RESUMEN
OBJECTIVE: To evaluate the treatment of serious and uncontrollable intracranial hypertension in patients with acquired immunodeficiency syndrome who developed cryptococcal meningitis. METHODS: All cases of cryptococcal meningitis with elevated pressure and acquired immunodeficiency syndrome were reviewed in detail and described. RESULTS: Cerebrospinal fluid shunting dramatically improved these critically ill patients and was much more successful than serial lumbar punctures or the use of high-dose dexamethasone. CONCLUSION: Patients with acquired immunodeficiency syndrome who develop cryptococcal meningitis and who suffer serious visual loss or ocular palsies with elevated pressures should be considered for cerebrospinal fluid shunting at an early stage.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Derivaciones del Líquido Cefalorraquídeo , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/cirugía , Meningitis Criptocócica/complicaciones , Adulto , Femenino , Humanos , Lactante , Hipertensión Intracraneal/diagnóstico por imagen , Masculino , Meningitis Criptocócica/diagnóstico por imagen , Persona de Mediana Edad , Tomografía Computarizada por Rayos XAsunto(s)
Fármacos Anti-VIH/efectos adversos , Clima , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Indinavir/efectos adversos , Cálculos Renales/inducido químicamente , Fármacos Anti-VIH/uso terapéutico , Ingestión de Líquidos , Florida , Infecciones por VIH/complicaciones , Inhibidores de la Proteasa del VIH/uso terapéutico , Humanos , Indinavir/uso terapéutico , Cálculos Renales/complicacionesAsunto(s)
Infecciones por VIH/inmunología , Infecciones por HTLV-I/inmunología , Adulto , Recuento de Linfocito CD4 , Linfocitos T CD8-positivos/inmunología , Infecciones por VIH/complicaciones , Infecciones por VIH/virología , Infecciones por HTLV-I/complicaciones , Infecciones por HTLV-I/virología , Humanos , Masculino , ViremiaRESUMEN
These agents seem beneficial in all HIV-infected patients with CD4 counts under 500 cells/mm3, but the effects are time limited and related to baseline immune status. Active viral replication is now known to occur even during periods of clinical latency.
Asunto(s)
Antivirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , HumanosRESUMEN
PURPOSE: To describe the clinical, radiographic, and laboratory features of sinus disease in human immunodeficiency virus (HIV)-infected individuals. PATIENTS: Seventy-two patients with a history of sinusitis identified from 1,461 consecutive admissions (667 patients) to the HIV ward at The Johns Hopkins Hospital. METHODS: Retrospective chart review. SETTING: The Johns Hopkins Hospital. RESULTS: Sinusitis was identified in 72 HIV-infected patients, predominantly individuals with a CD4 cell count of less than 200/mm3. A history of respiratory infections such as bacterial pneumonia, bronchitis, and otitis media was common. Although nasal congestion and postnasal drainage were found in the majority of patients, symptoms of sinusitis were often nonspecific and the diagnosis was incidental in 28 patients (33%). Magnetic resonance imaging or computed tomography was significantly more sensitive than plain radiography (p less than 0.001) in defining the extent of the disease, particularly with posterior sinus involvement, which occurred in the majority of the patients. The number of radiologically abnormal sinuses correlated inversely with the CD4 count. Although the majority of patients responded at least partially to antibiotic therapy, only 15% had complete resolution of clinical symptoms. Fifty-eight percent of patients had clinical and/or radiographic evidence of recurrent/persistent sinus infection, and chronicity correlated with a CD4 count less than 200/mm3 (p less than 0.001). CONCLUSIONS: Sinusitis in HIV-infected patients is common, severe, and difficult to treat. Patients with CD4 counts less than 200/mm3 are prone to disease involving multiple sinuses that responds incompletely to antibiotic therapy, often resulting in chronic sinusitis. Unlike the immunocompetent host, the majority of the HIV-infected patients with advanced immunodeficiency develop posterior sinus disease.