1/58. Management of opportunistic infections in acquired immunodeficiency syndrome. I. Treatment.A case report of a patient infected with human immunodeficiency virus (hiv) is described. The patient presents with a multitude of medical complaints that are of acute or subacute onset. The medical examination of these complaints is described and includes algorithms for the diagnosis and treatment of the most common hiv-related opportunistic infections, including pneumocystis carinii pneumonia, toxoplasmosis, mycobacterium avium complex, cytomegalovirus infection, and cryptococcal meningitis.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
2/58. Successful treatment of cytomegalovirus colitis with ganciclovir in a patient with adult T cell leukemia lymphoma: case report.An 84-year-old patient with adult T cell leukemia lymphoma (ATLL) developed diarrhea on day 5 of chemotherapy and was diagnosed with cytomegalovirus (CMV) colitis. sigmoidoscopy revealed multiple superficial erosions surrounded by a flare. Computed tomography (CT) and ultrasonogram of the abdomen revealed marked thickening of the colonic mucosa. There were 186 CMV antigen-positive leukocytes per 31,000 white blood cells (WBC). A colonic biopsy specimen showed typical CMV nuclear inclusions. Immunohistological study of the specimen was positive for CMV antigen. Administration of ganciclovir (DHPG) 500 mg/day for 14 days improved the diarrhea and other symptoms. On day 30 of the chemotherapy, the patient developed diarrhea again but was diagnosed with pseudomembranous colitis instead of CMV colitis. At that time, CMV antigenemia and a histologic study for CMV were negative. The stool was positive for clostridium difficile toxin antigen. ATLL patients are believed to be immunocompromised hosts and often develop opportunistic infections such as CMV infection. Most suffer from CMV pneumonia at the end of their course of therapy. Few gastrointestinal (GI) CMV infections are seen in ATLL patients and details of CMV colitis have never been reported. When an ATLL patient develops diarrhea that barely responds to conventional therapy, CMV colitis and pseudomembranous colitis should be listed in the differential diagnosis.- - - - - - - - - - ranking = 0.2keywords = opportunistic infection (Clic here for more details about this article) |
3/58. cytomegalovirus pneumonitis as an initial presentation in an hiv-infected patient.Human immunodeficiency (hiv) infection often presents with an unusual symptom complex. Although cytomegalovirus (CMV) is a frequent opportunistic infection in the late stage of acquired immunodeficiency syndrome (AIDS), CMV pneumonitis as an initial manifestation of hiv infection is not documented in the medical literature. We report a previously healthy patient with bilateral interstitial pulmonary infiltrates who was found to have CMV pneumonitis; only later was hiv virus infection diagnosed. cytomegalovirus is a frequently isolated pathogen from respiratory secretions in AIDS patients. The role of CMV as a sole pulmonary pathogen is controversial. After exclusion of other pathogens, CMV was demonstrated by histological changes and viral culture in our case. This case indicates that pulmonary infiltrates presenting as the first manifestation of hiv infection can be caused by CMV infection.- - - - - - - - - - ranking = 0.2keywords = opportunistic infection (Clic here for more details about this article) |
4/58. Esophageal ulcer caused by cytomegalovirus: resolution during combination antiretroviral therapy for acquired immunodeficiency syndrome.A 36-year-old man with a 5-year history of untreated human immunodeficiency virus (hiv) infection had odynophagia for 14 days. Fifteen days earlier, he had begun taking trimethoprim-sulphamethoxazole and combination antiretroviral therapy that included lamivudine, zidovudine, and nelfinavir. He had no history of opportunistic infection. The cd4 lymphocyte count was 67/microL and hiv-rna level was 359,396 copies/mL. Esophagogastroduodenoscopy revealed a large, well-circumscribed esophageal ulceration 31 cm from the incisors. Histopathologic examination of esophageal biopsy specimens showed cytopathic changes diagnostic of cytomegalovirus (CMV). In situ dna hybridization was positive for CMV. While combination antiretroviral therapy was continued, the esophageal symptoms resolved within 4 days of endoscopy without specific therapy for CMV. Follow-up endoscopy 4 weeks later revealed a normal-appearing esophagus, and the patient has remained symptom-free for 10 months.- - - - - - - - - - ranking = 0.2keywords = opportunistic infection (Clic here for more details about this article) |
