1/10. Pneumococcal vaccine failure in an hiv-infected patient with fatal pneumococcal sepsis and HCV-related cirrhosis.Pneumoccocal vaccination of hiv-positive individuals is recommended to prevent pneumococcal infection. We present a case of a 44-year-old hiv-infected male who came to the emergency room with bacterial pneumonia and sepsis. The patient also had a history of HBV and HCV infection. He expired in the emergency room and blood cultures were positive for streptococcus pneumoniae. The autopsy confirmed the clinical diagnosis and, in addition, hepatitis c-related cirrhosis and splenic abnormalities. The patient had no history of opportunistic infections. His CD4 count 3 months prior to coming to the emergency room was 216 cells/microL with a viral load of 1,270 copies/mL. The patient had received Pneumovax two years before his death. The organism isolated from blood cultures was streptococcus pneumoniae isotype 3, a strain included in Pneumovax. This is a case of pneumococcal vaccine failure with a fatal outcome in a person with an hiv infection and hepatitis c-related liver cirrhosis.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
2/10. Fatal sepsis in an AIDS patient during therapy for pneumocystis carinii pneumonia.The case of a patient with a newly diagnosed hiv infection and pneumocystis carinii pneumonia is presented. Despite treatment with high-dose trimethoprim/sulfamethoxazole (TMP/SMX) and prednisone with initial improvement, the patient acutely deteriorated with severe acidosis and died on the 4th day of hospitalization. cryptococcus neoformans grew the next day in broncheoalveolar lavage (BAL) and blood culture. As simultaneous presence of more than one opportunistic infection can occur in these patients, systematic workup for other common opportunistic infections must be performed.- - - - - - - - - - ranking = 2keywords = opportunistic infection (Clic here for more details about this article) |
3/10. Multiple opportunistic AIDS-associated disorders strictly related to immunodeficiency levels, in a girl with congenital hiv infection.A 16-year-old girl with vertical hiv disease treated since birth suffered from six different AIDS-defining disorders until now. Even during the highly active antiretroviral therapy, multiple aids-related opportunistic infections may complicate the course of long-term congenital hiv disease, showing a strict relationship with immunological deterioration, which occurs shortly after virologic failure, due to an extensive genotypic resistance to all available antiretroviral compounds.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
4/10. salmonella arizonae bacteremia as the presenting manifestation of human immunodeficiency virus infection following rattlesnake meat ingestion.Recurrent nontyphoid salmonella septicemia is one of the opportunistic infections characteristic of AIDS. The increased incidence of severe salmonellosis in immunocompromised patients is due, in part, to defective cellular immunity. The literature contains reports of nine cases of extraintestinal salmonella arizonae infections in patients ingesting rattlesnake capsules, all of whom had known underlying medical illnesses. We describe a previously healthy Hispanic man who developed S. arizonae bacteremia as his initial manifestation of infection with the human immunodeficiency virus (hiv). The patient ultimately stated that he had consumed rattlesnake meat for medicinal purposes--a relatively common practice among Hispanics. S. arizonae was cultured from the powder of all capsules remaining in his possession. To our knowledge, this represents the first reported case of S. arizonae bacteremia as the presenting manifestation of hiv infection following the ingestion of capsules containing rattlesnake meat.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
5/10. Relapsing, bacteremic klebsiella pneumoniae meningitis in an AIDS patient.The acquired immunodeficiency syndrome (AIDS) is manifested by severe immunologic (predominantly T-lymphocyte) abnormalities and opportunistic infections. Central nervous system (CNS) infections are frequent. Pathogens causing CNS infections in AIDS patients include parasites, fungi, and viruses and are similar to those reported in other states of impaired cell mediated immunity (CMI). A case of relapsing, bacteremic klebsiella pneumoniae meningitis in an AIDS patient is presented.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
6/10. Overwhelming strongyloidiasis: an unappreciated opportunistic infection.strongyloides stercoralis is an intestinal nematode which infects a large portion of the world's population. Individuals with infection confined to the intestinal tract are often asymptomatic but may have abdominal pain, weight loss, diarrhea, and other nonspecific complaints. Enhanced proliferation of the parasite in compromised hosts causes an augmentation of the normal life-cycle. Resultant massive invasion of the gastrointestinal tract and lungs is termed the hyperinfection syndrome. If the worm burden is excessive, parasitic invasion of other tissues occurs and is termed disseminated strongyloidiasis. A variety of underlying conditions appear to predispose to severe infections. These are primarily diseases characterized by immunodeficiency due to defective T-lymphocyte function (Table 1). Individuals with less severe disorders become compromised hosts because of therapeutic regimens consisting of corticosteroids or other immunosuppressive medication. The debilitation of chronic illness or malnutrition also predisposes to systemic stronglyloidiasis. The diagnosis of strongyloidiasis can be readily made by microscopic examination of concentrates of upper small bowel fluid, stool, or sputum. Important clues suggesting this infection include unexplained gram-negative bacillary bacteremia in a compromised host who may have vague abdominal complaints, an ileus pattern on X-ray, and pulmonary infiltrates. eosinophilia is helpful, if present, but should not be relied upon to exclude the diagnosis. The treatment of systemic infection due to strongyloides stercoralis with