Serosurvey of Rickettsia typhi and Rickettsia felis in HIV-infected patients.

Consistent with the effects of HIV on cell-mediated immunity, an increased susceptibility to intracellular microorganisms has been observed. Rickettsiae are obligate intracellular microorganisms. The aim of this study was to examine Rickettsia typhi and Rickettsia felis infections in HIV+ population. Sera of 341 HIV+ patients were evaluated by indirect immunofluorescent assay. Age, sex, residential locality, risk behavior, stage according to criteria of the Center for Disease Control and Prevention, CD4+/CD8+ T cells, Hepatitis B antigen, and Hepatitis C serology were surveyed. Seroprevalences of R. typhi and R. felis infection were 7.6% and 4.4%, respectively. No associations were found between seropositivities and the assessed variables. Findings were similar to those obtained in healthy subjects from the same region.

Disseminated infection by Mycobacterium sherrisii and Histoplasma capsulatum in an African HIV-infected patient.

Mycobacterium sherrisii is a new species of opportunistic, slow-growing, non-tuberculous Mycobacterium closely related to Mycobacterium simiae that can currently be identified with the sequence of 16S rARN gene and the heat-shock protein 65. Few cases of patients infected by this Mycobacterium have been reported and all of them were associated with human immunodeficiency virus or other immunosuppressive conditions. Clinical management is complex, because there is not a clear correlation between the in vitro antibiotic susceptibility testing and the patient's clinical outcome.

[Genitourinary mycobacteriosis: retrospective study of 45 cases in a general hospital]. / Micobacteriosis genitourinaria: estudio retrospectivo de 45 casos en un hospital general.

INTRODUCTION: Genitourinary tuberculosis (GUT) is the third most frequent extrapulmonary tuberculous infection, following pleural and nodal involvement. Associated clinical symptoms are mild, and the diagnosis and treatment of this condition are often delayed. METHODS: This study determines the clinical and epidemiological characteristics, and outcome of patients diagnosed with GUT in our center over the last 10 years. Patients with positive Löwenstein-Jensen urine or biopsy culture, or pathologic study suggestive of tuberculosis were included. Cases of multifocal tuberculosis and positive Löwenstein-Jensen, but with no urinary symptoms or radiological alterations, were considered to have mycobacteriuria. RESULTS: Forty-five patients were analyzed (62% men; mean age, 49.4 years). Among the total, 33% had a coexisting disease (14 were infected by human immunodeficiency virus). Twenty-six patients (57%) had renal tuberculosis, 5 (11%) orchiepididymitis, and 14 (31%) were classified as having mycobacteriuria. The most frequent clinical manifestations were urination syndrome (61%), low back pain (44%), and macroscopic hematuria (12%). Ziehl stain was positive in 38% cases. Urine culture was positive for other microorganisms in 9 patients (20%). Intravenous urography oriented the diagnosis in 87.5% of cases. The average interval between onset of symptoms and diagnosis was 15 months. Cure without sequelae was obtained in 60%. Surgery was indicated in 10 patients. CONCLUSIONS: The index of suspicion for GUT should be high when patients present with repeated urinary syndromes. The current use of imaging studies other than urography and the finding of other microorganisms in urine culture can delay the diagnosis.

Micobacteriosis genitourinaria: estudio retrospectivo de 45 casos en un hospital general / Genitourinary mycobacteriosis: retrospective study of 45 cases in a general hospital

