1/47. typhoid fever and hiv infection: a rare disease association in industrialized countries.typhoid fever is still a global health problem, mainly in tropical and subtropical areas of the world and in developing countries, where relatively elevated morbidity and mortality rates still are present, mostly because of persisting poor hygienic conditions. In the majority of Mediterranean regions, including italy, the disease is constantly present, though with a low prevalence rate, as a result of an endemic persistence of salmonella typhi infection.1-4 On the other hand, in industrialized countries, most cases of S. typhi infection are related to foreign travel or prior residence in endemic countries.4-6 In the united states, 2445 cases of typhoid fever have been reported in the decade 1985 to 1994, and the annual number of cases remained relatively stable over time: over 70% of episodes were acquired in endemic countries (mostly mexico and india).6 The persisting morbidity of S. typhi also may be supported by the increasing resistance rate of this pathogen against a number of commonly used antimicrobial compounds. For instance, 6% of 331 evaluable S. typhi strains were resistant to ampicillin, chloramphenicol, and cotrimoxazole, and 22% of isolates were resistant to at least one of these three agents in a recent survey performed in the united states.6 The spread of antibiotic resistance among S. typhi isolates is emerging in many countries, and multidrug-resistant strains have been isolated, as well as isolates with poor susceptibility to fluoroquinolones,3-5,7-9 so that in vitro susceptibility should be determined for all cultured strains, and antimicrobial treatment should be adjusted accordingly. Nevertheless, fluoroquinolones (e.g., ciprofloxacin and pefloxacin) or third-generation cephalosporins, still represent the best choice for empirical treatment,2,4,6-8,10 and mortality remains rare in Western countries (less than 1% of episodes), although it is expected to be greater in developing areas of the world. The aim of this report is to describe two cases of typhoid fever that occurred in patients with human immunodeficiency virus (hiv) infection, a rarely reported disease association in industrialized countries.- - - - - - - - - - ranking = 1keywords = world (Clic here for more details about this article) |
2/47. Human bites and the risk of human immunodeficiency virus transmission.The risk of human immunodeficiency virus (hiv) transmission following a bite injury is important to many groups of people. The first are those who are likely to be bitten as an occupational risk, such as police officers and institutional staff. Another group are represented by the victims and perpetrators of crimes involving biting, both in attack and defense situations. The possibility of these bites transmitting a potentially fatal disease is of interest to the physicians who treat such patients and the legal system which may have to deal with the repercussions of such a transmission. Bite injuries represent 1% of all emergency department admissions in the united states, and human bites are the third most common following those of dogs and cats. The worldwide epidemic of hiv and acquired immunodeficiency syndrome (AIDS) continues, with >5 million new cases last year and affecting 1 in 100 sexually active adults. A review of the literature concerning human bites, hiv and AIDS, hiv in saliva, and case examples was performed to examine the current opinion regarding the transmission of hiv via this route. A bite from an hiv-seropositive individual that breaks the skin or is associated with a previous injury carries a risk of infection for the bitten individual.- - - - - - - - - - ranking = 0.5keywords = world (Clic here for more details about this article) |
3/47. Dermatofibroma parasitized by Leishmania in hiv infection: a new morphologic expression of dermal Kala Azar in an immunodepressed patient.Visceral leishmaniasis is a protozoan infection that may complicate the course of patients with human immunodeficiency virus (hiv). Dermatofibroma is a cutaneous fibrohistiocytic lesion considered neoplastic by some authors and inflammatory by others. Eruptive dermatofibromas have been described in patients with hiv infection or with other altered immunity situations. We present the case of a 32-year-old, hiv-positive man with visceral leishmaniasis who complained of the appearance of a cutaneous lesion in the leg formed by the coexistence of dermatofibroma and Leishmania parasitic colonization. As far as we know, this type of association has not been reported previously. We consider that the dermatofibroma could have developed as an unusual form of fibrohistiocytic reaction to leishmania. From a practical approach, we recommend the search of leishmaniasis in dermatofibroma in immunosuppressed patients.- - - - - - - - - - ranking = 16850.586613521keywords = leishmaniasis (Clic here for more details about this article) |
