1/4. Unusual patterns of histoplasma capsulatum meningitis and progressive multifocal leukoencephalopathy in a patient with the acquired immunodeficiency virus.Disseminated histoplasmosis (DH) and progressive multifocal leukoencephalopathy occur in acquired immunodeficiency syndrome (AIDS). At autopsy, DH patients with central nervous system involvement almost always show extensive involvement of the lungs and reticuloendothelial system in addition to the brain, and progressive multifocal leukoencephalopathy is manifest as multiple demyelinating lesions in several locations in the brain. We describe an AIDS patient with a long history of aggressively treated DH who died with DH in the brain only; fungus was not found elsewhere at autopsy. In addition, there was a papovavirus infection restricted to the cerebellum with predominant involvement of the internal granular cell layer; again, demyelinating lesions were not found elsewhere in the brain. Each of these patterns of brain involvement is rare. As the incidence of AIDS increases and patients are treated aggressively, the frequency of unusual neuropathologic patterns of opportunistic infections may be expected to increase.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
2/4. meningitis due to histoplasma capsulatum and mycobacterium tuberculosis in a returned traveler with acquired immunodeficiency syndrome.histoplasmosis has rarely been reported in taiwan, and its clinical manifestations may be similar to those of tuberculosis. With increasing international travel, physicians need to be aware of the possibility of this disease when caring for patients with advanced human immunodeficiency virus (hiv) infection who have traveled to endemic areas. A 55-year-old Chinese male from Burma presented with concurrent histoplasmosis and tuberculous meningitis as the initial opportunistic infection of acquired immunodeficiency syndrome. fever, altered mentation, pancytopenia, splenomegaly and marked elevations of serum lactate dehydrogenase (3601 U/L) and ferritin (>10(6) ng/mL) were noted. Despite treatment with amphotericin b and antituberculous therapy, the patient died on the 25th day of hospitalization. This case illustrates the complexity and challenges of management of opportunistic infections in travelers returning from Southeast asia who are in the advanced stage of hiv infection.- - - - - - - - - - ranking = 2keywords = opportunistic infection (Clic here for more details about this article) |
3/4. amphotericin b in the treatment of candida meningitis in three neonates.candidiasis is an opportunistic infection and may result in significant morbidity and mortality in neonates. Cerebral candidiasis is rare and usually associated with systemic candidiasis. Information concerning the toxicity and efficacy of antifungal therapy for neonates is limited. In this report, we present three neonates with candidiasis. All of the patients were premature with low birth weights, and received antibiotic therapy for one to four weeks before the onset of candidiasis. candida albicans was isolated from cerebrospinal fluid cultures. amphotericin b was given administered at an initial dose of 0.25 mg/kg/day intravenously (IV) and increased to a dosage of 2 mg/kg/day, and therapy was continued for three to four weeks. A transient and mild elevation in hepatic enzyme concentration was observed in two patients, and transient thrombocytopenia occurred in all of them.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
4/4. aspergillosis infection in neurosurgical practice.Fungal infections including those due to aspergillus are rare in neurosurgical practice despite their possible inclusion in many differential diagnoses. Recently, these diseases have been diagnosed with increasing frequency, principally as opportunistic infections in patients undergoing treatment for diseases resulting in immune compromise. The epidemiology is poorly understood as mycoses are not notifiable diseases. We have recently been involved in the care of seven patients with aspergillosis between 1988 and 1991. Its presentation, with abscess formation, granulomas, the rhinocerebral form, meningitis, hydrocephalus and vascular involvement, is varied. The majority of cases were seen in immunocompromised patients following haematogenous dissemination from a pulmonary or gastro-intestinal focus. Direct spread from sinus infection has also been seen. The prognosis is poor despite modern antifungal treatment, which in part reflects the primary underlying condition.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |