RESUMO
Delusional infestation remains a debilitating condition that is therapeutically challenging for clinicians. This case series identifies 23 patients with delusional infestation in an Australian setting. The majority of patients are women and unlikely to have a psychiatric comorbid background. The use of unnecessary anti-parasitic medication is prevalent.
Assuntos
Ectoparasitoses/diagnóstico , Ectoparasitoses/epidemiologia , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Ectoparasitoses/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esquizofrenia Paranoide/psicologiaAssuntos
Complexo AIDS Demência/virologia , Encéfalo/virologia , Genes nef/genética , HIV-1/genética , Leucócitos Mononucleares/virologia , Sequência de Bases , Encéfalo/patologia , DNA Viral/análise , DNA Viral/sangue , DNA Viral/genética , Feminino , Variação Genética , Humanos , Dados de Sequência Molecular , Família Multigênica , Filogenia , Análise de Sequência de DNA , Deleção de SequênciaAssuntos
Complexo AIDS Demência/complicações , Síndrome da Imunodeficiência Adquirida/complicações , Infecções por HIV/complicações , Pancitopenia/complicações , Trombocitopenia/complicações , Adulto , Biópsia , Evolução Fatal , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/sangue , Soropositividade para HIV/diagnóstico , HIV-1/isolamento & purificação , Humanos , Mononucleose Infecciosa/complicações , MasculinoRESUMO
Western blots (immunoblots) for the detection of immunoglobulin M (IgM) antibodies specific for herpes simplex virus type 1 (HSV-1) and HSV-2 in patients' sera were developed. The locations of the type-specific glycoprotein G (gpG-2) of HSV-2 (92- and 140-kDa forms) and glycoprotein C of HSV-1 (gpC-1), which carries mostly type-specific antigenic epitopes, were checked with specific monoclonal antibodies. Western blot assays for IgM antibody to gpC-1 or gpG-2 were performed after depletion of IgG by precipitation with anti-human IgG. In patients with primary HSV-2 genital infections, seroconversion of IgM and IgG antibodies to both the 92- and 140-kDa forms of gpG-2 was observed, although both antibodies appeared in convalescent-phase serum after the first week. IgM and IgG antibodies to low-molecular-size polypeptides (40 to 65 kDa) were the first antibodies observed in patients with primary infection, but these antibodies were cross-reactive with HSV-1 and HSV-2. However, in patients with recurrent HSV-2 infections, IgG antibodies to both forms of gpG-2 and the low-molecular-size polypeptides were found no matter how early after onset the patient was bled, and IgM to gpG-2 did not appear. In patients with nonprimary initial genital HSV-2 infections, IgG antibody to HSV-1 was demonstrated in the first serum specimen, and HSV-2-specific IgM was found in 39% of the serum specimens. Hence, the Western blot assay can be used to test for IgM antibody to gpG-2, allowing for the retrospective diagnosis of inital HSV-2 infections and its use as a supplementary test to the gpG-2 IgG enzyme-linked immunosorbent assays developed elsewhere. In contrast, IgM antibody to gpG-2 is not usually detected in patients with recurrent HSV-2 infections.
Assuntos
Herpes Genital/diagnóstico , Herpesvirus Humano 2/imunologia , Imunoglobulina M/sangue , Proteínas do Envelope Viral/imunologia , Adulto , Anticorpos Monoclonais , Anticorpos Antivirais/sangue , Especificidade de Anticorpos , Antígenos Virais , Western Blotting/métodos , Western Blotting/estatística & dados numéricos , Criança , Pré-Escolar , Epitopos , Estudos de Avaliação como Assunto , Herpes Genital/imunologia , Herpesvirus Humano 1/imunologia , Humanos , Imunoglobulina G/sangue , Lactente , Recidiva , Sensibilidade e EspecificidadeRESUMO
The risk of human immunodeficiency virus (HIV) spread by heterosexual contact is emerging as a risk factor for women in Sydney in the 1990's. As shown by this study, heterosexual exposure to the virus accounted for 40% of women in Western Sydney acquiring the disease between 1989-1991 inclusive, compared with 0% in 1982-1985 inclusive. Further public awareness of this mode of transmission and information on safe sex practices is necessary to limit the spread of the AIDS virus.
