HIV-associated tuberculosis in Africa exemplified by Zimbabwe

In Africa, a rapid increase of human immunodeficiency virus (HIV)-associated tuberculosis cases has been observed; 80% of a worldwide 6 million dually infected persons live in this part of the world. The annual risk of progression to clinically overt tuberculosis in dually infected persons approaches the lifetime risk in persons with tuberculosis but no HIV infection. Zimbabwe is an example which illustrates the rapid increase in notified tuberculosis cases since 1985, accounted for primarily by HIV-associated tuberculosis cases. In sputum-smear positive HIV-associated tuberculosis, classical symptoms are reported with the same frequency as in HIV negative cases. Thus, case-finding activities need not be altered. In sputum-smear negative patients, reliable diagnostic tests are not available. Therapeutic trials are widely used and this causes overdiagnosis of tuberculosis. Extrapulmonary manifestations are common in HIV-associated tuberculosis. A majority of lymph node enlargements, pleurisy and pericarditis in Africa are now due to tuberculosis. If compliance is ensured, response to chemotherapy is excellent, but overall case fatality and relapse rates are increased. The cost-effectiveness of tuberculosis control programmes using directly observed therapy for at least the first 2 months of treatment is well established. With the prominent global significance of tuberculosis and the possibility of cost-effective interventions, a commitment to the fight against the worldwide epidemic is more important than ever before.     

Predicting delirium in elderly patients: development and validation of a risk-stratification model

A study of determine the seroprevalence rate and clinical presentation of HIV-associated pulmonary tuberculosis was carried out in Jos between October 1990 and September 1991. Out of the 180 newly diagnosed pulmonary tuberculosis patients, 11(6.1%) were confirmed seropositive for HIV-1 and 2. The peak age range for both tuberculosis and HIV infection in both sexes is 20-40 years. The risk of HIV infection was associated with multiple sex partners and blood transfusion. There was no significant difference in the clinical presentation of pulmonary tuberculosis between HIV-seropositive and seronegative patients (P > 0.1). However, diarrhoea, lymphadenopathy and marked weight loss were found to be significantly associated with HIV infection (P < 0.05). The mean lymphocyte count of HIV seropositives was significantly lower than seronegatives (P < 0.01).     

The Philippine cynomolgus monkey (Macaca fasicularis) provides a new nonhuman primate model of tuberculosis that resembles human disease

A nonhuman primate model of tuberculosis that closely resembles human disease is urgently needed. We have evaluated the Philippine cynomolgus monkey, Macaca fasicularis, as a model of TB. Cynomolgus monkeys challenged intratracheally with extremely high doses of Mycobacterium tuberculosis (10(5) or 10(4) CFU) developed an acute, rapidly progressive, highly fatal multilobar pneumonia. However, monkeys challenged with moderate or low doses of M. tuberculosis (相似文献   

Epidemiology and pathogenesis of AIDS-related lymphomas

Among patients with congenital and acquired immunodeficiencies, non-Hodgkin's lymphoma (NHLs ) are the most common tumors of the immune system. In the setting of human immunodeficiency virus (HIV) infection, as many as 10% to 20% of people ultimately developed NHLs. These tumors are clinically aggressive, frequently involve extranodal sites, and often exhibit unique features that distinguish them from NHL arising in individuals with other forms of immunosuppression. Important in the development of HIV-associated NHL are cytokines and other factors that induce B-cell proliferation and increase the likelihood of mutations of c-myc, bcl-6, and other tumor-suppressor genes with carcinogenic potential. Specific forms of HIV-associated NHL are linked to expression of Epstein-Barr virus (EBV)-latent proteins; the newly described DNA virus, Karposi's sarcoma-associated herpesvirus/human herpesvirus-8 (KSHV/HHV-8); and perhaps HIV. Elucidation of the factors that contribute to the high incidence of NHL among patients infected with HIV provides insights into important elements of lymphomagenesis.     

HIV infection and the kidney

HIV-infected patients may present with a variety of patterns of renal involvement. Acute renal failure is common and most often a result of sepsis, hypotension, and nephrotoxic agents. It is potentially avoidable, and support through the period of renal failure may lead to resolution of the renal dysfunction. HIV-associated nephropathy is a unique pattern of sclerosing glomerulopathy that ranges in prevalence from 1 to 10% of the HIV-infected population in different geographic locales. This complication of HIV infection will likely present a growing challenge to the medical community as HIV infection continues to spread worldwide. Deciphering the pathogenetic mechanisms of this most rapidly progressive form of focal segmental sclerosis is not only clinically relevant, but will hopefully provide valuable insights into the mediation of the more common idiopathic form of the disease. The potential for improved renal survival of patients with HIV-associated nephropathy has become more realistic with the development and use of antiretroviral agents, as well as studies on the role of immunosuppression and ACE inhibition in this population. An awareness of other glomerular lesion and tubulointerstitial lesions has broadened our understanding of populations with renal disease who have been infected by HIV. Moreover, as prolonged survival of HIV-infected individuals is being achieved with modern antiviral therapy, the percentage of patients surviving with nephropathy will likely grow in coming years. Awareness of the growth of this population and those requiring short- and long-term hemodialysis and peritoneal dialysis will allow appropriate planning for ESRD in the HIV-infected population.     

Detection of HIV infection in pulmonary tuberculosis patients

Well documented 112 pulmonary tuberculosis patients were studied for the prevalence of human immunodeficiency virus (HIV) seropositivity by using two antibody screening tests along with western blot test. Nineteen of the pulmonary tuberculosis patients were HIV seropositive, 12 were acid-fast bacillus smear positive; 12 patients were tuberculin skin test positive and 15 patients were culture positive. As the incidence of HIV infection is increasing in India, it is observed that patients co-infected with HIV and TB are also on the rise. Recognition of the dual infection and taking adequate steps to deal with this epidemic are needed.     

Human immunodeficiency virus (HIV) infection and arthritis

A variety of inflammatory arthritic conditions are observed in the setting of HIV infection. The epidemiology of these disorders is a point of current controversy, although it appears that several unique syndromes are clinically associated. The pathogenesis of these disorders remains unclear, but we hope that further work in this area will lend important insights into the mechanisms of both HIV-associated and non-HIV associated rheumatic disease. The overall management of such patients is based on recognizing the underlying HIV infection and the judicious use of antirheumatic drug therapy. Rheumatologists need to be aware of the natural history of HIV infection and its clinical manifestations.     

Oral manifestations of HIV disease

Oral disease is frequently associated with HIV. While nearly all oral disorders associated with HIV infection also occur in other conditions characterized by immunosuppression, no other condition is associated with as wide and significant a spectrum of oral disease as is HIV infection. Many HIV-associated oral disorders occur early in HIV infection, not infrequently as the presenting sign or symptom. Thus, early detection of associated oral disease should, in many cases, result in earlier diagnosis of HIV infection. Likewise, awareness of the variety of oral disorders which can develop throughout the course of HIV infection, and coordination of health care services between physician and dentist, should improve overall health and comfort of the patient. This paper reviews the clinical, diagnostic and therapeutic aspects of HIV-associated oral disorders.     

Long-term survival of an AIDS patient with a tuberculous cerebral abscess

Unlike other forms of tuberculosis, tuberculous cerebral abscess is a rare complication of human immunodeficiency virus (HIV) infection and usually presents at a late stage of the disease. This article describes a case of tuberculous cerebral abscess in an HIV-infected patient that was effectively treated with surgery and chemotherapy. The patient has survived more than 5 1/2 years since being diagnosed and remains in good health.     

Tuberculosis in Australia: bacteriologically confirmed cases and drug resistance, 1994 and 1995. Report of the Australian Mycobacterium Reference Laboratory Network

The Australian Mycobacterium Reference Laboratory Network collected and analysed laboratory data on isolates of Mycobacterium tuberculosis reported during 1994 and 1995. The total number of confirmed isolates was 708 in 1994 and 705 in 1995. This represents an annual incidence of approximately 4 cases of laboratory confirmed tuberculosis per 100,000 population. These figures are similar to those reported in previous years and confirms that the incidence of tuberculosis in Australia remains stable. The incidence rate varied between States. Overall the male:female ratio fell, and there were signs of a downward shift in the median age. We were unable to assess the impact of HIV infection on the number of isolates reported. Positive microscopy was obtained in 55-60% of patients with pulmonary disease. Approximately 8% of isolates had in vitro resistance to at least one of the four standard anti-tuberculosis drugs. Over the two year period seven strains were found to be multi-drug resistant. Overall, the data from 1994-1995 gives no indication of a significant change in the drug susceptibility profiles of isolates from Australian patients with tuberculosis.     

Pulmonary tuberculosis in 1996. Recent data and practical consequences for the anesthesiologist

Tuberculosis is one of the most widespread diseases, occurring in more than eight million persons, and about three million die annually of tuberculosis. In industrialized countries, the incidence has increased significantly over the last 10 years. HIV infection is a main factor leading to this increase. Outbreaks of nosocomial tuberculosis among patients and healthcare workers have been reported. Tuberculosis is often caused by multidrug-resistant bacilli in patients with HIV infection. Physicians must be aware of this danger and careful adherence to guidelines is required to prevent further nosocomial spread of the disease. Airborne transmission by inhalation of infectious aerosol justifies appropriate measures for respiratory isolation to protect medical staff and other patients from the transmission of tuberculosis. In combination with some anaesthetic agents, antituberculous drugs may be responsible for hepatic toxicity. Influence of tuberculosis on regional anaesthesia and mechanical ventilation is also considered.     

Effects of asynchronous stimulation on the human quadriceps femoris muscle

The human immunodeficiency virus (HIV) epidemic is associated with a marked increase of tuberculosis cases. The influence of HIV on diagnostic methods for tuberculous lymphadenitis is less clear. In an environment of high HIV and tuberculosis prevalence in Blantyre, Malawi, a prospective study compared results of basic procedures diagnosing tuberculous lymphadenitis with the outcome of histology and/or culture. One hundred out-patients, aged 15-55 years, with extra-inguinal lymphadenopathy not responding to general antibiotics, entered the study. Among 52 cases, with whom all procedures were carried out in accordance with the protocol, 38 (73%) were diagnosed as tuberculous lymphadenitis; 84% of the latter (32/38) were seropositive for HIV. Needle aspirate and biopsy smears stained by the Ziehl-Neelsen technique contributed little to detecting tuberculosis, 8% and 11% respectively. In contrast, macroscopic caseation of excised lymph nodes showed a high yield of 82%, which was similar to histology, and higher than that of L?wenstein-Jensen culture (61%). The study suggested that HIV positivity of tuberculous lymphadenitis patients decreased the possibility of histology and culture both being indicative of tuberculosis (odds ratio 0.10; P = 0.06). Consequently histology results, often used as the single definitive method, failed to diagnose 18% (7/38) of tuberculosis cases. However, it was reassuring that 4 simple methods, which can safely be carried out at district level, could be expected to diagnose 80-95% of tuberculous lymphadenitis cases in a timely and cost-effective manner.     

Comparison of molecular changes in lung cancers in HIV-positive and HIV-indeterminate subjects

CONTEXT: Human immunodeficiency virus (HIV) infection has been associated with an increasing incidence of malignancy, and HIV-infected persons have an increased incidence of primary lung carcinoma compared with the general population. OBJECTIVE: To investigate the molecular changes present in HIV-associated lung tumors and compare them with those present in lung carcinomas arising in HIV-indeterminate subjects ("sporadic tumors"). DESIGN: Convenience sample. SUBJECTS: Archival tissues from 11 HIV-positive persons and from 35 persons of indeterminate HIV status. SETTING: University-based medical centers and affiliated hospitals. MAIN OUTCOME MEASURES: Analysis of frequency of loss of heterozygosity (LOH) and microsatellite alteration (MA) using polymerase chain reaction and 16 polymorphic microsatellite markers at 8 chromosomal regions frequently deleted in lung cancer. Presence of HIV and human papillomavirus (HPV) sequences. RESULTS: The overall frequency of LOH at all chromosomal regions tested and the frequencies at most of the individual regions were similar in the 2 groups. Frequency of MA present in the HIV-associated tumors (0.18) was 6-fold higher than in sporadic tumors (0.03) (P<.001). At least 1 MA was present in 10 (91%) of 11 HIV-associated tumors vs 17 (48%) of 35 sporadic tumors (P=.02). Molecular changes were independent of tumor stage and gender. HIV and HPV sequences were not detected in the HIV-associated lung carcinomas. CONCLUSIONS: Microsatellite alterations, which reflect widespread genomic instability, occur at greatly increased frequency in HIV-associated lung carcinomas. Although the mechanism underlying the development of increased MAs is unknown, it may play a crucial role in the development of many HIV-associated tumors.     

