Subject(s)
AIDS-Related Opportunistic Infections , Acquired Immunodeficiency Syndrome , HIV Infections , Immune Reconstitution Inflammatory Syndrome , Mpox (monkeypox) , Humans , HIV Infections/complications , HIV Infections/drug therapy , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/drug therapy , AIDS-Related Opportunistic Infections/drug therapy , Antiretroviral Therapy, Highly ActiveABSTRACT
Treatment options for Achromobacter xylosoxidans are limited. Eight cystic fibrosis patients with A. xylosoxidans were treated with 12 cefiderocol courses. Pretreatment in vitro resistance was seen in 3 of 8 cases. Clinical response occurred after 11 of 12 treatment courses. However, microbiologic relapse was observed after 11 of 12 treatment courses, notably without emergence of resistance.
Subject(s)
Achromobacter denitrificans , Cystic Fibrosis , Gram-Negative Bacterial Infections , Adult , Anti-Bacterial Agents/therapeutic use , Cephalosporins , Child , Cystic Fibrosis/complications , Cystic Fibrosis/drug therapy , Gram-Negative Bacterial Infections/drug therapy , Humans , CefiderocolABSTRACT
HIV complicates the diagnostic and therapeutic approaches to idiopathic thrombotic thrombocytopenic purpura (TTP), prompting debate in the literature regarding the benefit of plasma exchange versus simple plasma infusion. Herein we present a case of HIV-TTP, initially treated conservatively with plasma infusion but because of progressive neurologic decline, required urgent plasma exchange for resolution of hematologic derangements and neurologic sequelae. Based on the available literature, there appears to be a spectrum of HIV-associated TTP disorders. Patients with advanced HIV disease and opportunistic infections who present with thrombotic microangiopathy tend to respond to simple plasma infusion, while patients with less progressive HIV disease tend to behave like those with idiopathic TTP, requiring plasma exchange rather than simple plasma infusion. This article illustrates that in patients with HIV-TTP who do not respond to plasma infusion, early escalation to plasma exchange may help avoid life-threatening complications such as seizures and even death.