INTRODUCCIÓN. La tuberculosis genitourinaria (TGU) es la afección extrapulmonar más frecuente tras la pleural y ganglionar. Dada su escasa sintomatología clínica su diagnóstico y tratamiento son, a menudo, tardíos. MÉTODOS. Estudio de las características clínicas, epidemiológicas y evolutivas de los pacientes diagnosticados de TGU en nuestro centro los últimos10 años. Se han incluido los pacientes con cultivo de Löwenstein positivo, en orina o en muestras de biopsiaso con estudio anatomopatológico compatible con tuberculosis. Los casos de tuberculosis multifocal, Löwenstein positivo sin clínica urinaria ni alteraciones radiológicas se consideraron micobacteriuria. RESULTADOS. Se han analizado 45 pacientes (el 62%hombres con una edad media de 49,4 años). En el 33%coexistía enfermedad de base (14 infectados por el virus de la inmuno deficencia humana). Se diagnosticaron de tuberculosis renal 26 pacientes (57%), 5 (11%) de orquiepididimitis y 14 (31%) se catalogaron como micobacteriuria. La sintomatología más frecuente fue síndrome miccional (60%), dolor lumbar (44%) y hematuriama croscópica (12%). La tinción de Ziehl fue positiva en el38% de los casos. El urocultivo fue positivo para otros gérmenes en 9 pacientes (20%). La urografía intravenosa orientó el diagnóstico en 28/32 casos (87,5%). El intervalo medio de síntomas previos al diagnóstico fue de 15 meses. La curación sin secuelas se logró en el 60%. Se indicó cirugía en 10 casos. CONCLUSIONES. Se debe incrementar el grado de sospechade TGU ante síndromes urinarios de repetición. La menor utilización actual de la urografía frente a otras pruebas de imagen y el hallazgo de otros gérmenes en el urocultivo pueden retrasar el diagnóstico (AU)

INTRODUCTION. Genitourinary tuberculosis (GUT) is the third most frequent extrapulmonary tuberculous infection, following pleural and nodal involvement. Associated clinical symptoms are mild, and the diagnosis and treatment of this condition are often delayed. METHODS. This study determines the clinical and epidemiological characteristics, and outcome of patients diagnosed with GUT in our center over the last 10 years. Patients with positive Löwenstein-Jensen urine or biopsyculture, or pathologic study suggestive of tuberculosis were included. Cases of multifocal tuberculosis and positive Löwenstein-Jensen, but with no urinary symptoms or radiological alterations, were considered to have mycobacteriuria. RESULTS. Forty-five patients were analyzed (62% men; mean age, 49.4 years). Among the total, 33% had acoexisting disease (14 were infected by human immunodeficiency virus). Twenty-six patients (57%) had renal tuberculosis, 5 (11%) orchiepididymitis, and 14 (31%)were classified as having mycobacteriuria. The most frequent clinical manifestations were urination syndrome(61%), low back pain (44%), and macroscopic hematuria(12%). Ziehl stain was positive in 38% cases. Urine culture was positive for other microorganisms in 9 patients (20%).Intravenous urography oriented the diagnosis in 87.5% of cases. The average interval between onset of symptoms and diagnosis was 15 months. Cure without sequelae was obtained in 60%. Surgery was indicated in 10 patients. CONCLUSIONS. The index of suspicion for GUT should be high when patients present with repeated urinary syndromes. The current use of imaging studies other than urography and the finding of other microorganisms inurine culture can delay the diagnosis (AU)

[Infectious osteitis pubis]. / Osteítis infecciosa del pubis.

INTRODUCTION: Infectious osteitis pubis is an uncommon disease that must be distinguished from the noninfectious form of this condition. METHODS: Four cases of infectious osteitis pubis diagnosed over the last ten years in our hospital are described. RESULTS: The diagnosis was established on the basis of clinical symptoms, consistent imaging studies, and positive blood cultures (2/4) or bone biopsy (2/4). Prolonged antibiotic treatment with previous debridement of abscesses provided favorable outcomes (4/4). CONCLUSION: Infectious osteitis pubis should be suspected in patients with groin pain and predisposing factors.

Osteítis infecciosa del pubis / Infectious osteitis pubis

INTRODUCCIÓN. La osteítis infecciosa del pubis es una entidad poco frecuente que debe diferenciarse de su formano infecciosa. MÉTODOS. Descripción de cuatro casos de osteítis infecciosa del pubis diagnosticados en los últimos 10 años en nuestro centro. RESULTADOS. El diagnóstico se estableció mediante clínica e imagen sugestiva junto con hemocultivos positivos (2/4) o por biopsia ósea (2/4). La antibioticoterapia prolongada, con desbridamiento en caso de absceso, ofreció resultados satisfactorios (4/4).CONCLUSIÓN. La osteítis infecciosa del pubis debe sospecharse en pacientes con dolor inguinal y factores predisponentes (AU)

