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1/15. rhodococcus equi infection in patients with AIDS.

    rhodococcus equi is an emerging opportunistic pathogen of hiv-I infected patients. It is an aerobic, Gram-positive coryneform bacterium which acts as a facultative intracellular micro-organism, multiplying in the phagosome of macrophages. Eighteen cases of R. equi infection in hiv-I positive patients have now been reported. Sixteen of these had pneumonia, of which 12 had cavitating lung lesions. A history of contact with farm animals, which are the primary hosts of R. equi, was found in only three patients. There was a delay in establishing a definite diagnosis in most cases as this depended upon the isolation of R. equi from sputum, bronchoalveolar lavage fluid, or blood. Treatment included surgical resection in five patients and erythromycin with a second antibiotic in 13 cases, but II of the 18 patients died from the infection. In this report we describe our experience of R. equi pneumonia in two AIDS patients and review the published cases of the disease in man.
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2/15. Newly discovered mycoplasma isolated from patients infected with hiv.

    Mycoplasmas have been isolated from patients with acquired immunodeficiency syndrome (AIDS) and they may contribute to the pathogenesis of this disease. We have isolated repeatedly a previously unknown mycoplasma from the urine of an hiv-positive male homosexual and, subsequently, from the urine of 5 hiv-positive patients with AIDS. The mycoplasma was not found in the urine of 98 healthy control subjects. The organism has an unusual tip-like structure with densely packed fine granules and metabolizes both glucose and arginine for growth. Antigenic and dna analyses show the organism to be distinct from other known mycoplasmas. The mycoplasma displays in-vitro activities associated with virulence in vivo. In addition, electronmicroscopy shows that the mycoplasma can invade and attach to various human and animal cells. We are investigating whether the new mycoplasma has a role in human disease.
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3/15. infection due to cryptococcus neoformans of unusual morphology in a patient with AIDS.

    cryptococcus neoformans with a rare morphology of hand-mirror appearance was demonstrated by direct microscopic preparation of both cerebrospinal fluid (CSF) and sputum of a patient with AIDS. In addition, one to six blastoconidia were seen at the tip of a germ-tube like structure. Cr. neoformans was isolated in pure culture and the identification was confirmed by biochemical and serological tests as well as by animal pathogenicity.
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4/15. rhodococcus equi infection in the patient with AIDS: literature review and report of an unusual case.

    rhodococcus equi is an aerobic, intracellular, gram-positive rod-coccus that is partially acid fast. The organism is primarily a pathogen in animals and has only rarely been seen in immunocompromised humans. Its most common manifestation is a slowly progressive pneumonia that may cavitate. Infections are thought to be acquired via respiratory exposure to animals or soil. R. equi infections are difficult to treat, usually requiring prolonged administration of parenteral antibiotics and often necessitating surgical drainage. A case of cavitary pneumonia and recurrent bacteremia with R. equi in a patient with AIDS is reported, and the current literature on R. equi infections in humans is reviewed.
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5/15. Bronchial and gastrointestinal cryptosporidiosis in AIDS.

    cryptosporidiosis is a coccidial protozoan initially reported in domestic animals. It is primarily a gastrointestinal organism that does not invade mucosa. It was first described in 1976 in developing countries as an etiology of infantile diarrhea with inanition and malnutrition. Gastrointestinal involvement in patients with AIDS has been increasingly reported. We report a case of combined gastrointestinal and bronchial cryptosporidiosis. cryptosporidium is an acid-fast organism which was successfully treated with erythromycin.
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6/15. rhodococcus equi: an emerging opportunistic pathogen?

    Human infection with rhodococcus equi is apparently rare with most published reports describing the development of lung abscesses in immunocompromised hosts. Of only 18 cases of infection previously recorded, four have recently occurred in patients with the acquired immune deficiency syndrome (AIDS). In australasia, R. equi has frequently been isolated from soil and infected farm animals yet no human infections have been reported thus far. Three cases of R. equi infection have occurred in new zealand and, collectively, they cover a wider spectrum of disease than that previously recognised. The natural history of R. equi infections, their clinical features and treatment are described in the light of our recent experience.
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7/15. cryptosporidiosis.

    In the united states, the four groups at high risk of cryptosporidiosis are animal handlers, foreign travelers, children in day care centers and immunocompromised patients, including those with acquired immunodeficiency syndrome. In immunocompetent patients, the sporadic diarrheal illness is self-limited. diagnosis is made by the identification of cryptosporidium oocysts in stool specimens, but these parasites are easily overlooked and may be confused with yeast. At present, there is no specific therapy for this infection.
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8/15. Opportunistic lung infection caused by Rhodococcus (corynebacterium) equi.

    Rhodococcus (formerly corynebacterium) equi, a common animal pathogen, can cause a slowly evolving pneumonia in humans, particularly immunocompromised people. The authors describe two patients; one with acquired immunodeficiency syndrome. On chest radiographs, R. equi produces chronic, localized pulmonary opacities that can cavitate. The main differential diagnoses are tuberculosis and fungal infection.
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9/15. Unexpected toxicity from radiation therapy in two patients with Kaposi's sarcoma receiving interferon.

    Two homosexual men with Kaposi's sarcoma and acquired immune deficiency received radiation therapy to the oral mucosa while treatment with recombinant leukocyte A interferon was being given systemically at a dose of 36 million units. Symptoms of radiation mucositis developed after the administration of 900 rad in the first patient and 1,050 rad in the second patient. radiation therapy had to be stopped after doses of 1,100 and 2,100 rad, respectively, had been given. Both patients had to be admitted to the hospital for supportive care and the second patient required placement of a feeding tube. To our knowledge, no other clinical observations suggesting interactions of radiation therapy and interferon have been reported. We discuss the results of experiments with cultured cells and experimental animals which suggest that such interactions occur and may be successfully exploited therapeutically.
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10/15. Human cryptosporidiosis in immunocompetent and immunodeficient persons. Studies of an outbreak and experimental transmission.

    infection with cryptosporidium occurred in 12 immunocompetent persons who had direct contact with the feces of infected calves during three unrelated outbreaks of calf cryptosporidiosis. Nine of the twelve subjects had diarrhea and abdominal cramps that lasted 1 to 10 days. Infections were diagnosed and monitored by detection of oocysts in feces, with a modified Sheather's flotation technique and phase-contrast microscopy. oocysts of cryptosporidium were isolated from calves but not from other animals with which these subjects had been in contact. oocysts of cryptosporidium were also detected during repeated examinations of feces from two immunodeficient patients with persistent cryptosporidiosis. An apparently identical infection was transmitted to calves and mice, using oocysts from infected calves and human beings. oocysts from an immunodeficient person also produced infections in kittens, puppies, and goats. This study shows that cryptosporidium may produce a moderate self-limited illness in immunocompetent persons, which contrasts sharply with the prolonged severe diarrhea in immunocompromised patients who contract cryptosporidiosis. Calves with diarrhea should be considered a potential source of human infection, and immunocompromised persons should avoid contact with such animals.
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