1/303. Progressive multifocal leukoencephalopathy in a patient with acquired immunodeficiency syndrome (AIDS) manifesting Gerstmann's syndrome.We reported a case of acquired immunodeficiency syndrome (AIDS) via multiple blood transfusions, who manifested progressive multifocal leukoencephalopathy (PML) about 18 months after the development of AIDS. PML initiated with right hemiparesis, dysphasia, and Gerstmann's syndrome and resulted in death within 2 months after the onset. neuroimaging examinations revealed white matter lesions mainly in the left posterior parietal lobe. The cortical gray matter also showed abnormal signal intensity. Peripheral CD4 lymphocyte count was 81/microl. Routine cerebrospinal fluid (CSF) examinations were negative. CSF antibodies against herpes simplex virus, varicella-zoster virus, cytomegalovirus, Epstein-Barr virus as well as serum antibody against toxoplasma gondii were negative. Though autopsy or biopsy of the brain was not performed, jc virus genomes were detected in the CSF sample by a polymerase chain reaction, and their sequencing showed unique alterations of the regulatory regions, characteristic to PML-type jc virus.- - - - - - - - - - ranking = 1keywords = cytomegalovirus (Clic here for more details about this article) |
2/303. Neovascularization of the optic disc after highly active antiretroviral therapy in an AIDS patient with cytomegalovirus retinitis--A new immune recovery-related ocular disorder?A patient with AIDS and cytomegalovirus (CMV) retinitis developed a massive bilateral peripheral occlusive vasculopathy with a bilateral neovascularization of the optic disc five weeks after the introduction of highly active antiretroviral therapy (HAART). No associate cause of occlusive vasculopathy was found. Occlusive vasculopathy and optic disc neovascularization may be an immune recovery-related ocular disorder.- - - - - - - - - - ranking = 47.055583560751keywords = cytomegalovirus retinitis, cytomegalovirus, retinitis (Clic here for more details about this article) |
3/303. cytomegalovirus retinitis in the era of highly active antiretroviral therapy.A number of striking changes have occurred recently in the presentation and course of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS) who are receiving highly active antiretroviral therapy (HAART). Before the use of HAART, CMV retinitis was the most common intraocular infection in patients with AIDS, occurring in up to 40% of patients, typically when CD4 cell counts have decreased to less than 0.10 x 10(9)/L. By studying CMV retinitis, clinicians can investigate whether the rejuvenated immune system that results from HAART can effectively control opportunistic infections in patients with AIDS. In some patients, retinitis has not progressed when specific anti-CMV therapy was discontinued, but a number of patients have developed substantial intraocular inflammation, which has resulted in decreased visual acuity. Anterior uveitis, cataract, vitritis, cystoid macular edema, epiretinal membrane, and disc edema may occur in patients with CMV retinitis who have experienced HAART-associated elevation in CD4 cell counts. Since immune recovery uveitis does not occur in eyes without CMV retinitis, the ocular inflammation appears to be related to the CMV infection. Anti-CMV maintenance therapy likely can be safely discontinued in some patients with CMV retinitis if CD4 cell counts are stable or increasing and have been higher than 0.10 x 10(9)/L for at least 3 months. Immune recovery in patients receiving HAART has been effective in controlling opportunistic infections, but it may also result in intraocular inflammation, which can have adverse effects on the eye.- - - - - - - - - - ranking = 5.0277599708424keywords = cytomegalovirus, retinitis (Clic here for more details about this article) |
4/303. Isolation of cytomegalovirus-specific cytotoxic t-lymphocytes from gut-associated lymphoid tissue (GALT) of HIV type 1-infected subjects.Cytomegalovirus (CMV) can be an important opportunistic infection in hiv-1-infected patients, particularly when the CD4 T-cell count drops below 50 lymphocytes/mm3. CMV-associated disease, including retinitis, pneumonitis, gastroenteritis, and encephalitis, is estimated to affect up to 40% of AIDS patients. We have studied the cellular immune response to CMV in gut-associated lymphoid tissue (GALT) of hiv-1-infected patients. Two patients with chronic diarrhea of unknown etiology were examined by flexible sigmoidoscopy and upper endoscopy. biopsy specimens were obtained from lymphoid-associated tissue sites in rectum and duodenum. Both patients were seropositive for CMV IgG, but had not been treated with ganciclovir, and neither had clinical signs of CMV disease. Mononuclear cell cultures were established from GALT and blood and assayed for the presence of CMV-specific CD8 T cells. CD8 T-cell phenotype and function were assessed by MHC Class I tetramer staining, using an HLA-A*0201 tetramer complex specific for peptide 495-503 (NLVPMVATV) of CMV lower matrix protein pp65, and by a standard 51Cr release assay. CMV pp65-specific cytotoxic lymphocytes (CTL) were detected in GALT and blood MNC from both patients. These results demonstrate that hiv-1-infected subjects seropositive for CMV, but without active CMV gastrointestinal disease, harbor CMV-specific CTL in intestinal lymphoid tissue. This is the first report of isolation of CMV-specific CTL in GALT and will lead to greater understanding of the pathogenesis of CMV disease in human mucosal tissue.- - - - - - - - - - ranking = 4.3661599973493keywords = cytomegalovirus, retinitis (Clic here for more details about this article) |
5/303. Immune reconstitution syndromes in human immuno-deficiency virus infection following effective antiretroviral therapy.Effective antiretroviral therapy leads to rapid decrease in plasma hiv-1 rna, frequently followed by an increase in CD4 T-helper cell counts. The improvement of immune function during highly active antiretroviral therapy has important impact on natural history of AIDS-related opportunistic disorders. Here we describe cases of unusual clinical inflammatory syndromes in CMV retinitis, hepatitis c, and atypical mycobacteriosis in hiv-1 infected patients associated with the initiation of antiretroviral therapy. Pathogenetic implications and therapeutic management of these new immunopathologic syndromes are discussed.- - - - - - - - - - ranking = 0.36615999734931keywords = retinitis (Clic here for more details about this article) |