INTRODUCTION. Infectious osteitis pubis is an uncommon disease that must be distinguished from the non-infectious form of this condition. METHODS. Four cases of infectious osteitis pubis diagnosed over the last ten years in our hospital are described. RESULTS. The diagnosis was established on the basis of clinical symptoms, consistent imaging studies, and positive blood cultures (2/4) or bone biopsy (2/4).Prolonged antibiotic treatment with previous debridement of abscesses provided favorable outcomes (4/4).CONCLUSION. Infectious osteitis pubis should be suspected in patients with groin pain and predisposing factors (AU)

Seroprevalence of Bartonella spp. infection in HIV patients in Catalonia, Spain.

BACKGROUND: Although the first clinical descriptions of Bartonella infection were associated with immunocompromised patient with bacillary angiomatosis, we currently know that this organism is directly involved in diseases affecting a large number of patients, regardless of their immune status. Cat scratch disease, hepatic peliosis, and some cases of bacteraemia and endocarditis, are directly caused by some species of the genus Bartonella. The purpose of this study was to determinate the prevalence of IgG antibodies against Bartonella henselae and B. quintana in HIV patients and to identify the epidemiological factors involved. METHODS: Serum samples were collected from HIV patients treated at Hospital de Sabadell. Antibodies to B. henselae and B. quintana from 340 patients were examined by indirect immunofluorescence assay (IFA). Significance levels for univariate statistical test were determined by the Mann-Whitney U test and chi2 test. RESULTS: Of 340 patients, 82 were women and 258 men, with a median age of 42.21 +/- 10.35 years (range 16-86 years). Seventy-six (22.3%) patients reacted with one or more Bartonella antigens. Of all the factors concerning the seroprevalence rate being studied (age, sex, intravenous drugs use, alcohol consumption, CD4 levels, AIDS, HCV, HBV, residential area), only age was statistically significant. CONCLUSION: A high percentage of HIV patients presents antibodies to Bartonella and is increasing with age.

Epidemiological and clinical features, response to HAART, and survival in HIV-infected patients diagnosed at the age of 50 or more.

BACKGROUND: Over the last years, the mean age of subjects with HIV infection and AIDS is increasing. Moreover, some epidemiological and clinical differences between younger and older HIV-infected individuals have been observed. However, since introduction of HAART therapy, there are controversial results regarding their response to HAART. The aim of the present study is to evaluate epidemiological and clinical features, response to HAART, and survival in elderly HIV-infected patients with regard to younger HIV-infected patients. METHODS: A prospective cohort study (1998-2003) was performed on patients from Sabadell Hospital, in Northeast of Spain. The cohort includes newly attended HIV-infected patients since January 1, 1998. For the purpose of this analysis, data was censured at December 31, 2003. Taking into account age at time of diagnosis, it was considered 36 HIV-positive people aged 50 years or more (Group 1, G1) and 419 HIV-positive people aged 13-40 years (Group 2, G2). Epidemiological, clinical, biological and therapy data are recorded. Statistical analysis was performed using Chi-squared test and Fisher exact test, Mann-Whitney U test, Kaplan-Meier, Log Rank test, and Two-Way ANOVA from random factors. RESULTS: G1 showed higher proportion of men than G2. The most common risk factors in G1 were heterosexual transmission (P = 0.01) and having sex with men or women (P < 0.001). G1 and G2 show parallel profiles through the time regarding immunological response (P = 0.989) and virological response (P = 0.074). However, older people showed lower CD4 cell counts at first clinic visit (P < 0.001) and, eventually, they did not achieve the same counts as G2. G1 presented faster progression to AIDS (P < 0.001) and shorter survival (P < 0.001). CONCLUSION: Older patients have different epidemiological features. Their immunological and virological responses are good. However, older patients do not achieve the same CD4 cell counts likely due to they have lower counts at first clinic visit. Thus, it is essential physicians know older HIV-infected patients features to consider the possibility of HIV infection in these patients with the aim of treatment would not be delayed.

Efficacy and safety of pegylated interferon-alpha2b plus ribavirin for the treatment of chronic hepatitis C in HIV-infected patients.

