1/11. bile duct-duodenal fistula caused by AIDS/hiv-associated tuberculosis.Although infrequent, digestive fistulae in hiv/AIDS patients have been reported throughout the digestive tract from the esophagus to the anus, with predominance of esophageal fistulae. AIDS/hiv-associated opportunistic infections may invade the digestive system and lead to fistula formation. Tuberculosis is the most common infection associated with these esophageal fistulae. We report here one case of bile duct-duodenal fistula in a female AIDS patient with associated abdominal mycobacterium tuberculosis infection compromising lymph nodes of the hepatic pedicle where the fistula was found. According to the reviewed literature, this is the third case of bile duct-duodenal fistula associated with abdominal tuberculosis in AIDS patient, and the first where both the fistula and the tuberculosis infection were diagnosed at laparotomy for acute abdomen. Whether the AIDS patient with abdominal pain needs or not a laparotomy to treat an infectious disease is often a difficult matter for the surgeon to decide, as most of the times appropriate medical treatment will bring more benefit.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
2/11. Disseminated tuberculosis, pulmonary aspergillosis and cutaneous herpes simplex infection in a patient with infliximab and methotrexate.CASE PRESENTATION: Despite chemoprophylaxis with isoniazid a 58-year-old Creole patient with mild rheumatoid arthritis developed disseminated tuberculosis, pulmonary aspergillosis and cutaneous herpes simplex infection during treatment with infliximab and methotrexate. TREATMENT: The patient received antituberculous drugs (ethambutol, isoniazid, pyrazinamide, rifampicin), amphotericin b, flucytosine, and valaciclovir, along with prolonged intensive care treatment and mechanical ventilation. CONCLUSIONS: The present case confirms that isoniazid prophylaxis (300 mg once daily, during 6 months) does not protect against the reactivation and dissemination of latent tuberculosis. It also shows that combined treatment with infliximab and methotrexate may induce severe immunosuppression with prolonged leukocytopenia and depressed cellular immunity, leading to multiple opportunistic infections. Extensive diagnostic testing, early start of antimicrobial therapy and enteral immunonutrition, and further infection prevention with selective decontamination of the digestive tract may have been the key to a good clinical outcome.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
3/11. Serious infections associated with anticytokine therapies in the rheumatic diseases.The ability to target and neutralize macrophage-derived inflammatory cytokines, particularly tumor necrosis factor-alpha (TNF-alpha), has emerged in recent years as one of the most important advances in the treatment of rheumatoid arthritis, Crohn's disease, and several other systemic inflammatory diseases. In rheumatoid arthritis, for example, these biological agents rapidly reduce signs and symptoms of joint inflammation and profoundly slow the progression of joint damage. However, data that have emerged following food and Drug Administration approval of these agents have alerted clinicians to an increased likelihood of opportunistic infections in patients treated with these agents, particularly tuberculosis. The effect of TNF inhibition on the frequency of infection with more common bacterial pathogens is less clear. Animal models of tuberculosis and other opportunistic infections have demonstrated the importance of TNF-alpha in controlling and containing intracellular pathogens. The spectrum of infections reported to date in the setting of anti-TNF-alpha treatment is reviewed here. In addition, relevant animal data illustrating potential mechanistic roles for TNF-alpha in host responses to infection are also reviewed.- - - - - - - - - - ranking = 2keywords = opportunistic infection (Clic here for more details about this article) |
4/11. Disseminated cryptococcosis in a human immunodeficiency virus-negative patient: a case report.cryptococcus neoformans is a widely distributed saprophytic fungus that may cause opportunistic infections in normal and immunocompromised individuals particularly in patients with hiv infection. Disseminated infection in hiv-negative individuals is occasionally seen: a 57-year-old hiv-negative Turkish female initially presented with enlarged mediastinal lymph nodes and a large pulmonary parenchymal nodule, eventually diagnosed with disseminated cryptococcosis and tuberculosis.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
5/11. Persistent mediastinal and axillary lymph node tuberculosis in a renal transplant patient with successful outcome.Tuberculosis is an opportunistic infection that carries substantial morbidity and mortality in renal transplant recipients. We report here about a 21 year-old man with a living related renal transplant from his mother who developed persistent extra-pulmonary tuberculosis. The disease showed aggressive invasion to the axillary and mediastinal regions with abscess formations, despite standard antituberculosis treatment. During the course of the disease, immunosuppressive therapy was stopped, and the patient received extraordinary doses of multiple antituberculosis drugs. The patient then showed an uneventful course with good clinical and radiological responses.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