5/58. cytomegalovirus infection in systemic necrotizing vasculitis: causative agent or opportunistic infection?We report on a 69-year-old woman who presented with myalgia, hearing impairment, fever, night sweats, weight loss, muscular weakness, paresthesia, hypesthesia, and hypalgesia. sural nerve biopsy showed demyelinative and axonal polyneuropathy due to necrotizing vasculitis with fibrinoid necrosis. A positive test for antineutrophil cytoplasmic antibodies (ANCA) with a perinuclear immunofluorescence pattern directed against myeloperoxidase was more suggestive of microscopic polyangiitis (MPA) than of polyarteritis nodosa (PAN), the possible differential diagnoses. In addition, positive tests for cytomegalovirus (CMV) antibodies (immunoglobulin (Ig)M and IgG) and the detection of CMV-dna in sputum specimens by polymerase chain reaction (PCR) were indicative of active CMV infection. Treatment with ganciclovir and anti-CMV immunoglobulin in addition to prednisolone medication for 6 months resulted in rapid improvement of the clinical symptoms without relapse. CMV infection has been described to be related to ANCA-associated vasculitis in non-immunocompromized patients and may be either a causative agent or an opportunistic infection. Identification of a viral etiology in patients with atypical ANCA-associated vasculitides may lead to different, less aggressive treatment approaches, including antiviral therapy.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
6/58. Massive lower gastrointestinal hemorrhage caused by CMV disease as a presentation of hiv in an infant.The gastrointestinal (GI) manifestations of acquired immunodeficiency syndrome in children are related to opportunistic infections like cytomegalovirus (CMV). CMV disease of the GI tract is a major cause of morbidity and mortality in immunocompromised patients: it typically produces mucosal ulcerations that can result in pain, bleeding, diarrhea, and GI perforation, often around the cecum. Preoperative diagnosis may be difficult, plain films and barium enema are often non-specific, and endoscopic evaluation is impossible when there is massive bleeding. The patient usually needs surgery to establish the correct diagnosis and initiate appropriate treatment. The use of gancyclovir for CMV disease in the postoperative period has improved the prognosis.- - - - - - - - - - ranking = 0.2keywords = opportunistic infection (Clic here for more details about this article) |
7/58. Significant post-transplant hypogammaglobulinemia in six heart transplant recipients: an emerging clinical phenomenon?BACKGROUND: The recent development of powerful agents such as mycophenolate mofetil and tacrolimus has altered current regimens for the prevention and treatment of allograft rejection. Questions have been raised about these newer regimens in terms of susceptibility to opportunistic infections and effects on host defenses. Severe hypogammaglobulinemia has been infrequently described in solid organ transplant recipients, but has been recently noted in six heart transplant recipients at one center, of whom five were receiving a combination of tacrolimus, mycophenolate mofetil, and prednisone. methods: Case summaries of six recent heart transplant recipients with total immunoglobulin g (IgG) levels of less than 310 mg/dl, five of whom had cytomegalovirus (CMV) infection and three of whom had multiple infections including nocardia, invasive trichophyton, and acinetobacter bacteremia. Previous literature was reviewed with the aid of a medline search using the search terms hypogammaglobulinemia; kidney, liver, heart, lung, and organ transplantation; mycophenolate mofetil; tacrolimus; cyclosporine; azathioprine; and nocardiosis. RESULTS: We here report six cardiac transplant recipients seen over a period of one year who were found to have immunoglobulin g levels of 310 mg/dl or below (normal: 717-1400 mg/dl). The first five patients were diagnosed because of evaluation for infections; the sixth, who was asymptomatic with an IgG level of 175, was found during screening for hypogammaglobulinemia instituted as a result of these first five patients. All six patients had received steroid pulses for rejection; all received mycophenolate mofetil; and 5/6 had been switched from cyclosporine to tacrolimus because of steroid-resistant