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1/140. Disseminated Mycobacterium genavense infection in a patient with acquired immunodeficiency syndrome: first case report in taiwan.

    Mycobacterium genavense is a recently described fastidious mycobacterium identified as a pathogen causing disseminated infection in patients with advanced human immunodeficiency virus (HIV) disease. In this report, we describe the first reported case of disseminated M. genavense infection in a patient with acquired immunodeficiency syndrome (AIDS) in taiwan. A 22-year-old Chinese man was found to be seropositive for HIV at age 18, in 1993. In 1997, he presented with abdominal pain, weight loss, low cd4 lymphocyte count, hepatomegaly, and generalized lymphadenopathy. Microscopic examination of a biopsy specimen from an inguinal lymph node showed both ill- and well-formed noncaseating granulomas. Numerous acid-fast bacilli were present in the histiocyte cytoplasm. Although the organism did not grow on conventional solid media used in our laboratory, two molecular biology techniques, including polymerase chain reaction (PCR) followed by sequencing of 16S rRNA, and PCR together with restriction enzyme fragment polymorphism analysis, confirmed the M. genavense infection. The patient's abdominal symptoms responded well to a chemotherapy regimen that included ethambutol, ciprofloxacin, and clarithromycin, and he survived more than 6 months after diagnosis. However, the lymphadenopathy was still present at his final follow-up. Our report indicates that disseminated infection with M. genavense should be added to the list of differential diagnoses of secondary infections in advanced AIDS patients in taiwan.
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ranking = 1
keywords = mycobacterium
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2/140. Management of opportunistic infections in acquired immunodeficiency syndrome. I. Treatment.

    A case report of a patient infected with human immunodeficiency virus (HIV) is described. The patient presents with a multitude of medical complaints that are of acute or subacute onset. The medical examination of these complaints is described and includes algorithms for the diagnosis and treatment of the most common HIV-related opportunistic infections, including pneumocystis carinii pneumonia, toxoplasmosis, mycobacterium avium complex, cytomegalovirus infection, and cryptococcal meningitis.
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ranking = 0.57019821337749
keywords = avium complex, avium, complex
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3/140. Immunopathology as a result of highly active antiretroviral therapy in hiv-1-infected patients.

    OBJECTIVE: Unusual clinical inflammatory syndromes associated with underlying previously unrecognized opportunistic infections are increasingly being noted shortly after starting highly active antiretroviral therapy (HAART). This study examined the possible relationship between such unexpected disease manifestations and in vitro parameters of microbial antigen-specific immune reactivity in patients infected with hiv-1 who had a Mycobacterium avium intracellulare or mycobacterium xenopi infection. DESIGN: in vitro T-cell proliferation experiments were performed after specific stimulation of a patient's peripheral blood mononuclear cells (PBMC) with M. avium and M. xenopi antigen and non-specific stimulation with phytohaemagglutinin (PHA). The results were compared with appropriate controls. patients: Five patients who presented with unusual clinical syndromes associated with M. avium or M. xenopi infection within weeks of experiencing large rises in CD4 cell counts following the initiation of antiretroviral therapy. RESULTS: In all patients except one, mycobacteria-specific lymphoproliferative responses rose significantly following HAART; this was temporally associated with elevations in CD4 cell counts and the occurrence of clinical disease. The patient with M. xenopi infection appeared to clear his infection subsequently without antimycobacterial therapy. In three of the four patients with M. avium infection, antimycobacterial treatment could be stopped without recurrence of infection. CONCLUSION: Our findings support the hypothesis that HAART may lead to clinically relevant inflammation as a result of restoration of specific immune reactivity against microbial pathogens that are subclinically present at the time treatment is initiated. Continuation of HAART may subsequently result in protective immunity and clearance of infection.
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ranking = 0.28576543694984
keywords = intracellulare, avium
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4/140. Infection by rhodococcus equi in a patient with AIDS: histological appearance mimicking Whipple's disease and mycobacterium avium-intracellulare infection.

    rhodococcus equi pneumonia with systemic dissemination is being reported increasingly in immunocompromised patients. This is the first case report of disseminated R equi infection with biopsy documented involvement of the large intestine. The patient was a 46 year old male with AIDS who was diagnosed with cavitating pneumonia involving the left lower lobe. R equi was isolated in culture from the blood and lung biopsies. Subsequently, the patient developed anaemia, diarrhoea, and occult blood in the stool. colonoscopy revealed several colonic polyps. Histological examination of the colon biopsies showed extensive submucosal histiocytic infiltration with numerous Gram positive coccobacilli and PAS positive material in the histiocytes. Electron microscopy showed variably shaped intrahistiocytic organisms which were morphologically consistent with R equi in the specimen. Disseminated R equi infection may involve the lower gastrointestinal tract and produce inflammatory polyps with foamy macrophages which histologically resemble those seen in Whipple's disease and mycobacterium avium-intracellulare infection.
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ranking = 7.256699413393
keywords = avium-intracellulare, intracellulare, avium
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5/140. Generalized mycobacterium genavense infection in HIV-infected patients: detection of the mycobacterium in hospital tap water.