Assuntos
Soropositividade para HIV/transmissão , Comportamento Sexual , Adolescente , Adulto , Feminino , Soropositividade para HIV/epidemiologia , Educação em Saúde , Humanos , New South Wales/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To determine the prevalence of antibody to herpes simplex virus type 2 (HSV-2) in patients attending a general public antenatal clinic and three public sexually transmitted disease (STD) clinics in Sydney. BACKGROUND: Highly specific tests for herpes simplex type 2 antibody, using the glycoprotein G2, have been recently introduced, allowing determination of past asymptomatic infection. Overseas studies have confirmed the long held suspicion that asymptomatic infection is more common than clinical genital herpes. The seroprevalence of HSV-2 in antenatal and STD clinic patients varies markedly in different countries. These are the first data available for Australia by means of this highly specific test. DESIGN: Cross-sectional study of seroprevalence in these two patient groups. Sera used in the antenatal study were those submitted for routine antenatal screening for viral markers. PARTICIPANTS: Two hundred and twenty-nine consecutive patients attending the Westmead Hospital antenatal clinics, and 107 consecutive patients attending three public STD clinics. HYPOTHESES: That Australian populations show a relatively high prevalence of past asymptomatic infection with HSV-2; and that higher rates of infection will be found in patients attending STD clinics and with past or current histories of STDs. MAIN OUTCOME MEASURES: Comparison of HSV-2 seroprevalence between antenatal clinic patients and STD clinic patients; and associations of HSV-2 antibody with age, sex, occupation, country of birth, a history of current or past STDs and antibody to HSV-1. RESULTS: Antibody to HSV-2 was found in 14.5% of antenatal clinic patients and 40% of STD clinic patients. None of the antenatal patients and less than half of the seropositive STD clinic patients reported clinical genital herpes. Associations with age, socioeconomic status and previous HSV-1 infection were less marked than in studies from the United States. Female STD clinic patients had a significantly higher seroprevalence than males and three times the seroprevalence of age-matched antenatal clinic patients. The correlation between HSV-2 antibody and current gonorrhoea was more marked than that between HSV-2 and other STDs. CONCLUSION: Asymptomatic infection with HSV-2 is quite common in Australian antenatal patients and more common in patients with STDs, who have higher rates of sexual exposure.
Assuntos
Herpes Simples/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Instituições de Assistência Ambulatorial , Anticorpos Antivirais/análise , Austrália/epidemiologia , Estudos Transversais , Feminino , Herpes Simples/etnologia , Herpes Simples/imunologia , Humanos , Imunoensaio , Masculino , Gravidez , Complicações Infecciosas na Gravidez/etnologia , Complicações Infecciosas na Gravidez/imunologia , Cuidado Pré-Natal , Prevalência , Infecções Sexualmente Transmissíveis/complicações , Simplexvirus/imunologia , Fatores SocioeconômicosRESUMO
Pseudomonas putrefaciens has been described as a rare cause of both lower-limb cellulitis and septicemic illness with significant morbidity. We report a case of P. putrefaciens infection in a patient with refractory lower-limb cellulitis and ulceration complicated by thrombocytopenia, hypotension, and mental obtundation in the apparent absence of bacteremia. This scenario raises the possibility of significant production of exotoxins by P. putrefaciens in vivo.
