patient developed skin lesions, three displayed diverse lung involvement, and one presented pyrogenic liver abscesses caused by Staphylococcus aureus.

Ultrasonography of periportal fibrosis in schistosomiasis mansoni in Brazil.

In patients with hepatosplenic schistosomiasis, characteristic thickening of the walls of the portal vein in the hilus and its central and peripheral branches is observed. In an area of high prevalence of the disease in Brazil, 424 individuals older than 5 years have been examined by abdominal ultrasonography and 146 presented fibrosis, classified as central in 31 (21%), peripheral in 56 (38%), and both central and peripheral in 59 (40%). The mean ages of the subjects in the 3 groups were 45.7, 24.1 and 31.9 years, respectively (P < 0.05). The presence of central fibrosis was associated with the presence of peripheral fibrosis (odds ratio 10.7, P < 0.000001). Splenomegaly was found in 16% and 15% of individuals with peripheral and both central and peripheral fibrosis, respectively. No subject with central but no peripheral fibrosis and splenomegaly was identified. We conclude that central fibrosis occurs among older subjects but should not be considered a criterion for advanced disease.

Acute schistosomiasis: report on five singular cases.

The cases of five patients with unusual manifestations of acute schistosomiasis mansoni are described in this paper. One patient developed skin lesions, three displayed diverse lung involvement, and one presented pyogenic liver abscesses caused by Staphylococcus aureus.

[The Queixadinha Project: morbidity and control of schistosomiasis in an endemic area in the northeast of Minas Gerais, Brazil]. / O Projeto Queixadinha: a morbidade e o controle da esquistossomose em área endêmica no nordeste de Minas Gerais, Brasil.

In an endemic area for schistosomiasis in the northeast of the state of Minas Gerais in Brazil 516 individuals have been submitted to clinical and laboratory examination, ultrasonography of the abdomen and dopplerecocardiography in order to define the morbidity of schistosomiasis before and after treatment. A high prevalence of schistosomiasis (66.3%) and of severe disease (9.5% with palpable spleens) were recorded. Ultrasonography classified liver periportal fibrosis as light (19.4%), moderate (27.6%) and intense (6.8%), and 46.0% presented no periportal fibrosis. Twenty one out of the 53 individuals (39.6%) with palpable spleens did not present liver fibrosis on ultrasound. Periportal lymph nodes were described in 33.8% of the population and anti-KLH antibodies were found in the serum of 40.7%. Urinary alterations compatible with the glomerulopathy of schistosomiasis were observed in 4.5% of the population, and 11.7% of the individuals examined by dopplerecocardiography had pulmonary hypertension. Twelve months after treatment for schistosomiasis the prevalence of the disease dropped from 66.3% to 25.0%. In Queixadinha, a profile of the morbidity of schistosomiasis has just been established.