either thiabensazole 25 mg/kg orally twice daily is satisfactory if the diagnosis is made early. Because of several unusual features of this illness in compromised hosts, the standard recommendation for 2 days of therapy should be abandoned in such patients. Immunodeficiency, corticosteroids, and bowel ileus reduce drug efficacy. Thus a longer treatment period of at leuch as blind loops or diverticula necessitate longer treatment. Stool specimens and upper small bowel aspirates should be monitored regularly and treatment continued several days beyond the last evidence of the parasite. In particularly difficult situations where either worm eradication is impossible or reinfection is probable, short monthly courses of antihelminthic therapy seem to be effective in averting recurrent systemic illness. Finally, prevention of hyperinfection or dissemination due to strongyloides stercoralis can be accomplished by screening immunocompromised hosts with stool and upper small bowel aspirate examinations. These would be especially important prior to initiating chemotherapy, or before giving immunosuppressive medications or corticosteroids to patients with nonneoplastic conditions such as systemic lupus erythematosus, nephrotic syndrome, or renal allografts.- - - - - - - - - - ranking = 4keywords = opportunistic infection (Clic here for more details about this article) |
7/10. listeria monocytogenes: a rare cause of opportunistic infection in the acquired immunodeficiency syndrome (AIDS) and a new cause of meningitis in AIDS. A case report.A forty-two year-old male homosexual with the acquired immunodeficiency syndrome (AIDS) developed listeria monocytogenes septicemia and meningitis. The gastrointestinal tract was the likely portal of entry. The patient was treated with intravenous ampicillin with complete and permanent resolution of his listerial infection. Although L. monocytogenes infection has been reported as an uncommon complications of AIDS, we are unaware of Listeria meningitis being previously reported in an AIDS patient. It is hoped that this case report will alert health care workers to the possibility of Listeria infection in AIDS patients, particularly since this infection responds well to readily-available antibiotic therapy. The microbiology, epidemiology, clinical, and neurologic aspects of listerial infection and general aspects of the acquired immunodeficiency syndrome are discussed.- - - - - - - - - - ranking = 4keywords = opportunistic infection (Clic here for more details about this article) |
8/10. Recurrent salmonella typhimurium bacteremia associated with the acquired immunodeficiency syndrome.Seven Haitian and one white patient with the acquired immunodeficiency syndrome and salmonella typhimurium bacteremia were identified over a 28-month period. In three patients bacteremia developed concurrently with an opportunistic infection associated with the acquired immunodeficiency syndrome. The remaining five patients had their initial episodes of bacteremia 3 to 11 months before the diagnosis of the acquired immunodeficiency syndrome. These five patients had signs suggestive of the syndrome, plus evidence of disordered cellular immune function (lymphopenia, anergy, decreased T-helper cells, decreased proliferative responses, and a deficiency in mononuclear-cell alpha interferon production). salmonella typhimurium bacteremia in the appropriate clinical setting may be an opportunistic pathogen associated with the acquired immunodeficiency syndrome.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
9/10. Salmonella bacteremia as manifestation of acquired immunodeficiency syndrome.Multiple opportunistic infections are characteristic of the acquired immunodeficiency syndrome (AIDS). Although bacterial pathogens have presented few problems, we have noted an emerging problem with salmonellal infection among patients with AIDS. A review of all stool and blood cultures from adults between January 1982 and July 1984 showed that 80 stool cultures were positive for Salmonella species; serogroup B was the most common isolated. Eight (10%) were isolated from patients with AIDS. Nineteen blood cultures were positive for Salmonella species. Six (32%) were isolated from patients with AIDS: three were positive for Salmonella serogroup B; two yielded Salmonella choleraesuis; and one yielded Salmonella serogroup D. In three (50%), Salmonella bacteremia was a presenting manifestation of AIDS. Bacteremias were recurrent in five patients. Thus, it appears that AIDS not only predisposes patients to serious salmonellal infections but also compromises their ability to eradicate these bacteria.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
10/10. Infections in hairy-cell leukemia.In order to determine the nature of infectious complications in hairy-cell leukemia we studied 20 consecutive patients seen at UCLA and analyzed the available literature. The incidence of serious infection in our series was 40%, and pneumonia and septicemia due to pseudomonas and E. coli organisms were the leading types of infections. Fungal infections with Cryptococci and histoplasma organisms were documented, and a single case of pneumocystis carinii pneumonia was observed. Noninfectious fever occurred in 30% of our patients. There was a clear relationship between fungal disease and corticosteroid therapy, and the overall incidence of infection was correlated with the degree of neutropenia and corticosteroid treatment. No relationship was found between age, duration of disease, or the use of cytotoxic chemotherapy and infectious complications. Of the 13 infectious episodes, 11 occurred in patients prior to splenectomy. Only two episodes were seen in splenectomized patients, both occurring in the immediate postoperative period. We conclude that splenectomy has a beneficial effect in reducing the incidence of infections in hairy-cell leukemia and that corticosteroids should be used cautiously, since they predispose to opportunistic infection in this disease.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
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