Assuntos
Celulite (Flegmão)/microbiologia , Exotoxinas/biossíntese , Infecções por Pseudomonas/microbiologia , Pseudomonas/metabolismo , Úlcera Cutânea/microbiologia , Idoso , Celulite (Flegmão)/complicações , Humanos , Hipotensão/complicações , Masculino , Transtornos Mentais/complicações , Pseudomonas/isolamento & purificação , Infecções por Pseudomonas/complicações , Úlcera Cutânea/complicações , Fases do Sono , Trombocitopenia/complicaçõesRESUMO
This case report describes a 50-year-old man from South America with AIDS who developed disseminated histoplasmosis with focal lymph node involvement. Treatment with ketoconazole was initially successful. Six weeks after cessation of ketoconazole he died of what was thought to be relapse of histoplasmosis.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Histoplasmose/etiologia , Histoplasmose/tratamento farmacológico , Humanos , Cetoconazol/uso terapêutico , Linfonodos/microbiologia , Masculino , Pessoa de Meia-IdadeAssuntos
Soropositividade para HIV/epidemiologia , Metadona , Transtornos Relacionados ao Uso de Substâncias/imunologia , Adulto , Austrália , Estudos Transversais , Feminino , Anticorpos Anti-HIV/análise , Soropositividade para HIV/imunologia , Soropositividade para HIV/reabilitação , Humanos , Masculino , Gravidez , Estudos Prospectivos , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaAssuntos
Síndrome da Imunodeficiência Adquirida/complicações , Neoplasias Bucais/patologia , Sarcoma de Kaposi/patologia , Adulto , Neoplasias Gengivais/patologia , Humanos , Masculino , Neoplasias Bucais/etiologia , Neoplasias Palatinas/patologia , Sarcoma de Kaposi/etiologia , Neoplasias Cutâneas/patologia , Neoplasias da Língua/patologiaRESUMO
The successful use of guided percutaneous needle aspiration in the management of four patients with solitary splenic abscess is described. Two patients had needle aspiration alone and two patients, with large splenic abscesses, had drainage tubes inserted. The procedures were well tolerated and allowed rapid microbiological diagnosis with selection of appropriate antibiotic therapy. The techniques were useful in patients felt to be poor anaesthetic risks, and the complications of splenectomy were avoided.
Assuntos
Abscesso/cirurgia , Infecções por Escherichia coli/cirurgia , Esplenopatias/cirurgia , Infecções Estreptocócicas/cirurgia , Abscesso/diagnóstico por imagem , Idoso , Infecções por Bacteroides/cirurgia , Drenagem/métodos , Infecções por Escherichia coli/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Esplenopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Ten patients with bacteremia due to methicillin-resistant Staphylococcus aureus were treated with vancomycin. These patients were compared with matched controls, nine bacteremic patients with methicillin-sensitive S. aureus, and one patient with penicillin-sensitive S. aureus. Controls were treated with a penicillin. There were no significant differences in time to defervescence, metastatic infections, relapse, mortality, need for surgical drainage, or duration of therapy. Fifteen of 19 episodes of serious methicillin-resistant S. aureus infection responded to vancomycin. Severe toxic effects included tinnitus, neutropenia, rash, and possible nephrotoxicity. Tolerance (a minimal bactericidal concentration to minimal inhibitory concentration ratio of at least 32), but not a minimal bactericidal concentration of at least 32 mg/L, correlated with therapeutic failure (respectively, p = 0.04 and p = 0.11, Fisher's exact test). Bacteremic infections due to methicillin-resistant and methicillin-sensitive S. aureus cause similar morbidity and mortality. Vancomycin is effective but potentially toxic therapy for most serious infections due to methicillin-resistant S. aureus. In-vitro tests may not predict therapeutic efficacy.
Assuntos
Meticilina/farmacologia , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/uso terapêutico , Relação Dose-Resposta a Droga , Humanos , Meticilina/uso terapêutico , Testes de Sensibilidade Microbiana , Resistência às Penicilinas , Sepse/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Vancomicina/efeitos adversos , Vancomicina/sangueRESUMO
Pneumonia due to Escherichia coli (E. coli) has a reported mortality of up to 70 per cent. Most infections are associated with underlying disease, and follow bacteraemia from a genitourinary or gastrointestinal source. This report describes two patients with bacteraemic E. coli pneumonia, presumed secondary to aspiration of E. coli from the oropharynx. Both patients presented a rapidly progressive illness with hypotension. Response of the pneumonia to early, appropriate antimicrobial therapy, was complete. Our cases are discussed with particular reference to clinical features of the infection and choice of antimicrobial therapy.