Low response rates and concerns about safety have limited the implementation of treatment for chronic hepatitis C (CHC) in patients with HIV infection. The efficacy and safety of pegylated interferon (peg-IFN) plus ribavirin in HIV-infected patients with CHC were evaluated in a prospective, open-label, multicenter study. Sixty patients with persistently high transaminases, positive HCV-RNA, CD4 count > or = 300 cells/microl, and HIVRNA <10,000 copies/ml were included. Patients were given peg-IFN 80-150 microg/week plus ribavirin 800-1200 mg/day. Treatment was scheduled for 24 weeks for genotypes 2/3 and 48 weeks for genotypes 1/4. In an intent- to-treat analysis, 16 (26.7%) patients achieved a sustained virological response (SVR). Twenty patients (33.3%) discontinued treatment prematurely, but only in 10 (16.6%) was discontinuation due to adverse events. Negative predictive values for SVR on the basis of HCV-RNA decline between baseline and week 4 were 100% for 1- and 2-log10 fall, and positive predictive values were 40% and 58.3% for 1- and 2-log10 fall, respectively. CD4 fell by a median of 216 cells during treatment, but no HIV-associated complications occurred. In conclusion, treatment with peg-IFN alpha-2b plus ribavirin is safe and clears RNA-HCV in about one-quarter of HIV-infected patients with CHC. Efforts should be focused on optimizing management of side effects and counseling to improve adherence and to keep patients on treatment. Assessment of HCV-RNA at week 4 may help guide early therapeutic decision making.

[Clinical and epidemiological study of a series of HIV-infected patients over 50 years old]. / Estudio de una serie clínica de pacientes infectados por el VIH mayores de 50 años.

INTRODUCTION: The epidemiology of human immunodeficiency virus (HIV) infection has changed in recent years. Cases in persons over the age of 50 have increased, and the most frequent mode of transmission is sexual contact. The objective of this study is to analyse the epidemiological, clinical and evolution characteristics of a clinical series of HIV-infected patients over 50 years old at the time of diagnosis. METHODS: 165 HIV-infected patients over the age of 50, attended at Hospital Clinic (Barcelona) and Corporació Parc Taulí (Sabadell) during the period of 1985 to 2001, were studied. RESULTS: Among the total, 81% of the patients were men, mean age at the time of diagnosis was 58.5 years, and 81.8% had acquired the disease by sexual contact. The median initial CD4 T cell count was 216 cells/microl. Initial viral load was 1,000-100,000 copies/ml in 45.2% of the patients, whereas 52.3% had > 100,000 copies/ml. At the time of diagnosis, 30.9% had an AIDS-defining disease. The main opportunistic diseases were pulmonary tuberculosis, Kaposi's sarcoma, P. jiroveci (before carinii) pneumonia and non-Hodgkin lymphoma. Mortality due to AIDS was 32.7%. CONCLUSIONS: Subjects over 50 years old diagnosed with HIV-infection were predominantly men, who acquired the infection by sexual contact. A high percentage of patients were diagnosed with the development of an opportunistic disease.

Estudio de una serie clínica de pacientes infectados por el VIH mayores de 50 años / Clinical and epidemiological study of a series of HIV-infected patients over 50 years old

INTRODUCCIÓN. La epidemiología de la infección por el virus de la inmunodeficiencia humana (VIH) ha cambiado en los últimos años. Se observa un aumento de casos de infección en personas mayores de 50 años, y el mecanismo de transmisión más frecuente es la vía sexual. El objetivo de este estudio es analizar las características epidemiológicas, clínicas y evolutivas de una serie clínica de pacientes infectados por el VIH mayores de 50 años en el momento del diagnóstico. MÉTODOS. Se estudiaron 165 pacientes infectados por el VIH mayores de 50 años procedentes del Hospital Clínic de Barcelona y de la Corporació Parc Taulí de Sabadell en el período comprendido entre 1985 y 2001. RESULTADOS. El 81% de los pacientes eran varones. La edad media en el momento del diagnóstico fue de 58,4 años. El 81,8% adquirieron la infección por vía sexual. La media de CD4 iniciales fue de 216 cél./ml. El 45,2% de los pacientes presentaban una carga viral inicial entre 1.000 y 100.000 copias/ml y el 52,3% > 100.000 copias/ml. El 30,9% de los pacientes presentaban una enfermedad definitoria de sida en el momento del diagnóstico. Las principales enfermedades oportunistas fueron la tuberculosis pulmonar, el sarcoma de Kaposi, la neumonía por Pneumocystis jiroveci (antes carinii) y el linfomano hodgkiniano. El 32,7% murieron por sida. CONCLUSIONES. Las personas mayores de 50 años que se infectaron por el VIH eran predominantemente varones y adquirieron la infección por vía sexual. Existe una alta proporción de pacientes que fueron diagnosticados por una enfermedad oportunista (AU)