rejection. Transient neutropenia (absolute neutrophil count less than 1000) was observed in 2/6; 3/6 had received OKT3 therapy for refractory rejection. These six patients were treated with a combination of antimicrobials, immunoglobulin replacement, and decrease in immunosuppressive therapy. CONCLUSION: The finding of unexpected hypogammaglobulinemia and concomitant infectious complications in six heart transplant recipients highlights a possible complication in a subset of patients receiving newer immunosuppressive agents. A larger prospective study is underway to determine risk factors for development of post-transplant hypogammaglobulinemia and to assess pre-transplant immune status of these recipients. Monitoring of immunoglobulin levels in high-risk patients receiving intensified immunosuppressive therapy for rejection may help to prevent infectious complications.- - - - - - - - - - ranking = 0.2keywords = opportunistic infection (Clic here for more details about this article) |
8/58. autopsy case of alcoholic hepatitis and cirrhosis treated with corticosteroids and affected by pneumocystis carinii and cytomegalovirus pneumonia.A case of the very early phase of pneumocystis carinii pneumonia in a human immunodeficiency virus (hiv)-negative man with alcoholic hepatitis and cirrhosis treated with steroids is presented. A 40-year-old man with a 10-year history of alcohol abuse was admitted to hospital with jaundice, fever and macrohematuria. Laboratory examinations revealed neutrophilic leukocytosis and a serum bilirubin level of 13.9 mg/dL. The serum bilirubin level rose to 28.5 mg/dL over 1 month. prednisolone administered orally for 10 days produced a slight improvement in the jaundice and fever. After an interval of a week, it was resumed and maintained for 22 days (total dose, 1555 mg) until the patient died of a massive hemorrhage from ruptured vessels of a gastric ulcer. An autopsy disclosed P. carinii pneumonia in the lower lobe of the left lung, cytomegalovirus infection in both lungs and the esophagus, and esophageal candidiasis. To our knowledge, this is the first report of P. carinii pneumonia together with cytomegalovirus infection in an hiv-negative alcoholic patient. The present case suggests that a rare opportunistic infection such as P. carinii pneumonia might be caused by treating cirrhosis and alcoholic hepatitis with corticosteroids, even if only for a relatively short period.- - - - - - - - - - ranking = 0.2keywords = opportunistic infection (Clic here for more details about this article) |
9/58. Ileal perforation caused by cytomegalovirus infection in an immunocompetent adult.A 71-year-old woman developed a small bowel perforation due to cytomegalovirus infection. She did not taken any immunosuppressive medication and her cellular immunity was normal. Surgical resection and antiviral therapy with ganciclovir led to complete recovery. As far as we know, this paper reports the first case of small bowel perforation due to cytomegalovirus infection in a non-immunocompromised patient. Nevertheless the patient was known with diabetes mellitus. It should be emphasised that elderly patients have impaired immune defences and may be unsuspected hosts of opportunistic infections.- - - - - - - - - - ranking = 0.2keywords = opportunistic infection (Clic here for more details about this article) |
10/58. guillain-barre syndrome after heart transplantation.We present two cases of guillain-barre syndrome (acute idiopathic neuritis) that developed after heart transplantation involving immunosuppression with cyclosporine, azathioprine, and steroids. The literature contains only two previous reports of posttransplant guillain-barre syndrome, both involving patients maintained with azathioprine and steroid immunosuppression after kidney transplantation. In our two cases (and in one of the previous cases), the syndrome was preceded by a sudden increase in the amount of serum immunoglobulin M antibody to cytomegalovirus. One of our patients improved neurologically after plasmapheresis, but neither patient appeared to benefit from the administration of gamma globulin. Because further immunosuppression would predispose the transplant patient to other opportunistic infections, we advocate a trial of plasmapheresis in the treatment of guillain-barre syndrome in this population.- - - - - - - - - - ranking = 0.2keywords = opportunistic infection (Clic here for more details about this article) |
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