1/30. Chronic active hepatitis B exacerbations in human immunodeficiency virus-infected patients following development of resistance to or withdrawal of lamivudine.lamivudine is a nucleoside analog with activity against human immunodeficiency virus (hiv) and hepatitis b virus (HBV). patients coinfected with hiv and HBV may have hepatitis flares when lamivudine therapy is discontinued or when resistance of HBV to lamivudine emerges. This retrospective, descriptive study conducted in three tertiary care medical centers describes patients coinfected with hiv type 1 and HBV who presented with a spectrum of clinical and subclinical hepatitic responses to lamivudine withdrawal or resistance. One patient had fulminant hepatic failure and a second patient had subclinical hepatitis when lamivudine therapy was discontinued and a more efficacious antiretroviral regimen was substituted. Three patients had flares of hepatitis after 13 to 18 months of lamivudine therapy. lamivudine withdrawal or emergence of lamivudine-resistant mutants in patients coinfected with hiv and HBV may result in severe hepatitis. Clinicians caring for patients with coinfection with hiv and HBV should be aware of the possibility that a hepatitis B flare may occur in previously asymptomatic carrier patients.- - - - - - - - - - ranking = 1keywords = coinfection (Clic here for more details about this article) |
2/30. coinfection of visceral leishmaniasis and Mycobacterium in a patient with acquired immunodeficiency syndrome.We report a case of coinfection of visceral leishmaniasis and mycobacterium avium-intracellulare in the same lesions in the small bowel and bone marrow of a 33-year-old man with acquired immunodeficiency syndrome who complained of abdominal pain and chronic diarrhea. The duodenal mucosa and bone marrow biopsy specimens showed numerous foamy macrophages packed with two forms of microorganisms that were identified histologically and ultrastructurally as Leishmania and Mycobacterium species. Visceral leishmaniasis is rarely suspected in patients residing in nonendemic countries including the united states. It should be included in the differential diagnosis for opportunistic infection in patients with acquired immunodeficiency syndrome. An appropriate travel history is important. To our knowledge, this is the first reported case showing coinfection of visceral leishmaniasis and mycobacterium avium-intracelluulare in the same lesion in a patient with acquired immunodeficiency syndrome.- - - - - - - - - - ranking = 2keywords = coinfection (Clic here for more details about this article) |
3/30. Cytomegalovirus and cryptosporidium infections in AIDS: a necropsy study.A case of coinfection of cytomegalovirus (CMV) and cryptosporidium in an AIDS patient is reported. Chronic diarrhea was the presenting symptom. Etiologic agents were diagnosed only at postmortem evaluation. CMV intranuclear inclusions were seen in the terminal ileum, colon and vermiform appendix. cryptosporidium oocysts were also present in the intestinal brush border of the colon. Improvement of diagnostic procedures such as colonic biopsy and the use of appropriate staining procedure for AIDS patients with diarrhea can help identify the cause of illness.- - - - - - - - - - ranking = 1keywords = coinfection (Clic here for more details about this article) |
4/30. Mixed infection caused by two species of fusarium in a human immunodeficiency virus-positive patient.We report on a case of mixed infection caused by two species of fusarium in a human immunodeficiency virus-positive patient with lymphoma who was neutropenic due to chemotherapy. The patient showed the typical signs of a disseminated fusarial infection, with fusarium solani isolated from skin lesions and F. verticillioides isolated from blood. The report discusses how difficult it is to make an accurate diagnosis when an immunosuppressed patient is infected with more than one fungal species, especially when the species are morphologically very similar.- - - - - - - - - - ranking = 2.6149564949274keywords = mixed infection (Clic here for more details about this article) |