6/11. Esophageal fistulas associated with mycobacterial infection in patients at risk for AIDS.Although opportunistic infections of the esophagus occur commonly in acquired immunodeficiency syndrome (AIDS), inflammation is generally limited to the mucosal surface. During a 7-month interval, six men at risk for AIDS underwent barium esophagography because of persistent symptoms of esophageal disease. In each case, transmural inflammation of the esophagus was found (esophagomediastinal communication in three cases and esophagobronchial fistulas in three cases). Two patients had an esophagoesophageal fistula, an inflammatory lesion that has not, to the authors' knowledge, been previously described with mycobacterial infection. Mycobacterial infection was documented by means of culture findings in all six patients (mycobacterium tuberculosis in five, M avium in one). In three cases mycobacteria were either seen in or cultured from esophageal biopsy specimens. The finding of deep esophageal ulceration, intramural dissection, or fistula formation in a patient with AIDS should suggest the diagnosis of esophageal tuberculosis.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
7/11. Secondary pulmonary alveolar proteinosis occurring in two patients with acquired immune deficiency syndrome.This report describes two patients with acquired immune deficiency syndrome (AIDS) in whom respiratory failure and opportunistic infection associated with secondary alveolar proteinosis developed. In one patient, the alveolar proteinosis was apparently secondary to mycobacterium tuberculosis and in the other to pneumocystis carinii and cytomegalovirus infection. Both patients died of respiratory failure, and it was suspected that secondary alveolar proteinosis could have been a contributing cause of death.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
8/11. central nervous system tuberculosis with the acquired immunodeficiency syndrome and its related complex.central nervous system tuberculosis occurred in three patients with the acquired immunodeficiency syndrome (AIDS) and seven patients with aids-related complex who were evaluated for 48 months. Nine patients were intravenous drug abusers and one was Haitian. Five patients had cerebral-ring-enhancing lesions and three had hypodense areas. The clinical spectrum included meningitis in two patients, multiple cerebral abscesses in one, and tuberculomas in four. All mycobacterium tuberculosis isolates were sensitive to standard antituberculous drugs. All patients received treatment with isoniazid, rifampin, and pyrazinamide; six patients also received streptomycin. Three patients with AIDS died of opportunistic infection preceded by central nervous system tuberculosis. Among the patients with the aids-related complex, three improved with treatment, three were lost to follow-up, and one died. Tuberculosis should be considered in the differential diagnosis of central nervous system mass lesions in intravenous drug abusers with AIDS or aids-related complex. Because patients with tuberculosis can be cured, biopsy of accessible brain mass lesions should be mandatory. Preventive therapy may be indicated in drug abusers without disease.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
9/11. histoplasmosis in the acquired immune deficiency syndrome.This report describes the experience with disseminated histoplasmosis in seven of 15 patients with the acquired immune deficiency syndrome (AIDS) diagnosed in Indianapolis since 1981. Three were homosexual, two were intravenous drug addicts, one was the spouse of another patient with AIDS and disseminated histoplasmosis, and the seventh was a hemophiliac. Six had associated infections: candidiasis in three, pneumocystis carinii pneumonia, recurrent mucocutaneous herpes simplex infection, and disseminated mycobacterium avium infection in two each, and disseminated infection with an unidentified mycobacterium in one. Clinical diseases suggested sepsis in four. histoplasma fungemia occurred in five, but the diagnosis was established first by visualization of organisms in blood or bone marrow in three. Results of histoplasma serologic tests were positive in each. Three died before receiving 50 mg of amphotericin b, three had prompt improvement with amphotericin b, and one was treated with ketoconazole to prevent dissemination. However, two of the three patients treated with amphotericin b had relapses after a 35 mg/kg course, and the third died within a month following therapy. Disseminated histoplasmosis is a major opportunistic infection in patients with AIDS from endemic areas. AIDS should be strongly considered in otherwise healthy persons with disseminated histoplasmosis, especially if risk factors for AIDS are present. amphotericin b is not curative in these patients.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
10/11. Aspergillosis of the nervous system. Report of two cases.Two cases of aspergillus infection of the nervous system are reported. In the first case it occurred in a healthy individual and presented as a space occupying lesion mimicking a tuberculous granuloma. In the second case it was an opportunistic infection in a patient with predisposing conditions and manifested as chronic meningitis with fatal arteritis.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
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