1/17. Acute phlegmonous jejunitis and viridans streptococcal peritonitis associated with bronchial carcinoma.A 61-y-old man developed acute non-specific phlegmonous jejunitis associated with relatively mild diffuse peritonitis. Bacteriological cultures of the abundant peritoneal fluid resulted in only growth of viridans streptococci (streptococcus mitis and S. salivarius). Antibiotic treatment had a favourable effect, but a hitherto unknown bronchial cancer led to his death 5 months later. It is assumed that this peculiar case was the result of the immunosuppressive effect related to the malignant neoplasm (opportunistic infection).- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
2/17. nocardia asteroides lung abscess in acute ulcerative colitis treated with cyclosporine.cyclosporine is a potent suppresser of cell-mediated immunity that is mainly used in organ transplantation to prevent rejection. It is also being used increasingly outside of transplantation and probably is the only new treatment to have made an impact in acute ulcerative colitis (UC) resistant to steroid therapy. We describe a case of nocardia asteroides lung abscess in a patient treated with cyclosporine for acute steroid resistant UC that was successfully managed with antibiotics and by discontinuing cyclosporine. With increasing use of cyclosporine for acute UC it is to be anticipated that opportunistic infections such as Nocardia will be more frequently encountered in the future.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
3/17. Acute respiratory failure following HAART introduction in patients treated for pneumocystis carinii pneumonia.Cases of paradoxical worsening of opportunistic infections shortly after the beginning of highly active antiretroviral therapy (HAART) prompted questions on the optimal timing of introduction of HAART in patients with inaugural aids-related opportunistic infections. We describe three cases of acute respiratory failure after early introduction of HAART in patients treated for pneumocystis carinii pneumonia (PCP). The three patients had severe PCP that initially improved with anti-PCP and adjunctive steroid therapy. HAART was introduced 1 to 16 d after diagnosis of PCP, and steroids were stopped on Day 15. Seven to 17 d after HAART introduction, the three patients developed a second episode of severe acute respiratory failure with high-grade fever and patchy alveolar opacities on the chest roentgenogram. PCP resistant to cotrimoxazole, pulmonary superinfection, and drug-related pneumonitis were suspected but subsequently ruled out. bronchoalveolar lavage and lung pathologic findings showed severe nonspecific pulmonary inflammatory foci surrounding a few persistent P. carinii cysts. All three patients recovered after HAART interruption or steroid reintroduction. We conclude that acute respiratory failure can recur after initiation of antiretroviral therapy in patients being treated for severe PCP. This phenomenon could result from rapid pulmonary recruitment of fully competent immune and inflammatory cells responding to a few persistent P. carinii cysts. A short course of steroid therapy may suppress this reaction.- - - - - - - - - - ranking = 2keywords = opportunistic infection (Clic here for more details about this article) |
4/17. Sinopulmonary aspergillosis in children with hematological malignancy.invasive pulmonary aspergillosis is a serious infectious complication in immunocompromised especially neutropenic patients. Despite improvements in early diagnosis and effective treatment, invasive pulmonary aspergillosis is still a devastating opportunistic infection. These infections also interfere with the anticancer treatment. We report our experience in the diagnosis and therapeutic management of sinopulmonary aspergillosis in 4 children with hematologic malignancy. All patients except the first were neutropenic when sinopulmonary aspergillosis was diagnosed. Clinical signs included fever, cough, respiratory distress, swallowing difficulty, headache, facial pain-edema and hard palate necrosis. Radiodiagnostic methods showed bilateral multiple nodular infiltrations, soft tissue densities filling all the paranasal sinuses, and bronchiectasis. Diagnosis of aspergillosis was established by bronchoalveolar lavage in one case, tissue biopsy, positive sputum and positive cytology, respectively, in the other 3 cases. One patient was treated with liposomal amphotericin b and other 3 cases were treated with liposomal amphotericin b itraconozole. Outcome was favorable in all cases except the one who died due to respiratory failure. early diagnosis, appropriate treatment and primary disease status are important factors on prognosis of aspergillus infections in children with hematological malignancy.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
5/17. Disseminated histoplasmosis in patients receiving low-dose methotrexate therapy for psoriasis.BACKGROUND--Low-dose methotrexate sodium therapy used for nonmalignant disease has been associated with a variety of opportunistic infections with pathogens occurring in patients with defective cellular immunity. This article describes the unusual development of disseminated histoplasmosis as a probable complication of immunosuppression resulting from use of methotrexate. OBSERVATIONS--We report the cases of three patients in whom disseminated histoplasmosis developed while receiving low-dose methotrexate therapy for psoriasis. disease manifestations were unusually severe in two of the three patients. All three cases were disseminated, and two cases resulted in illnesses requiring intensive medical treatment. Each patient responded appropriately to antifungal treatment, although one patient has required long-term suppressive treatment because of persistent histoplasma antigenuria. These cases illustrate the risk for opportunistic fungal infections in patients receiving low-dose methotrexate therapy for nonmalignant diseases. CONCLUSIONS--histoplasma should be added to the list of pathogens to be suspected in patients receiving such therapy.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
