1/86. meningioma in four patients with human immunodeficiency virus infection.We describe four patients infected with the human immunodeficiency virus (HIV) who had development of meningiomas. In contrast to those in the general population who have meningiomas, all our patients were young men; the mean age was 40 years (range, 32 to 50). Their risk behavior for HIV was homosexuality (three patients) and intravenous drug use (one patient). The CD4 cell count in each of the three homosexual men was less than 50/microL and was 280/microL in the drug user. Imaging studies showed enhancing lesions in three of the patients. Although each of these meningiomas could have occurred in otherwise normal young to middle-aged men, we speculate that the meningiomas may have grown in these HIV-infected hosts because of either loss of immune function or dysregulation of cytokines.- - - - - - - - - - ranking = 1keywords = virus (Clic here for more details about this article) |
2/86. Cutaneous T-cell lymphoma and human immunodeficiency virus infection: 2 cases and a review of the literature.Cutaneous non-Hodgkin's lymphomas are rare in patients with hiv-1 infection and almost all of the cases reported are of T-cell lineage with histopathological features of mycosis fungoides or sezary syndrome. We studied 2 cases of mycosis fungoides in hiv-1-positive patients who were intravenous drug abusers and were in stage II and IV C2 (CDC'86), respectively. The first patient (stage II) had multiple, erythematous and infiltrated large plaques on the abdomen, back, arms and legs, whereas the second patient (stage IV) had smaller erythematous, slightly scaly and infiltrated pruritic plaques on the trunk and limbs. Their CD4 lymphocyte counts were 634 and 250 cells/mm3, respectively. Biopsies showed features consistent with mycosis fungoides, with an epidermotropic pattern. The immunohistochemical study revealed a T-cell lineage of this atypical infiltrate. Both patients partially responded to topical steroid ointment, showing moderate improvement. Further biopsies performed 6 months later confirmed the prior diagnosis of mycosis fungoides. No tumour stage was observed during a 2-year follow-up. We conclude that mycosis fungoides is rare in HIV-positive patients, but must be included in the differential diagnosis of erythematous plaques in these patients. In suspected, but non-diagnostic cases of mycosis fungoides in HIV-positive patients, only a close clinical and histopathological follow-up can confirm the diagnosis.- - - - - - - - - - ranking = 0.8keywords = virus (Clic here for more details about this article) |
3/86. Transmission of hepatitis c within Australian prisons.Transmission of hepatitis c virus (HCV) within prisons has long been suspected but has not been satisfactorily documented. We present four cases of HCV infection occurring during periods of continuous imprisonment. Each subject was HCV seronegative on entering prison and on repeat testing after 4-52 months in prison, but subsequently became seropositive. Two subjects gave a history of injecting drug use, and the most likely means of infection in the other two subjects were lacerations from barbers shears and lacerations arising from physical assault. There is an urgent need for detailed study of the incidence of HCV infection and the modes of transmission in prisons.- - - - - - - - - - ranking = 0.2keywords = virus (Clic here for more details about this article) |
4/86. Nosocomial transmission of hepatitis b virus infection through multiple-dose vials.The source of acute hepatitis b virus (HBV) infection in two women (55 and 72 years old) was investigated. They displayed no risk factors for acquiring HBV infection, other than treatment with local anaesthetic injections some months previously. The HBV strains were sequenced and showed distinct homology to strains seen in Swedish intravenous drug users (IVDU). Prior to these patients' acute infection, an outbreak of HBV had occurred among IVDU in the same county. Analysis of the HBV strains from six of these IVDUs showed their core promoter, precore and pre-S sequences (679 nucleotides) to be identical to those from the two patients. Cross-contamination between samples was excluded and the most likely source of infection was thought to be multiple-dose vials of local anaesthetic that had been contaminated with the HBV strain circulating among the IVDU population in the community. We believe that multiple-dose vials have no place in modern healthcare and recommend sequence homology analysis as an alternative or additional way to trace a source of HBV infection.- - - - - - - - - - ranking = 1keywords = virus (Clic here for more details about this article) |
5/86. Long-term non-progression of hiv-1 in a patient coinfected with HTLV-II.A 37-year-old man coinfected with hiv-1 and human T-lymphotropic virus type II presumably through injection drug use had a high CD4 count and low HIV viral load without anti-retroviral therapy for over six years. As an HIV long-term non-progressor, his case supports the hypothesis that coinfection with HTLV-II does not adversely affect the course of HIV disease.- - - - - - - - - - ranking = 0.2keywords = virus (Clic here for more details about this article) |
