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1/1759. Persistent damage to enterocytozoon bieneusi, with persistent symptomatic relief, after combined furazolidone and albendazole in AIDS patients.

    AIM: To investigate morphological changes in enterocytozoon bieneusi and the duration of symptomatic relief after combination treatment with furazolidone and albendazole in AIDS patients. methods: Four severely immunocompromised AIDS patients with symptomatic E bieneusi infection of the gut received an 18 day course of combined furazolidone and albendazole (500 800 mg daily). All patients were monitored for parasite shedding in stool by light microscopy at the end of treatment and monthly during follow up. At the end of treatment, duodenal biopsy specimens obtained from three patients were studied by transmission electron microscopy by two pathologists blind to the patients' treatment or clinical outcome. Duodenal biopsy specimens obtained from one of the patients two months after completion of treatment were also studied electronmicroscopically. RESULTS: All patients had long lasting symptomatic relief, with a major decrease--or transient absence--of spore shedding in stools from completion of treatment. After treatment, changes in faecal spores were persistently found by light microscopy in all cases, and there was evidence of both a substantial decrease in the parasite load and ultrastructural damage in the parasite in all biopsy specimens. The treatment was well tolerated, and no patient had clinical or parasitological relapse during follow up (up to 15 months). CONCLUSIONS: The long lasting symptomatic relief observed in all four treated patients correlated with the persistent decrease in parasite load both in tissue and in stool, and with the morphological changes observed in the life cycle of the protozoan. These data suggest that combined treatment with furazolidone and albendazole is active against E bieneusi and may result in lasting remission even in severely immunocompromised patients. ( info)

2/1759. Adipsic hypernatremia in two patients with AIDS and cytomegalovirus encephalitis.

    In patients with acquired immune deficiency syndrome (AIDS), hypoosmolality is frequently observed, whereas hypernatremia is distinctly rare. We report two patients with advanced AIDS and cytomegalovirus (CMV) encephalitis, who developed severe hypernatremia without any thirst sensation, that is, adipsic hypernatremia. Both developed severe hypernatremia of up to 164 and 162 mmol/L, with serum osmolalities of 358 and 344 mOsmol/kg while remaining alert and denying thirst. serum antidiuretic hormone (ADH) levels were 0.9 and 1.5 pg/mL, inappropriately low for the concomitant serum osmolalities. vital signs were stable. During hypernatremia, urine osmolalities were 327 and 340 mOsmol/kg, and urine Na levels were 56 and 119 mmol/L, respectively. Periventricular white matter lesions were seen on cerebral nuclear magnetic resonance imaging (NMRI) in case 1, but the pituitary appeared normal in both cases. survival after onset of hypernatremia was 6 and 4 weeks, respectively. autopsy in case 1 showed typical findings of CMV encephalitis but normal pituitary, confirming that infection with hiv or CMV most likely caused the dysfunction of the central osmostat. ( info)

3/1759. PCR-based diagnosis of a case of herpetic whitlow in an AIDS patient.

    Herpetic infections are common complications in AIDS patients. The clinical features could be uncommon and antiviral chemotherapy is imperative. A rapid diagnosis could prevent incorrect approaches and treatment. The polymerase chain reaction is a rapid, specific and sensible method for dna amplification and diagnosis of infectious diseases, especially viral diseases. This approach has some advantages compared with conventional diagnostic procedures. Recently we have reported a new PCR protocol to rapid diagnosis of herpetic infections with suppression of the dna extraction step. In this paper we present a case of herpetic whitlow with rapid diagnosis by HSV-1 specific polymerase chain reaction using the referred protocol. ( info)

4/1759. Laryngeal pathology in the acquired immunodeficiency syndrome: diagnostic and therapeutic dilemmas.