4/47. Human immunodeficiency virus infection transmitted through breast milk.Perinatal acquisition of human immunodeficiency virus is responsible for most cases of pediatric AIDS. breast feeding has been found to carry a higher risk of transmission of hiv and is not recommended to hiv infected mothers in the western world. In our country we have to be aware of the increasing incidence of pediatric AIDS and the varied constellation of symptoms it can present with. Also, we have to ensure that safe blood is available to avoid transfusion acquired diseases.- - - - - - - - - - ranking = 0.5keywords = world (Clic here for more details about this article) |
5/47. Post-kala-azar dermal leishmaniasis during highly active antiretroviral therapy in an AIDS patient infected with leishmania infantum.We report a case of post-kala-azar dermal leishmaniasis (PKDL) in a woman with AIDS which occurred 13 months after a diagnosis of visceral leishmaniasis concomitantly with immunological recovery induced by highly active retroviral therapy. Cytokine pattern at the time of visceral leishmaniasis and PKDL diagnosis was studied and pathogenic implications were discussed.- - - - - - - - - - ranking = 39318.035431549keywords = leishmaniasis (Clic here for more details about this article) |
6/47. Serious adverse events attributed to nevirapine regimens for postexposure prophylaxis after hiv exposures--worldwide, 1997-2000.In September 2000, two instances of life-threatening hepatotoxicity were reported in health-care workers taking nevirapine (NVP) for postexposure prophylaxis (PEP) after occupational human immunodeficiency virus (hiv) exposure. In one case, a 43-year-old female health-care worker required liver transplantation after developing fulminant hepatitis and end-stage hepatic failure while taking NVP, zidovudine, and lamivudine as PEP following a needlestick injury (1). In the second case, a 38-year-old male physician was hospitalized with life-threatening fulminant hepatitis while taking NVP, zidovudine, and lamivudine as PEP following a mucous membrane exposure. To characterize NVP-associated PEP toxicity, CDC and the food and Drug Administration (FDA) reviewed MedWatch reports of serious adverse events in persons taking NVP for PEP received by FDA (Figure 1). This report summarizes the results of that analysis and indicates that healthy persons taking abbreviated 4-week NVP regimens for PEP are at risk for serious adverse events. Clinicians should use recommended PEP guidelines and dosing instructions to reduce the risk for serious adverse events.- - - - - - - - - - ranking = 2keywords = world (Clic here for more details about this article) |
7/47. Visceral leishmaniasis in human immunodeficiency virus (hiv)-infected and non-hiv-infected patients. A comparative study.Visceral leishmaniasis is an endemic infection in Mediterranean countries, where it has become a frequent complication of acquired immunodeficiency syndrome (AIDS). The incidence of visceral leishmaniasis is increasing in spain due to human immunodeficiency virus (hiv)-related cases, but some aspects of its epidemiology, clinical features, and management remain unknown. In addition, no comparative clinical studies about the disease in hiv-infected and non-hiv-infected patients have been reported. During a 24-year period, 120 cases of visceral leishmaniasis were diagnosed at our institution and 80 (66%) were associated with hiv infection. The mean age at diagnosis was higher in hiv-infected that in non-hiv-infected patients (33.2 versus 23.2 yr; p = 0.002), but the male/female ratio was similar in both groups. The main risk factor for hiv infection was intravenous drug abuse (78.7%). The clinical presentation of leishmaniasis was similar in both groups, but hiv-infected patients had a lower frequency of splenomegaly than hiv-negative