6/303. Extensive enteric leiomyolysis due to cytomegalovirus enterocolitis in vertically acquired human immunodeficiency virus infection in infants.We report two infants with the acquired immunodeficiency syndrome (AIDS) and rectal bleeding due to cytomegalovirus (CMV) ileitis and colitis with minimal focal mucosal ulceration but with extensive leiomyolysis of the muscularis propria. Immunostaining and in situ hybridization for CMV showed numerous viral inclusions in the myocytes of the muscularis propria and vascular endothelium/smooth muscle with only occasional inclusions present in the muscularis mucosae. colectomy was curative in one patient; in the other the bowel was only examined at postmortem.- - - - - - - - - - ranking = 5keywords = cytomegalovirus (Clic here for more details about this article) |
7/303. Loss of cytomegalovirus-specific CD4 T cell responses in human immunodeficiency virus type 1-infected patients with high CD4 T cell counts and recurrent retinitis.Clinical histories are reported for 2 patients treated with highly active antiretroviral therapy (HAART) who experienced multiple relapses of cytomegalovirus (CMV) retinitis, despite suppression of human immunodeficiency virus type 1 (hiv-1) viremia and improvement in CD4 T cell counts (to >400 cells/microL). CMV-specific CD4 T cell immune reconstitution was measured directly, using cytokine flow cytometry, which revealed persistent deficits in CMV-specific CD4 T cell responses in both patients. CMV-specific T cells constituted 0.14% and 0.05% of the total CD4 T cell count in these patients, which is significantly lower than the percentages for 34 control subjects (0.6%-46%; CD4 T cell count range, 7-1039 cells/microL; P=.019). Deficits in pathogen-specific immune responses may persist in some individuals, despite suppression of hiv-1 replication and substantial increases in circulating CD4 T cells after HAART, and such deficits may be associated with significant morbidity from opportunistic infections.- - - - - - - - - - ranking = 6.8307999867465keywords = cytomegalovirus, retinitis (Clic here for more details about this article) |
8/303. Transient visual loss due to severe anemia in a patient with AIDS.We present a case of a patient with AIDS who developed a profound anemia caused by zidovudine, an important antiretroviral drug. In the setting of concurrent cytomegalovirus retinitis, the anemia produced transient visual loss that resolved with transfusion of red blood cells. Withdrawal of zidovudine resulted in a stable hemoglobin. This case describes an unusual manifestation of severe anemia. anemia itself is a very common complication of treatment with zidovudine, one of the most commonly used agents in the treatment of AIDS. The relationship of profound anemia to transient visual loss and the role played by zidovudine in anemia in AIDS patients are discussed.- - - - - - - - - - ranking = 11.42235589085keywords = cytomegalovirus retinitis, cytomegalovirus, retinitis (Clic here for more details about this article) |
9/303. Progressive outer retinal necrosis and acute retinal necrosis in fellow eyes of a patient with acquired immunodeficiency syndrome.PURPOSE: To describe an unusual concurrence of acute retinal necrosis and progressive outer retinal necrosis in fellow eyes of a patient with acquired immunodeficiency syndrome (AIDS). methods: Interventional case report. In a 37-year-old man with AIDS and herpes zoster keratitis in the right eye, progressive outer retinal necrosis developed in the right eye and acute retinal necrosis developed in the left eye. RESULTS: Disparate presentations of retinitis persisted in each eye, and retinal detachment and vision loss ensued in both eyes despite antiviral therapy. CONCLUSION: Distinct features of acute retinal necrosis and progressive outer retinal necrosis do not necessarily reflect systemic factors, and they may be variant manifestations of the same underlying infection.- - - - - - - - - - ranking = 0.36615999734931keywords = retinitis (Clic here for more details about this article) |
10/303. Ischemic maculopathy in patients with acquired immunodeficiency syndrome.PURPOSE: To describe the characteristics of ischemic maculopathy in patients with human immunodeficiency virus (HIV) infection, as a means of understanding this uncommon disorder more fully. methods: This is a multicenter, retrospective review of clinical data available for five HIV-infected patients who were given the diagnosis of ischemic maculopathy. RESULTS: All cases had been diagnosed on the basis of fluorescein angiograms obtained after patients complained of vision loss. Four of the five patients had bilateral macular disease. visual acuity at presentation in the nine affected eyes ranged from 20/20 to count fingers. Vision loss was gradual in both eyes of one patient and was abrupt in onset in seven eyes. Each of the seven eyes with abrupt vision loss had opacification of the superficial retina and/or intraretinal hemorrhages near the fovea. fluorescein angiography revealed enlargement of the foveal avascular zone and mild staining of the juxtafoveal vessels in affected eyes. Six eyes had active or clinically inactive cytomegalovirus retinitis at presentation, and a seventh eye developed cytomegalovirus retinitis 2 weeks later. All patients were receiving anticytomegalovirus drugs when they developed visual symptoms. visual acuity remained stable in five eyes, became worse in two eyes, and improved in two eyes; final visual acuity ranged from 20/25 to count fingers. CONCLUSIONS: Ischemic maculopathy may cause profound and permanent vision loss in HIV-infected individuals. fluorescein angiography should be considered in all HIV-infected patients with unexplained loss of vision. The pathogenesis of ischemic maculopathy remains unknown.- - - - - - - - - - ranking = 23.844711781701keywords = cytomegalovirus retinitis, cytomegalovirus, retinitis (Clic here for more details about this article) |
| | Next -> |