6/86. The patient who could not be discharged. How far should patient autonomy extend?A male patient was admitted to the acquired immune deficiency syndrome (AIDS) unit for hemodialysis. His history revealed that he was homeless and that he had tested positive for human immunodeficiency virus (HIV ). He also had a history of alcohol and intravenous drug abuse and tuberculosis. Based on the results of a chest X-ray, he was placed in respiratory isolation. During the next few days of his hospitalization, he exhibited nonadherent behavior toward the treatment regime. Because of previous verbal and physical abuse to staff and patients, all local hemodialysis centers refused to accept him as a patient. Thus, he became a patient who seemingly could never be discharged. A discussion related to the theoretical and practical scope of patient autonomy, institutional altruism vs. institutional self-interest, and the need for social policy to facilitate a just and humane resolution to this ethical situation is presented here.- - - - - - - - - - ranking = 0.2keywords = virus (Clic here for more details about this article) |
7/86. Silent oophoritis due to cytomegalovirus in a patient with advanced HIV disease.A case of isolated necrotizing cytomegalovirus (CMV) oophoritis disclosed only by necropsy studies in a patient with AIDS, is described. This unusual case report is discussed with a review of the literature dealing with CMV involvement of genital organs in the immunocompromised host, and in patients with HIV infection and AIDS.- - - - - - - - - - ranking = 1keywords = virus (Clic here for more details about this article) |
8/86. Two successive hepatitis c virus infections in an intravenous drug user.We report the case of an occasional intravenous drug user who developed two successive hepatitis c virus (HCV) infections. The first infection led to seroconversion (anti-HCV antibodies detected) and the detection of HCV rna in serum. After a spontaneous recovery (normalization of alanine aminotransferase levels and HCV rna clearance), a second HCV infection was observed, with the recurrence of HCV viremia. Antibody directed against HCV serotype 1 was detected throughout the follow-up monitoring, but two different HCV strains were identified during the two infectious episodes: genotype 1a for the first and genotype 3a for the second. This observation shows that primary HCV infection does not confer protective immunity against subsequent infection with viruses of other genotypes. This may hamper the development of a vaccine. Conflicting results were obtained in genotyping and serotyping assays, suggesting that the serotyping method cannot be used to identify the HCV type in patients, such as intravenous drug users, who are exposed to successive HCV infections.- - - - - - - - - - ranking = 1.2keywords = virus (Clic here for more details about this article) |
9/86. Disseminated osteoarticular sporotrichosis: treatment in a patient with acquired immunodeficiency syndrome.We report a case of multiple skin lesions, lymphadenopathy, and osteoarticular sporotrichosis in a man infected with human immunodeficiency virus (HIV). He subsequently died of tuberculosis after successful treatment for osteoarticular sporotrichosis with amphotericin b. We describe the unusual histopathology in disseminated sporotrichosis with acquired immunodeficiency syndrome (AIDS) and compare it with that seen in patients without AIDS. Although the optimal treatment of osteoarticular sporotrichosis in patients with AIDS is unknown, use of amphotericin b in our patient appeared successful. culture and histologic stains of all tissues taken at autopsy were negative for sporotrichosis. Recent studies of similar cases have shown initial treatment with amphotericin b followed by long-term maintenance with itraconazole to be beneficial.- - - - - - - - - - ranking = 0.2keywords = virus (Clic here for more details about this article) |
10/86. Dilated bile duct in patients receiving narcotic substitution: an early report.Narcotic substitution is now widely used. morphine can induce a spasm of the sphincter of oddi but dilation of bile duct has been reported only in an anecdotal case. In June 1995, we observed a first case of dilation of the common bile duct without organic obstacle in a hepatitis c virus (HCV)-infected patient who was under narcotic substitution, suggesting a causal relationship. We conducted a prospective study to evaluate the precise prevalence of bile duct abnormalities related to narcotic substitution in active intravenous drug or ex-intravenous drug users referred to our liver unit for histologic evaluation of HCV infection. We conducted a prospective study in a 30-month period of 334 HCV-infected patients, including 36 receiving narcotic substitution with methadone or buprenorphine. biliary tract was analyzed by ultrasonography and by endoscopy ultrasound in cases of bile duct abnormalities. Of the 36 patients under narcotic substitution, 3 (8.3%) had asymptomatic dilated bile duct without organic obstacle--defined as a common bile duct > or =9 mm--compared to 1 of 298 (0.03%; p < 0.001) of those who did not receive substitution. Narcotic substitution may lead to bile duct dilation that does not require invasive diagnosis procedures.- - - - - - - - - - ranking = 0.2keywords = virus (Clic here for more details about this article) |
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