RESUMO
Fifty-eight AIDS patients who previously had Pneumocystis carinii pneumonia (PCP) were enrolled in an open trial of zidovudine therapy. We analyzed baseline clinical and laboratory parameters to identify predictors of outcome. Fifty-eight patients were followed for a mean of 26.5 weeks. There were 17 deaths; the probability of survival at 24 weeks was 0.81. Forty-one participants had unsuccessful outcomes, which included new opportunistic infections (24), progressive neurologic deterioration (2), and drug toxicity, excluding anemia, necessitating discontinuation of zidovudine (15). Only 24 subjects (41%) were receiving zidovudine at the end of the study period including 17 who had neither opportunistic infection nor toxicity. Low baseline hemoglobin level (p less than 0.001) and poor performance status as measured by the Karnofsky scale (p less than 0.01) independently predicted unsuccessful outcome and early death. Low hemoglobin (p = 0.001), low platelet count (p = 0.016), and increased time since PCP (p = 0.008) predicted development of drug toxicity. Neither CD4 lymphocyte count nor p24 antigenemia correlated with outcome.
Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Zidovudina/uso terapêutico , Síndrome da Imunodeficiência Adquirida/sangue , Adulto , Seguimentos , Humanos , Contagem de Leucócitos , Infecções Oportunistas , Pneumonia por Pneumocystis , Probabilidade , Prognóstico , Recidiva , Linfócitos T Auxiliares-Indutores/patologia , Fatores de Tempo , Zidovudina/toxicidadeRESUMO
Human immunodeficiency virus (HIV)-related thrombocytopenia has been well described and requires therapy in about one half of the patients. Conventional modes of therapy with prednisone, danazol, immunoglobulin, and/or splenectomy have not been uniformly successful. We have administered zidovudine to three patients with HIV-related thrombocytopenia. All three patients responded with a sustained increase in their platelet counts, despite discontinuation of conventional therapy. Interruption of zidovudine therapy was associated with a decrease in platelet count. Concomitant with the elevation in platelet count with zidovudine therapy, there was a reduction in the circulating p24 antigen levels. Whether the elevations in the platelet count in these patients with HIV-related thrombocytopenia is due to the antiviral effect of zidovudine is unknown. It is clear that further studies examining the prospective use of zidovudine in the treatment of HIV-related thrombocytopenia are indicated.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Trombocitopenia/tratamento farmacológico , Zidovudina/uso terapêutico , Adulto , Terapia Combinada , Antígenos HIV/análise , Humanos , Imunização Passiva , Contagem de Leucócitos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas/efeitos dos fármacos , Linfócitos T Auxiliares-Indutores/efeitos dos fármacos , Trombocitopenia/etiologia , Trombocitopenia/imunologia , Zidovudina/farmacologiaRESUMO
A case of community-acquired Achromobacter xylosoxidans bacteremia in a patient with metastatic breast carcinoma is described. The patient's home drinking water was identified as the source of her bacteremia. The case represents the first in which a community-acquired infection due to this organism has been attributed to a documented water source.
Assuntos
Alcaligenes/isolamento & purificação , Sepse/microbiologia , Abastecimento de Água , Idoso , Neoplasias da Mama/complicações , Feminino , Humanos , Microbiologia da ÁguaRESUMO
Acute cytomegalovirus mononucleosis has been associated with maculopapular rashes, petechiae, purpura, urticaria, ulcerative lesions, and vesicular eruptions. Although erythema nodosum has been reported in association with a number of infectious and noninfectious diseases, to our knowledge it has not been associated with cytomegalovirus infections. We report the first case of an adult patient with acute cytomegalovirus mononucleosis who presented with erythema nodosum.