5/30. Fatal pneumonia in an AIDS patient coinfected with adenovirus and pneumocystis carinii.BACKGROUND: Adenovirus infections are common in immunocompromised hosts. However, pulmonary adenovirus infections rarely cause significant morbidity in hiv-infected patients. PATIENT: Here we describe a 27-year-old man with AIDS who presented with tachypnea, hypoxemia and an infiltrate in the upper left lobe on chest X-ray. bronchoscopy was performed and pneumocystis carinii was detected in bronchoalveolar lavage (BAL) fluid. Treatment with cotrimoxazole and prednisone initially resulted in improvement, but after 10 days the patient's clinical condition deteriorated rapidly and he died after 23 days due to respiratory failure. RESULTS: On autopsy histopathologic examination showed abundant "smudge cells," suggestive of adenoviral infection. Electron microscopy revealed adenovirus-like particles arrayed in a paracrystalline manner. Subsequent immunohistochemistry confirmed the extensive presence of adenovirus in addition to P. carinii. CONCLUSION: This case demonstrates a pathogenetic role for adenovirus coinfection in P. carinii pneumonia (PCP). Earlier diagnosis, e.g. by PCR analysis of the BAL fluid or transbronchial biopsy, might have led to the consideration of ribavirin treatment.- - - - - - - - - - ranking = 1keywords = coinfection (Clic here for more details about this article) |
6/30. Hepatocellular carcinoma in hiv-infected patients with chronic hepatitis c.OBJECTIVES: Chronic hepatitis c is frequently seen in hiv-positive subjects infected through needle sharing or transfusion of contaminated blood products. Progression to end-stage liver disease seems to occur faster in these patients. As the life expectancy of hiv-infected persons has dramatically improved since the introduction of highly active antiretroviral therapies, cirrhosis and eventually hepatocellular carcinoma (HCC) may be recognized at an increasing rate in patients coinfected with hiv and hepatitis c virus (HCV). methods: We identified the main features of hiv-infected individuals with end-stage liver disease due to HCV infection and diagnosed with HCC in three hiv/AIDS referral centers, and compared these features to those of a control group of patients with HCV-related HCC but without hiv infection. RESULTS: Seven hiv-infected patients were identified. Of these, six were <45 yr of age and had been intravenous drug users. The mean time between exposure to HCV and the development of HCC was estimated to be 17.8 yr. Two subjects were coinfected with hepatitis B and delta viruses, respectively. Only one individual had been diagnosed of an AIDS-defining condition before the diagnosis of HCC was made. However, all subjects had < 500 CD4 T cells at the time of HCC diagnosis. Five died within the first 4 months of follow-up. patients in the control group (n = 31) were significantly older (68.9 /- 8.9 vs 42.2 /- 10.4; p < 0.001) and the duration of HCV infection was significantly longer (28.1 /- 10.9 vs 17.8 /- 2.7; p < 0.05) than in those with hiv-HCV coinfection. CONCLUSIONS: HCC seems to occur at a younger age and after a shorter period of HCV infection in subjects coinfected with hiv. Thus, treatment of CHC should be encouraged in hiv-positive patients, and in those with HCV-related cirrhosis the periodic monitoring of alpha-fetoprotein and abdominal ultrasonography should be recommended.- - - - - - - - - - ranking = 1keywords = coinfection (Clic here for more details about this article) |
7/30. AIDS-related body cavity-based lymphoma. A case report.BACKGROUND: Body cavity-based lymphomas are rare malignancies in human immunodeficiency virus (hiv)-infected patients, but because of their unusual clinical, morphologic and immunophenotypic features, they are recognized as a distinct subgroup of lymphomas connected to human herpesvirus 8 (HHV-8) infection. CASE: A 39-year-old, hiv-positive, homosexual man was admitted to the hospital because of a left-sided pleural effusion that contained malignant lymphoid cells. He responded partially to a low-dose cyclophosphamide/doxorubycin/vincristine/prednisone regimen and died five months after the diagnosis of lymphoma. On cytology, the sediments contained exclusively large, round, neoplastic, lymphoid cells with abundant basophilic cytoplasm and large, round nuclei with prominent nucleoli. Many cells had immunoblastic features, and some had plasmocytoid differentiation. Mitotic figures were numerous. On flow cytometry, the homogeneous population of large cells expressed CD45, CD38, HLA-DR and CD7 positivity. Other specific T-, B- and NK-cell markers tested negative. polymerase chain reaction demonstrated Epstein-Barr virus (EBV) and HHV-8 in the malignant effusion. CONCLUSION: Primary effusion from lymphoma with molecular evidence of HHV-8 and EBV coinfection represents a distinct clinical and morphologic entity in AIDS patients. However, immunophenotypic markers of malignant clones can be diverse in different cases.