1/4. lung infection due to opportunistic fungus, Phialemonium obovatum, in a bone marrow transplant recipient: an emerging infection with fungemia and crohn disease-like involvement of the gastrointestinal tract.We report the first case of Phialemonium obovatum fungemia with subsequent caseating granulomatas in the lung and crohn disease-like involvement of the gastrointestinal tract in a bone marrow transplant recipient. This phaeoid fungus has been rarely described as an opportunistic infection in immunosuppressed patients. The patient was diagnosed with chronic myelogenous leukemia and underwent subsequent peripheral bone marrow transplant. After 6 months, he developed graft-versus-host disease of the skin and liver with fever and severe diarrhea. Fecal bacterial cultures and cytomegalovirus serologies were negative. Computed tomographic scan showed a peripheral pulmonary mass. A lung wedge biopsy of the lesion showed septate branching hyphae (4-5 microm in diameter) with terminal globular structures (10 microm in diameter). The hyphae were similar in width to that of an aspergillus species but had a more moniliform appearance. blood cultures grew a pure culture of P. obovatum. He was treated with amphotericin b and itraconazole for 6 months without remission of the diarrhea. Biopsies of the stomach, colon, and rectum showed granulomatous inflammation with marked crypt distortion simulating crohn disease. In retrospect, the fungus was found to be resistant to both of the aforementioned drugs and susceptible to voriconazole and posaconazole. The gastrointestinal findings raise the possibility of further dissemination of a partially treated Phialemonium infection.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
2/4. Severe gastrointestinal involvement in children with the acquired immunodeficiency syndrome.Five children with the acquired immunodeficiency syndrome (AIDS) and unusual gastrointestinal disease are described. Two children presented with malnutrition, abdominal distention, and diarrhea. One was found to have moderately severe villus atrophy on jejunal biopsy and was initially thought to have celiac disease. Jejunal biopsy from the second child revealed infiltration of the mucosa with acid-fast bacilli-laden macrophages. A third child suffered recurrent abdominal pain, progressive weight loss, diarrhea, and severe gastrointestinal hemorrhage secondary to infection with cytomegalovirus. Pseudomembranous necrotizing jejunitis associated with overgrowth of klebsiella pneumoniae in the duodenal fluid occurred in one patient. The fifth child presented in the newborn period with serratia marcescens cholecystitis. Gastrointestinal disease in children with AIDS may be due to idiopathic villus atrophy and bacterial or opportunistic infection.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
3/4. hiv-related gastrointestinal disease.Gastrointestinal disease is common in patients infected with hiv and can represent the first significant clinical illness. Diarrhoea, dysphagia, abdominal pain, jaundice or gastrointestinal bleeding may be the result of opportunistic infection, AIDS-related neoplasia, or infection with hiv alone. The spectrum of gastrointestinal tract and liver involvement in hiv infection is broad and has been well reviewed recently. This article is selective in that the main emphasis is placed on the variety of ways that hiv may first declare itself with symptoms in the gastrointestinal tract.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
4/4. Immunologically confirmed disseminated, asymptomatic encephalitozoon cuniculi infection of the gastrointestinal tract in a patient with AIDS.microsporidia are obligate intracellular protozoan parasites that infect a broad range of vertebrates and invertebrates. They are increasingly recognized as human pathogens, especially in patients infected with human immunodeficiency virus (hiv). Organisms of the genus Encephalitozoon have been implicated as a major cause of disseminated microsporidian infections in persons with AIDS. Until recently, E. hellem was the only Encephalitozoon species confirmed by antigenic or nucleic acid methods to have infected humans. We describe the clinical course and morphological features of a case of disseminated microsporidian infection with encephalitozoon cuniculi in an hiv-infected patient with chronic sinusitis, rhinitis, and keratoconjunctivitis. parasites were found in conjunctival swab, nasal discharge, sputum, urine, stool, and duodenal biopsy specimens, but no pulmonary, renal, or gastrointestinal symptoms were documented. The patient was treated with albendazole (400 mg po b.i.d.), resulting in complete remission of his ocular and nasal symptoms, and microsporidian spores disappeared from all sites. To our knowledge, this case is only the second of E. cuniculi infection in humans that has been confirmed by either antibody- or nucleic acid-based methods, and it is the first in which an Encephalitozoon species has been found in the intestinal tract of a human. microsporidiosis is an important emerging opportunistic infection in hiv-infected patients and, as documented in this report, has an expanding clinicopathologic spectrum.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |