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  • 1
    ISSN: 1365-2230
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The case of a 36-year-old HIV-1-positive patient is presented. After an episode of Pneumocystis carinii pneumonia and cytomegalovirus retinitis a pruritic lesion developed on the thigh with subsequent intracutaneous abscess formation and regional lymph-node enlargement. Mycabacterium kansasii was demonstrated in lymph-node and abscess material. With a tuberculostatic triple-drug regimen the lesions resolved completely. Cutaneous involvement in the course of non-tuberculous mycobacterium in the acquired immunodeficiency syndrome is discussed.
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  • 2
    ISSN: 1573-7284
    Keywords: Toxoplasmosis ; HIV infection ; Risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The objective of this study was to assess the risk of toxoplasmosis in HIV-positive subjects as a basis for primary prophylaxis. A retrospective chart review of 400 consecutive patients was carried out and clinical and laboratory markers at first presentation and follow-up data on the occurrence of toxoplasmosis were recorded. Independent variables were identified, laboratory parameters were stratified, and estimates for the risk of toxoplasmosis and the impact of different variables on its occurrence were made using conventional statistical methods. An increased risk of toxoplasmosis was strongly associated with a positive Toxoplasma gondii IgG EIA in conjunction with a CD4+ cell cont below 0.15/nl (the estimated risk of toxoplasmosis was 20% and 35% after 12 and 24 months, respectively) or a history of one or more opportunistic infections (the estimated risk was 12% and 30% after 12 and 24 months, respectively). Toxoplasma gondii-seropositive patients with CD4+ cell counts below 0.15/nl and those with antecedent opportunistic infections are most likely to develop toxoplasmosis and thus might benefit from primary prophylaxis. The risk of disease probably outweighs the risk of medication in these subjects. Prospective clinical trials are needed to define the optimal choice of drugs.
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  • 3
    ISSN: 1432-1440
    Keywords: Leishmaniasis ; HIV infection ; AIDS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We report the case of 43-year-old homosexual patient with HIV infection and a history of travel to the Far East in whom visceral leishmaniasis was the first infectious complication. Symptoms were fever, malaise, weight loss, hepatosplenomegaly, generalized lymphadenopathy, and oral thrush. Laboratory abnormalities included a slight elevation of liver enzymes, impairment of liver function tests, leukocytopenia, anemia, hypergammaglobulinemia, and markedly depressed CD4 + -cell counts. Despite initially successful treatment with pentavalent antimony, a relapse of leishmaniasis occurred after 7 months. Eradication of the infection was not achieved. Treatment was continued as a palliative chronic suppressive treatment with fortnightly pentamidine infusions. The clinical course was complicated by legionella pneumonia and the development of rapidly progressing Kaposi's sarcoma. The case is presented in detail, and the influence of HIV infection on the course of leishmaniasis is discussed.
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  • 4
    ISSN: 1432-1440
    Keywords: Herpes simplex virus ; Acyclovir resistance ; Foscarnet
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The case of a 25-year-old homosexual man with large inguinal and perianal ulcers is reported. He had been pretreated extensively with acyclovir. Herpes simplex virus (HSV) was identified in the ulcer tissue byin-situ hybridization. No clinical improvement with acyclovir but a prompt response to foscarnet was noted. In a relapse after 11 weeks an acyclovir-resistant HSV type 2 was isolated. Again, a prompt response to foscarnet was noted. The case is presented in detail, and the clinical impact of resistance of HSV to acyclovir is discussed.
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  • 5
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Chlamydia trachomatis wurde aus zehn von 188 Biopsaten (5,3%) isoliert, die aus verschiedenen Regionen des unteren Verdauungstraktes entnommen wurden. Die Diagnosen der Patienten (Durchschnittsalter 37,0 Jahre) waren: ulzerative Proktitis, Morbus Crohn, milde Colitis oder Colitis ulcerosa. Die Chlamydien-Isolierung war positiv bei sieben rektalen Biopsaten, zwei Biopsaten aus dem Sigma und einem Biopsat aus dem Zoekum, während alle Biopsate aus dem Colon ascendens, transversum oder descendens und dem terminalen Ileum negativ waren. Wir schließen daraus, daß die Isolierung vonC. trachomatis am effektivsten aus Rektum und Sigma ist und ein seltenes Ereignis aus anderen Regionen des unteren Verdauungstraktes darstellt.
    Notes: Summary Chlamydia trachomatis was isolated from ten of 188 biopsies (5.3%) obtained from different parts of the lower digestive tract. Patients (mean age 37.0 years) presented with ulcerative proctitis, Crohn's disease, mild colitis or ulcerative colitis. Seven rectal biopsies, two biopsies from the sigmoid flexure and one caecal biopsy were positive for chlamydial isolation whereas all biopsies taken from the colon ascendens, transversum or descendens and from the terminal ileum were negative. We conclude that isolation ofC. trachomatis is most effective from rectal and sigmoidal biopsies and is a rare event from other sites of the lower digestive tract.
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  • 6
    ISSN: 1432-1440
    Keywords: AIDS ; Diarrhea ; Bovine colostrum ; Cryptosporidiosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a prospective, open, uncontrolled study 25 patients infected with the human immunodeficiency virus with chronic refractory diarrhea and either confirmed cryptosporidiosis (n=7) or absence of demonstrable pathogenic organisms (n =18) were treated with a daily oral dose of 10 g of an immunoglobulin preparation from bovine colostrum over a period of 10 days. Among the 7 patients with cryptosporidiosis, this treatment led to complete remission in 3 and partial remission in 2. Among the 18 patients with diarrhea and negative stool culture, complete remission of diarrhea was obtained in 7 and partial remission in 4. In the remaining 2 patients with cryptosporidiosis and the 7 patients with diarrhea but no demonstrable pathogens treatment produced no significant improvement of the diarrhea. Subsequent doubling of the Lactobin dose (2 × 10 g daily) in 8 of the nonresponders led to complete remission in one case and at least partial remission in a further 4 patients. Treatment of refractory diarrhea with 10 g immunoglobulins from bovine colostrum per day constitutes an important therapeutic approach and led to complete (40%) or partial (24%) remission of diarrhea in 64% of the patients described here.
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  • 7
    ISSN: 1432-1440
    Keywords: HIV infection ; AIDS ; Pneumocystis carinii pneumonia ; Pentamidine inhalation ; Prophylaxis ; Pneumocystoma ; Nodular infiltrates ; Pulmonary masses
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Atypical pulmonary manifestations of Pneumocystis carinii infection and fair numbers of extrapulmonary and disseminated infections have lately been documented in patients with human immunodeficiency virus infection treated prophylactically with inhalative pentamidine. We report the case of a 32-year-old homosexual patient who was assessed for complaints of night sweats, weight loss, and progressive malaise. The patient denied any respiratory tract symptoms such as cough, sputum production, pleuritic chest pain, or shortness of breath. Chest X-ray revealed two large round noncavitating lesions in the lower lobe of the right lung. Pneumocystomas were diagnosed by fine-needle aspiration. A 3-week course of intravenous high-dose cotrimoxazole resulted in amelioration of symptoms but no change in the radiographic appearance of the pulmonary lesions. Four months later the patient is alive and stable and is being treated with pentamidine inhalation of 300 mg per 2 weeks and two tablets of pyrimethamine sulfadoxine per week.
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  • 8
    ISSN: 1432-1440
    Keywords: Human immunodeficiency virus infection ; Streptococcus pneumoniae ; Parotitis ; Lymph node abscess ; Cotrimoxazole
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The case of a 33-year-old patient with rapid onset of bilateral parotid gland and lymph node abscesses is described. The patient was positive for human immunodeficiency virus 1 and presented with a history of interstitial lymphocytic pneumonia and pneumococcal meningitis prior to admission. The patient received cotrimoxazole as primary prophylaxis againstPneumocystis carinii pneumonia. Fine needle aspiration from the abscesses yieldedStreptococcus pneumoniae. Penicillin G treatment in combination with surgical drainage of the lesions led to healing with minimal residual lymph node enlargement. No relapse was noted until 12 months after presentation.
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  • 9
    ISSN: 1432-1440
    Keywords: Acquired immunodeficiency syndrome ; Human immunodeficiency virus ; Leishmania donovanii ; Visceral leishmaniasis ; Kala-azar ; Intestinal pathogens ; Kaposi's sarcoma ; Parasites ; Parasitic pathogens ; Interferon-γ
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Visceral leishmaniasis (kala-azar) affecting HIV-infected patient is being reported in increasing frequency. A 40-year-old German bisexual patient with full-blown AIDS is described who presented with Kaposi's sarcoma, epigastric pain, diarrhea, and weight loss but without fever.Leishmania amastigotes were initially found in biopsies from stomach, duodenum, and a cutaneous Kaposi's sarcoma lesion but were later also recovered from bone marrow and lymph node. The patient received three courses of a combination of pentavalent antimony and interferon-γ. In addition to the common side effects such as fever, thrombocytopenia, and elevated amylase and lipase, a vivid progression of the Kaposi's sarcoma was noted. Tumor progression was temporally closely associated with treatment with interferon-γ. Because this phenomemon has also been observed in other patients, we advise caution when using interferon-γ in patients with Kaposi's sarcoma.
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  • 10
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The first case of disseminatedMycobacterium bovis infection with meningitis in an AIDS patient is reported. A 54-year-old male HIV-positive patient was admitted for evaluation of fever, weight loss, inappetence, fatigue and malaise.Mycobacterium bovis (non-BCG) was isolated from blood, bone marrow, stool, urine, sputum, abdominal lymph nodes and cerebrospinal fluid. Antituberculous therapy using a five-drug regimen plus steroids resulted in complete recovery.
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