INTRODUCTION. The epidemiology of human immunodeficiency virus (HIV) infection has changed in recent years. Cases in persons over the age of 50 have increased, and the most frequent mode of transmission is sexual contact. The objective of this study is to analyse the epidemiological, clinical and evolution characteristics of a clinical series of HIV-infected patients over 50 years old at the time of diagnosis. METHODS. 165 HIV-infected patients over the age of 50,attended at Hospital Clinic (Barcelona) and Corporació Parc Taulí (Sabadell) during the period of 1985 to 2001,were studied. RESULTS. Among the total, 81% of the patients were men, mean age at the time of diagnosis was 58.5 years, and 81.8% had acquired the disease by sexual contact. The median initial CD4 T cell count was 216 cells/ml. Initial viralload was 1,000-100,000 copies/ml in 45.2% of the patients, whereas 52.3% had > 100,000 copies/ml. At the time of diagnosis, 30.9% had an AIDS-defining disease. The main opportunistic diseases were pulmonary tuberculosis, Kaposi’s sarcoma, P. jiroveci (before carinii) pneumonia and non-Hodgkin lymphoma. Mortality due to AIDS was 32.7%. CONCLUSIONS. Subjects over 50 years old diagnosed with HIV-infection were predominantly men, who acquired the infection by sexual contact. A high percentage of patients were diagnosed with the development of an opportunistic disease (AU)

Bacillary angiomatosis caused by Bartonella quintana.

Bacillary angiomatosis is a disorder of neovascular proliferation involving skin and lymph nodes of immunosuppressed patients. Bartonella henselae or Bartonella quintana have been inculpated as causative by direct culture or PCR amplification of DNA sequences. Here, we report the clinical evolution of a patient infected with human immunodeficiency virus (HIV) whose B. quintana infection was diagnosed by PCR.

QT prolongation and Torsades de Pointes in patients infected with human immunodeficiency virus and treated with methadone.

Four patients infected with human immunodeficiency virus receiving antiretroviral treatment and high doses of methadone (>200 mg/day) presented with several syncopal episodes. A significant prolongation of the QTc interval was detected in all of them, and in 3 patients, > or =1 episode of Torsades de Pointes was recorded. The sequence of events in these cases suggests that high doses of methadone caused QT prolongation and provided the substrate for syncope and Torsades de Pointes.

Recurrent stroke as a manifestation of primary angiitis of the central nervous system in a patient infected with human immunodeficiency virus.

CONTEXT: Cerebral vasculitis in patients infected with human immunodeficiency virus (HIV) is usually related to additional or secondary infectious agents other than neoplastic diseases or HIV itself. OBJECTIVE: To describe a 31-year-old patient infected with HIV who presented with 2 recurrent, acute episodes of neurologic impairment in a 5-month period. DESIGN: Comparison of clinical and histologic data between the present case and previously published cases. SETTING: Community hospital. PATIENT: A 31-year-old, HIV-infected patient with recurrent strokes and chronic lymphocytic meningitis. INTERVENTION: After ruling out cardiac embolisms and coagulation disorders, the presence of central nervous system vasculitis, probably secondary to an infectious process, was suspected based on the clinical examination and cerebrospinal fluid abnormalities. RESULTS: Necropsy findings suggest the diagnosis of primary angiitis of the central nervous system, and the only infectious agent that could be found was HIV. CONCLUSIONS: Histologic studies were compatible with a diagnosis of primary angiitis of the central nervous system, but the pathogenic role of HIV in the genesis of the vasculitic process cannot be elucidated.