6/17. Esophageal candidiasis associated with acute infection due to human immunodeficiency virus: case report and review.Esophageal candidiasis, an opportunistic infection that generally occurs in the latest phases of infection due to the human immunodeficiency virus (hiv), is currently a diagnostic criterion for acquired immunodeficiency syndrome (AIDS). We recently treated one patient for esophageal candidiasis associated not with AIDS but with acute hiv infection. At follow-up 19 months later, he was well and had no symptoms related to infection with hiv. We reviewed nine previously reported cases of esophageal candidiasis associated with acute hiv infection. None of the patients involved had other predisposing illnesses or risk factors for candidiasis. The case described herein, together with those reviewed, supports a revision of the Centers for disease Control's clinical definition of primary hiv infection to include esophageal candidiasis in the clinical spectrum. Moreover, the value of esophageal candidiasis as a diagnostic criterion for AIDS should be reassessed.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
7/17. pyomyositis complicating the acquired immunodeficiency syndrome. A report of two cases with coexistent neutropenia.OBJECTIVE: To identify some factors contributing to the development of pyomyositis in patients with the acquired immunodeficiency syndrome (AIDS) by a report of two cases and a review of the literature. CLINICAL FEATURES: A 36-year-old man with AIDS presented with tenderness of the left adductor longus muscle; a 28-year-old man with AIDS presented with fever and left leg pain. Both men had a history of severe neutropenia induced by drug treatment and opportunistic infections requiring treatment in hospital. The pyomyositis was defined by a gallium-67 scan (and, in one case, by a computed tomography scan). In one case staphylococcus aureus was cultured from blood; in the other it was cultured from pus from the pyomyositic abscess. INTERVENTIONS: Both patients had their abscesses drained. The first patient was treated with flucloxacillin (2 g every four hours, given intravenously) and rifampicin (450 mg by mouth each day). The second patient was treated with flucloxacillin (2 g every four hours, given intravenously) and ticarcillin (3 g every six hours, given intravenously). OUTCOME: After their symptoms abated, both patients were discharged from hospital, taking flucloxacillin by mouth as ongoing treatment. CONCLUSIONS: staphylococcal infections are increasingly common in neutropenic patients. neutropenia is likely to have contributed to the development of pyomyositis in these patients.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
8/17. A case of acute encephalopathy caused by the human immunodeficiency virus apparently responsive to zidovudine.A case of acute encephalopathy, which apparently was caused by the human immunodeficiency virus and occurred late in the course of this infection yet before any opportunistic infections occurred, is presented. The encephalopathy was considered to be responsive to zidovudine and dexamethasone; this therapy resulted in an excellent, sustained clinical remission. Magnetic resonance images and the histopathological findings also are described.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
9/17. Diffuse intestinal ulceration after marrow transplantation: a clinicopathologic study of 13 patients.The cases of 13 allogeneic marrow transplant recipients who had undergone laparotomy for manifestations of severe enteritis were reviewed to determine the causes of the severe intestinal disease and to assess the relation between clinical, histologic, and microbiologic findings. Laparotomies were performed a median of 63 days (range, 11 to 273 days) after transplantation for suspected peritonitis, intestinal obstruction, or bleeding. Intestinal tissue was available from small bowel resections in nine patients, intraoperative biopsies in one, and from autopsies in three patients who died shortly after laparotomy. Widespread small bowel ulceration was present in all 13 cases. Four causes of ulceration were identified: chemoradiation toxicity (n = 2), acute graft-versus-host disease (GVHD) (n = 5), opportunistic infections superimposed on either GVHD or toxicity from chemotherapy (n = 4), and Epstein-Barr virus-associated lymphoproliferative disorder (n = 2). Intestinal infections, unrecognized before laparotomy, were due to cytomegalovirus (CMV), herpes simplex virus (HSV), adenovirus, and Torulopsis glabrata. CMV- and HSV-infected cells, often lacking diagnostic inclusions, were identified in the intestine by in situ hybridization with biotinylated dna probes. Eleven patients died in the perioperative period, and two died 452 and 558 days after surgery of complications of chronic GVHD. Poor outcomes were related to extensive intestinal involvement, which was commonly underestimated before surgery, failure to diagnose intestinal infections early, poor marrow function, impaired immunity, and refractoriness of severe GVHD.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
10/17. Early onset acute orbital involvement in childhood acute lymphoblastic leukemia.A 5-year-old girl with acute lymphoblastic leukemia undergoing induction chemotherapy experienced acute proptosis while agranulocytotic and febrile. Orbital biopsy showed leukemic infiltration, and complete resolution was achieved with local irradiation and chemotherapy. Early onset orbital involvement is highly unusual in acute lymphoblastic leukemia. In the setting of agranulocytosis and fever, rapidly enlarging intraorbital masses require urgent ophthalmologic attention. Immediate biopsy is indicated to distinguish between several treatable conditions including opportunistic infection, hemorrhage, and neoplastic infiltration.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
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