- - - - - - - - - - ranking = 1keywords = coinfection (Clic here for more details about this article) |
8/30. The effect of hiv coinfection on hepatitis c: A review.Many hepatitis c (HCV) infected patients are coinfected with hiv. As hiv-directed anti-viral therapy has delayed hiv progression and mortality, pathologic consequences of HCV infection are occurring at an increased rate. In this review, a case presentation delineating the clinical course of an hiv/HCV coinfected patient at our institution is presented. The pathobiology, interrelation of HCV and hiv infection in coinfected patients is discussed as well as the effect of treatment in this unique patient population. The interaction of hiv and HCV coinfection is complex. It is clear that hiv infection negatively affects the natural history of HCV, while hiv-directed therapy may enhance immunologic response and exacerbate hepatocellular injury induced by HCV. Further studies assessing the effect of anti-hiv and anti-HCV-directed therapy on the clinical course of HCV/hiv coinfected patients is warranted.- - - - - - - - - - ranking = 5keywords = coinfection (Clic here for more details about this article) |
9/30. Pulmonary infection caused by rhodococcus equi in hiv-infected patients: report of four patients from northern thailand.We report four human immunodeficiency virus (hiv)-infected patients (3 men and one woman, average age, 34.3 years) with pulmonary infection (two with pneumonia and two with lung abscess) caused by rhodococcus equi. These patients, who presented with fever and productive cough, were admitted to Nakornping Hospital in northern thailand. Chest roentgenograms showed pulmonary infiltration and/or cavitary lesions. Their conditions were poor because of severe anemia, and transfusion was necessary in three of the four patients. Before culture results were available, the etiologic microorganisms identified in sputum smears were gram-positive and acid-fast coccobacilli. One of the four patients had a mixed infection with R. equi and salmonella enteritidis. The mean cd4 lymphocyte count in the three tested patients was 10/mm3 (CD4/CD8 ratio = 0.057). Four isolates of R. equi were sensitive to imipenem, minocycline, erythromycin, vancomycin, and ciprofloxacin (minimum inhibitory concentrations; MICs,- - - - - - - - - - ranking = 2.6149564949274keywords = mixed infection (Clic here for more details about this article) |
10/30. coinfection of the retina by Epstein-Barr virus and cytomegalovirus in an AIDS patient.PURPOSE: To report an immunohistochemically proven case of a coinfection of the retina by Epstein-Barr virus and cytomegalovirus in a patient with acquired immunodeficiency syndrome (AIDS). DESIGN: Interventional case report. methods: Postmortem evaluation of retinal tissue of a 45-year-old female AIDS patient with atypical fibrinous iridocyclitis and vitritis in course of a cytomegalovirus retinitis in the left eye was performed for evidence of dual infection with cytomegalovirus and other herpes group viruses. Immunohistochemical examination with double-staining techniques and antibodies against Epstein-Barr virus and cytomegalovirus was used. RESULTS: In the retina of the left eye, cells reacting with antibodies against cytomegalovirus and cells stained with antibodies against Epstein-Barr virus were detected in the layer of ganglionic cells and the inner granular cell layer. CONCLUSION: Epstein-Barr virus coinfection should be taken into consideration in unusual cases of necrotizing cytomegalovirus retinitis in AIDS patients.- - - - - - - - - - ranking = 2keywords = coinfection (Clic here for more details about this article) |
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