1/25. Active intestinal tuberculosis with esophageal candidiasis due to idiopathic CD4( ) T-lymphocytopenia in an elderly woman.We describe a case of intestinal tuberculosis and esophageal candidiasis in an 85-year-old Japanese woman with idiopathic CD4 T-lymphocytopenia (ICL). The patient exhibited clinical symptoms of odynophagia, bloody diarrhea, and high fever. physical examination on admission showed a poor nutritional status. Endoscopic examination of the upper digestive tract revealed the esophageal mucosa to be covered with yellowish-white plaque-like lesions. Colonoscopic examination revealed multiple annular ulcerations with bleeding. She was diagnosed with intestinal tuberculosis by polymerase chain reaction (PCR) and fecal culture. Her CD4 T-lymphocyte count was 178/mm3 and no evidence of human immunodeficiency virus (hiv) infection was found. She was successfully treated with fluconazole and antituberculosis drugs. This case emphasizes the importance of opportunistic infections in elderly patients with predisposing conditions such as ICL.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
2/25. Radiological findings in the diagnosis of genitourinary candidiasis.The presence of fungus balls within the collecting system is an important clue to the radiological diagnosis of genitourinary candidiasis. In this report, an 8-month-old infant with this opportunistic infection is described. Emphasis is placed on the radiological findings of renal candidiasis, including previously unreported MR appearances. Sonographic and Doppler findings of accompanying Candida epididymitis are also described.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
3/25. Candida oesophagitis with hepatitis C virus: an uncommon association.Candida oesophagitis is an acquired immune deficiency syndrome (AIDS)-defining illness. We report a 28-year-old woman who presented with Candida oesophagitis with underlying chronic hepatitis C. The patient presented with anorexia and weakness and was noted to have raised serum transaminases. Upper-gastrointestinal endoscopy revealed Candida oesophagitis involving the whole oesophagus. Oesophageal biopsy demonstrated changes consistent with Candida oesophagitis. serology was positive for hepatitis c antibodies, and polymerase chain reaction (PCR) genotyped hepatitis C virus (HCV) as genotype 3. liver biopsy revealed chronic hepatitis with moderately active portal inflammation. A human immunodeficiency virus (hiv) test was non-reactive for types 1 and 2. The development of Candida oesophagitis in a patient with chronic HCV infection demands prompt consideration of general debility and immunosuppression as effects of HCV that led to an occurrence of opportunistic infection. Evaluation of this case provides insight into various mechanisms of immune suppression associated with HCV infection.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
4/25. candidiasis-associated hemophagocytic lymphohistiocytosis in a patient infected with human immunodeficiency virus.We describe a patient with acquired immunodeficiency syndrome who developed candidiasis-associated hemophagocytic lymphohistiocytosis (HLH), and we review the previously reported cases of this unusual clinical syndrome in patients infected with human immunodeficiency virus (hiv). HLH appears to follow a fulminant course in hiv-infected patients, which warrants an aggressive diagnostic and therapeutic approach. hiv itself may play a role in the pathogenesis of HLH, which is usually associated with opportunistic infections or malignancies. Therapy is usually directed at supportive care and treatment of the underlying disorders, although initiation of antiretroviral therapy may improve the eventual outcome in some cases.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
5/25. Small bowel obstruction secondary to disseminated candidiasis in an immunocompromised patient: radiologic-pathologic correlation.immunosuppression for therapeutic reasons (e.g. post transplantation, post chemotherapy), as well as pathologic immunodeficiency due to certain pathologic conditions (e.g. AIDS, leukemia), is increasingly encountered in daily medical practice. As a result, the concomitant risk for opportunistic infections is higher and immunocompromised patients may present with uncommon clinical and radiologic conditions. We report on a case of a 33-year-old immunocompromised woman with a history of recurrent T-cell lymphoblastic lymphoma, which presented with abdominal pain. Computed tomography (CT) images demonstrated significant small bowel dilatation, wall thickening, and high-density intestinal content, with a focal point of transition in the pelvis. Extensive fungal enteritis due to candida albicans with partial small bowel obstruction was found on autopsy.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
6/25. 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) |
7/25. Severe clinical manifestations of primary hiv infection.Three cases of oesophageal candidiasis in association with primary hiv infection are described. In each case the candidiasis was associated with a decreased number of circulating CD4 cells and responded well to treatment with ketoconazole. Clinicians should be aware that severe opportunistic infections may develop during this stage of infection, presumably as a result of transient immunodeficiency. We argue that the definition of primary hiv infection should be extended to include severe opportunistic infections and neurologic presentations.- - - - - - - - - - ranking = 2keywords = opportunistic infection (Clic here for more details about this article) |
8/25. 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) |
9/25. Lower gastrointestinal hemorrhage in renal transplant recipients.A review of the literature and our own series revealed 38 patients with lower gastrointestinal (LGI) hemorrhage among 4086 renal transplant recipients (0.9%). These patients represent 30% of 128 patients with major colorectal complications in this group. Of the 32 patients whose treatment and outcome were reported, only 12 (38%) were treated operatively. The overall mortality rate was 72%. The causes of LGI hemorrhage included colitis from opportunistic infections (42%); pseudomembranous, ischemic, or uremic colitis (40%); and idiopathic ulcers of the colon (18%). Colonoscopic, gross, and histopathologic findings of a patient with massive LGI hemorrhage from a fungal ulcer of the colon are the focus of this study, as are the implications of such findings. We propose an algorithm for diagnostic and therapeutic management decisions. We emphasize prompt diagnosis and the importance of colonoscopy. We propose withdrawal of immunosuppression and early operative intervention if the patient survival rate is to improve.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
10/25. Management of opportunistic infections complicating the acquired immunodeficiency syndrome.Therapy of opportunistic infection in patients with the acquired immunodeficiency syndrome is frustrating, and there is no convincing evidence that aggressive treatment and/or prophylaxis other than for pneumocystis infection can significantly prolong life. While much clinical effort is expended on treating sequential life-threatening infections, the overall course is usually progressively downhill. Thus, any real impact on the disease should be aimed at the causative viral agent, because it is destruction of a critical component of the immune system that predisposes to opportunistic infections.- - - - - - - - - - ranking = 6keywords = opportunistic infection (Clic here for more details about this article) |
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