Displacement of gold marker in immunoelectron microscopy of human respiratory cilia

The incidence of tuberculosis is rising in the United States. Similarly, the incidence of pulmonary tuberculosis in Taiwan is increasing, but that of large bowel tuberculosis in this region has not been reported. The purpose of this study was to investigate the changing disease pattern and to determine some possible surgical prognostic factors for large bowel tuberculosis. Seventy cases of large bowel tuberculosis treated at our institute during the period 1965-1995 were reviewed and analyzed. A steady decline in the case number of large bowel tuberculosis were noted from 1975, but there seems to be a slight increase in cases since 1990. The average age of these patients was 65.1 years, and none had human immunodeficiency virus infection. The ileocecum is the most common region of involvement. Of these 70 patients, 59 had not been definitively diagnosed until surgery. Active pulmonary tuberculosis was found in 18 patients (25.7%). The incidence of postoperative pulmonary complications was higher in patients with active pulmonary tuberculosis or disseminating large bowel tuberculosis. Postoperative abdominal complications, including intestinal obstruction, abdominal cutaneous fistula, and wound infection, were seen in 13 patients, none of whom had active pulmonary tuberculosis. Although the incidence of tuberculosis has been reduced for years, it is now rising. Physicians should bear in mind the possibility of large bowel tuberculosis in patients with intestinal obstruction without specific origin. Postoperative respiratory care is important for patients with pulmonary tuberculosis, with either active or disseminating lesions.     

Thrombocytopenia in HIV infection

Thrombocytopenia commonly occurs in individuals with HIV disease. However, profound thrombocytopenia, occurring in only 1.5% of cases, is relatively rare. The mechanisms of thrombocytopenia appear to be multifactorial: profound thrombocytopenia in HIV disease is related to an immune destruction either by antiplatelet antibodies or by immune complexes. In addition, a defect in platelet production is quite frequent both in immune thrombocytopenia (ITP) and in mild thrombocytopenia. This impaired platelet production may be due to an HIV infection of megakaryocytes that express a functional CD4 molecule. Treatment of HIV-associated thrombocytopenia is quite similar to that of non-HIV ITP. However, zidovudine increases the platelet count without correlation with its antiviral effect. In animal models and HIV patients, this enhancement of platelet count appears to be due to a stimulation of platelet production, the precise mechanism of which remains unknown. Splenectomy is as effective in severe HIV thrombocytopenia as in non-HIV ITP and has no significant adverse effects on HIV disease.     

The modulation by neurosteroids of the scopolamine-induced learning impairment in mice involves an interaction with sigma1 (sigma1) receptors

Pulmonary tuberculosis: primary tuberculosis, usually asymptomatic, represents the first infection and is shown by a parenchymal mostly mid-pulmonary focus and satellite lymphadenopathy. Postprimary pulmonary tuberculosis, mostly located in the upper fields may be caused by endogenous reinfection for reactivation of a hematogenous focus formed during primary infection or from exogenous reinfection. Extrapulmonary tuberculosis: it includes numerous forms mostly from hematogenous spread. Miliary tuberculosis may involve a number of organs and apparatus besides the lung. Tuberculous meningitis predominantly involves the base of the skull, the fluid is clear with hypoglycorrhachia and lymphocyte pleocytosis. Lymph node tuberculosis is generally unilateral and cervical. Tuberculous pleuritis is exudative or dry. Other forms of tuberculous serositis are pericarditis and peritonitis. Renal tuberculosis involves the medullaris and intestinal tuberculosis the ileocecum; tuberculous spondilitis (Pott's disease) involves the last dorsal vertebrae. Other forms are osteoarthritis, genital tract tuberculosis, pancreatitis, laryngitis, otitis.     