individuals (80.8% versus 97.4%; p = 0.02). hiv-infected patients had a greater frequency and degree of leukopenia, lymphocytopenia, and thrombocytopenia. Most of them were profoundly immunosuppressed (mean CD4 lymphocyte count, 90 cells/mm3) at the time of diagnosis of leishmaniasis, and 53.7% had AIDS. The sensitivity of serologic studies for Leishmania was significantly lower in hiv-infected than in non-hiv-infected patients (50% versus 80%; p < 0.001), but the diagnostic yield of bone marrow aspirate (67.1% versus 79.4%) and bone marrow culture (62.9% versus 66.6%) was similar in both groups. After initial treatment, the response rate was significantly lower in hiv-infected than in non-hiv-infected individuals (54.8% versus 89.7%; p = 0.001). The relapse rate was 46.2% and 7.5%, respectively (p < 0.001). Secondary prophylaxis with antimonial compounds or amphotericin b seems to be useful in preventing relapses in hiv-infected patients. The mortality rate was higher (53.7% versus 7.5%; p < 0.001) and the median survival time shorter (25 versus > 160 mo; p < 0.001) in AIDS patients than in hiv-negative individuals. Although leishmaniasis could contribute to death in a significant number of hiv-infected patients, it was the main cause of death in only a few of them. The CD4 lymphocyte count and the use of highly active antiretroviral therapy and secondary prophylaxis for leishmaniasis were the most significant prognostic factors for survival in AIDS patients. Visceral leishmaniasis behaves as an opportunistic infection in hiv-infected individuals and should be considered as an AIDS-defining disease.- - - - - - - - - - ranking = 67402.346454084keywords = leishmaniasis (Clic here for more details about this article) |
8/47. Visceral leishmaniasis in a Brazilian child infected perinatally with human immunodeficiency virus.This report describes a Brazilian child perinatally infected by hiv who presented visceral leishmaniasis. She showed the classic clinical features, and diagnosis was made by demonstration of amastigote forms of Leishmania in bone marrow aspirate. She responded well to traditional treatment with meglubine.- - - - - - - - - - ranking = 28084.311022535keywords = leishmaniasis (Clic here for more details about this article) |
9/47. Visceral leishmaniasis in an AIDS patient on successful antiretroviral therapy: failure of parasite eradication despite increase in CD4 T-cell count but low CD8 T-cell count.An unusual cutaneous relapse of visceral leishmaniasis (initially mistaken for eruptive histiocytomas) was seen in an AIDS patient despite good virological and CD4 T-cell responses to highly active antiretroviral therapy. splenectomy and the patient's low CD8 T-cell count are discussed as possible causes of failed disease control.- - - - - - - - - - ranking = 28084.311022535keywords = leishmaniasis (Clic here for more details about this article) |
10/47. Pancreatic involvement in co-infection visceral leishmaniasis and hiv: histological and ultrastructural aspects.The involvement of the gastrointestinal tract in the co-infection of hiv and Leishmania is rarely reported. We report the case of an hiv-infected adult man co-infected with a disseminated form of leishmaniasis involving the liver, lymph nodes, spleen and, as a feature reported for the first time in the English literature, the pancreas. light microscopy showed amastigote forms of Leishmania in pancreatic macrophages and immunohistochemical staining revealed antigens for Leishmania and also for hiv p24. Microscopic and ultrastructural analysis revealed severe acinar atrophy, decreased zymogen granules in the acinar cytoplasm and also nuclear abnormalities such as pyknosis, hyperchromatism and thickened chromatin. These findings might correspond to the histologic pattern of protein-energy malnutrition in the pancreas as shown in our previous study in pancreas with AIDS and no Leishmania. In this particular case, the protein-energy malnutrition may be due to cirrhosis, or, Leishmania or hiv infection or all mixed. We believe that this case represents the morphologic substratum of the protein energy malnutrition in pancreas induced by the hiv infection. Further studies are needed to elucidate these issues.- - - - - - - - - - ranking = 28084.311022535keywords = leishmaniasis (Clic here for more details about this article) |
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