    The acquired immunodeficiency syndrome has produced a growing population of patients who, because of their associated immune system compromise, are prone to opportunistic infections and neoplastic diseases. The larynx, with its relatively inaccessible yet critical anatomic location, is a site in which these processes can produce clinical dilemmas, with respect to diagnosis as well as to therapy. By presenting 4 cases involving unusual laryngeal problems in patients infected with the human immunodeficiency virus (hiv), we emphasize these inherent diagnostic and therapeutic problems. Otolaryngologists must be familiar with the many diagnostic possibilities and therapeutic alternatives when hiv-infected patients present with laryngeal complaints. ( info)

5/1759. Resolution of microsporidial sinusitis and keratoconjunctivitis by itraconazole treatment.

    PURPOSE: To report successful treatment of ocular infection caused by the microsporidium encephalitozoon cuniculi in a person with acquired immunodeficiency syndrome (AIDS) and nasal and paranasal sinus infection. METHOD: Case report. RESULTS: Microsporidial infection in a person with AIDS and with chronic sinusitis and keratoconjunctivitis was diagnosed by Weber modified trichrome stain and transmission electron microscopy. Symptoms completely resolved with itraconazole treatment (200 mg/day for 8 weeks) after albendazole therapy (400 mg/day for 6 weeks) was unsuccessful. CONCLUSION: itraconazole can be recommended in ocular, nasal, and paranasal sinus infection caused by E. cuniculi parasites when treatment with albendazole fails. ( info)

6/1759. Bilateral upper-lobe cavitary pneumocystis carinii pneumonia in a patient on dapsone prophylaxis.

    pneumocystis carinii pneumonia (PCP) presenting as bilateral upper-lobe cavitary disease is rare. Isolated upper-lobe involvement has traditionally been associated with aerosolized pentamidine prophylaxis. dapsone is a cheap and effective prophylactic agent against P carinii in patients who cannot tolerate trimethoprim-sulfamethoxazole. This is a case of a man who presented with bilateral upper-lobe cavitary P carinii pneumonia despite being on dapsone prophylaxis. bronchoalveolar lavage was negative for P carinii. Transbronchial biopsy was positive for P carinii. The patient improved significantly with radiological resolution on specific treatment for P carinii. PCP should be included in the differential diagnosis of upper-lobe cavitary lung disease, and a transbronchial biopsy should be performed when the diagnosis is suspected. ( info)

7/1759. An unusual presentation of paracoccidioidomycosis in an AIDS patient: a case report.

    A case of paracoccidioidomycosis presenting as a solitary pulmonary nodular lesion in a patient with acquired immunodeficiency syndrome (AIDS) is presented. This case illustrates that restricted lung lesions can also be found and diagnosed in immunodeficient patients. ( info)

8/1759. 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. ( info)

9/1759. A rare case of cotrimoxazole-induced eosinophilic aseptic meningitis in an hiv-infected patient.

    A case of cotrimoxazole-induced meningoencephalitis in an hiv-infected patient without signs of AIDS is reported. The patient developed an apparently generalized seizure, of cotrimoxazole, 1 month after first taking a dose of this drug and a febrile coma after a second dose 3 weeks later. Lumbar puncture revealed eosinophilic aseptic meningitis. The patient quickly recovered without sequelae and was given antiretroviral therapy plus pentamidine aerosolized and pyrimethamine as prophylaxis for opportunistic infections. No other adverse effects were observed. The report describes the diagnosis of this case supported by a commentary, including a literature review. ( info)

10/1759. Acute renal failure in a patient with AIDS: histoplasmosis-induced granulomatous interstitial nephritis.

    Although the most frequent cause of acute renal failure (ARF) in patients with AIDS is acute tubular necrosis (ATN) secondary to ischemic renal injury from septicemia, a spectrum of causes may result in ARF in these patients. We report a patient with AIDS who developed ARF and was found to have granulomatous interstitial nephritis as a result of disseminated histoplasmosis. histoplasma capsulatum was seen in the interstitium of the kidney on renal biopsy. The patient was treated with amphotericin b and itraconazole. Although he continues to require hemodialysis 3 months after his initial presentation, his other presenting symptoms have resolved with antifungal therapy. We also discuss the literature on disseminated histoplasmosis and renal failure. ( info)
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