Diagnosis of pulmonary tuberculosis complicating HIV infection: superiority of sputum smear over bronchoalveolar lavage.

Tuberculosis should be prominently considered in the differential diagnosis when an HIV-infected patient has respiratory symptoms. Sputum smears and culture for acid-fast organisms should always be obtained. Fiberoptic bronchoscopy to exclude other concurrent opportunistic infections is appropriate because Pneumocystis carinii complicates as many as 25% of the cases of pulmonary TB, but acid-fast sputum smears should always be obtained. It should not be assumed that bronchoalveolar lavage is superior to expectorated sputum smear for the rapid diagnosis of pulmonary tuberculosis.

Herpes simplex virus type 2 meningoencephalitis resistant to acyclovir in a patient with AIDS.

A case is reported of relapsing fatal meningoencephalitis caused by a neurovirulent thymidine kinase-positive (TK+) type 2 herpes simplex virus (HSV) that developed thymidine kinase deficiency (TK-) during intravenous acyclovir therapy. A patient with AIDS was admitted for acyclovir treatment of a persistent perirectal herpetic ulcer. He subsequently developed meningoencephalitis. A TK+ type 2 HSV was isolated from a brain biopsy specimen. A progressive and fatal relapse occurred, and a TK- type 2 HSV was isolated from his cerebrospinal fluid. Restriction endonuclease analysis of viral DNA from perianal, brain, and cerebrospinal fluid isolates were similar, suggesting that they were the same viral strain. Animal virulence studies indicated significant cutaneous virulence in immunocompromised mice models for the TK- isolates. This case is notable because TK- HSV have, in the past, lacked neurovirulence and because acyclovir resistance developed during therapy and caused the patient's death.