Isolated cervical tuberculosis in patients with HIV infection

OBJECTIVE: Tuberculosis isolated to the head and neck region is common in patients with HIV infection. However, the management of isolated head and neck tuberculosis has not been reported in the literature. This study was done to describe the characteristics of tuberculosis isolated to the head and neck region in patients infected with HIV and to detect differences in presentation and diagnostic management based on the status of HIV infection at presentation. METHODS: A retrospective study was performed including 38 patients infected with HIV who were seen with tuberculosis isolated to the head and neck region at two tertiary care centers during a 10-year period. These patients were divided into two groups on the basis of the HIV status at presentation, which indirectly reflects the level of immunosuppression. Group 1 included 11 patients (29%) with AIDS at presentation. Group 2 included 27 patients (71%) with HIV infection but not AIDS. RESULTS: The cervical lymphatics were the most common site for isolated head and neck tuberculosis (89%), with the supraclavicular nodes most often involved (53%). Extralymphatic involvement was less common (11%), but involved a variety of anatomic locations (skin, spinal cord, larynx, parotid). The presenting history and physical examination had a low sensitivity for tuberculosis in patients with HIV infection, mainly because of the presence of multiple confounding factors. Purified protein derivative testing was highly sensitive for tuberculosis in patients with HIV infection alone (61 %); however, its usefulness was diminished in patients with AIDS (14%; p=0.03). Fine-needle aspiration biopsy was 94% sensitive for diagnosing tuberculosis and was not affected by the status of HIV infection. Surgical biopsy was the gold standard for diagnosing tuberculosis but was associated with chronically draining fistulas in a significant number of cases (14%). CONCLUSIONS: These data suggest that tuberculosis should be considered in the differential diagnosis of all head and neck lesions in patients infected with HIV, even in the absence of pulmonary involvement. Purified protein derivative testing should be done liberally in these patients, with realization that the sensitivity of purified protein derivative testing is reduced in patients with AIDS. Fine-needle aspiration biopsy should be the key diagnostic test in this patient population, with open surgical biopsy reserved for highly suspicious cases in which other measures were not diagnostic.     

Renal pathology of human immunodeficiency virus infection

Renal complications of HIV infection are clinically and morphologically diverse. These may affect the glomerular, tubulointerstitial, and vascular compartments. Tubulointerstitial injury predominates in most autopsy-based studies, whereas glomerular disease is most frequently identified in biopsy-based studies. The most common glomerular lesion is HIV-associated focal segmental glomerulosclerosis and related mesangiopathies (collectively termed HIV-associated nephropathy). Increasingly, a variety of immune complex-mediated glomerular diseases such as membranoproliferative glomerulonephritis, IgA nephropathy and lupus-like nephritis, as well as hemolytic uremic syndrome/thrombotic thrombocytopenic purpura have been reported. The spectrum of tubulointerstitial lesions includes acute tubular necrosis, interstitial nephritis, diffuse infiltrative lymphocytosis syndrome, renal infection, and neoplasms including lymphoma and Kaposi's sarcoma. The pathological features of these conditions are reviewed with emphasis on clinical-pathological correlations and pathogenesis.     

Discovering the nursing profession through play. There is a player in each of us

To disclose the impact of human immunodeficiency virus (HIV) infection on the tuberculosis epidemic in Taiwan, we prospectively screened for HIV infection in patients with active pulmonary tuberculosis. A total of 378 patients who were admitted to the Taiwan Provincial Chronic Disease Control Bureau from January through December 1996 were enrolled. HIV serologic testing was performed by enzyme-linked immunosorbent assay (ELISA). A positive ELISA test was confirmed by Western blot analysis. One patient was infected with HIV. We conclude that the impact of HIV infection on the epidemic of tuberculosis in Taiwan is not significant at present.