    We describe 3 HIV-infected patients with disseminated M. genavense infection. The use of corticosteroids possibly favoured colonization and dissemination of atypical mycobacteria in these patients with low CD4 cell counts and may have masked symptoms of infection. The fact that these patients were treated with highly active antiretroviral therapy (HAART) together with antimycobacterial therapy may explain that 1 patient was free from mycobacteria 16 months after the end of specific treatment. Hospital tap water contained M. genavense at a concentration of >10 bacteria/l as examined by PCR. This species caused 12% of cases of non-tuberculous disseminated mycobacteriosis in HIV-infected patients at our hospital.
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ranking = 8
keywords = mycobacterium
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6/140. Successful treatment of spleen tuberculosis in a patient with human immunodeficiency virus infection.

    Tuberculosis in human immunodeficiency virus (HIV)-infected patients may act as a cofactor that accelerates the clinical course of HIV infection, and, indeed, HIV-infected patients with tuberculosis have a reduced survival rate compared to those without tuberculosis. diagnosis of tuberculosis in HIV-positive patients can be difficult because of nonspecific symptoms and the time required for the identification of mycobacteria by means of culture techniques. Recently, antiretroviral combination therapies have improved the outcome of several acquired immune deficiency syndrome (AIDS)-associated conditions. Unfortunately, the use of antiretroviral therapy for patients coinfected with HIV and mycobacterium tuberculosis is still to be fully evaluated. The complexity of side-effects due to antituberculosis medication and drug interaction represent important issues and combining an effective anti-HIV treatment with antituberculosis therapy is still a clinical challenge. We discuss here a case of spleen tuberculosis in a human immunodeficiency virus-positive patient who had a successful response after a diagnostic splenectomy and medical treatment that included classical antituberculosis treatment associated with antiretroviral therapy without protease inhibitors.
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ranking = 0.00018563709548823
keywords = complex
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7/140. 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.
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ranking = 1.4917860979552
keywords = avium-intracellulare, intracellulare, avium
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8/140. central nervous system toxoplasmosis in acquired immunodeficiency syndrome: An emerging disease in india.

    With the incidence of patients infected with human immuno-deficiency virus (HIV) increasing in india, the central nervous system (CNS) manifestations of the disease will be seen more frequently. The CNS may be primarily afflicted by the virus or by opportunistic infections and neoplasms secondary to the immune suppression caused by the virus. In india, although mycobacterium tuberculosis has been reported to be the most common opportunistic infection, toxoplasmosis may become as common owing to the ubiquitous nature of the protozoan. Since an empirical trial of medical therapy without histopathological diagnosis is recommended, the true incidence of this condition may remain under estimated. The role of ancillary tests such as radiology and serology in the initial diagnosis of this condition remain crucial. This report highlights two patients who were diagnosed to have acquired immuno-deficiency syndrome (AIDS) only after the biopsy of the intracranial lesion was reported as toxoplasmosis. Presently all patients for elective neurosurgery are tested for HIV antigen. The management protocol to be followed in a known patient with AIDS presenting with CNS symptoms is discussed in detail. The value of ancillary tests is also reviewed.
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ranking = 1
keywords = mycobacterium
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9/140. cytomegalovirus pneumonitis as an initial presentation in an HIV-infected patient.

    Human immunodeficiency (HIV) infection often presents with an unusual symptom complex. Although cytomegalovirus (CMV) is a frequent opportunistic infection in the late stage of acquired immunodeficiency syndrome (AIDS), CMV pneumonitis as an initial manifestation of HIV infection is not documented in the medical literature. We report a previously healthy patient with bilateral interstitial pulmonary infiltrates who was found to have CMV pneumonitis; only later was HIV virus infection diagnosed. cytomegalovirus is a frequently isolated pathogen from respiratory secretions in AIDS patients. The role of CMV as a sole pulmonary pathogen is controversial. After exclusion of other pathogens, CMV was demonstrated by histological changes and viral culture in our case. This case indicates that pulmonary infiltrates presenting as the first manifestation of HIV infection can be caused by CMV infection.
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ranking = 0.00018563709548823
keywords = complex
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10/140. mycobacterium avium complex causing endobronchial disease in AIDS patients after partial immune restoration.

    OBJECTIVE: To report the development of an unusual manifestation of pulmonary mycobacterium avium complex (MAC) infection in two patients with the acquired immune-deficiency syndrome (AIDS) after the commencement of combination antiretroviral chemotherapy. patients: Two Caucasian males with human immunodeficiency virus (HIV) infection and CD4 lymphocyte counts <0.05 x 10x9/1 and with plasma HIV polymerase chain reaction (PCR) >100,000 copies/ml who were commenced on combination antiretroviral chemotherapy including a protease inhibitor. RESULTS: Both patients developed endobronchial polypoid tumours within two months of commencing antiretroviral chemotherapy. histology demonstrated granuloma formation and acid-fast bacilli. Tissue from both patients grew M. avium. Both patients achieved significant suppression of viral replication and had significantly improved CD4 lymphocyte counts. Both required antimycobacterial therapy. CONCLUSIONS: Endobronchial polypoid tumours due to MAC infection have only been described in HIV-infected patients receiving antiretroviral chemotherapy. A degree of restored immunity is implicated in the pathogenesis of this unusual disease.
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ranking = 2.891437282164
keywords = avium complex, avium, complex
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