Association of herpes zoster ophthalmicus with acquired immunodeficiency syndrome and acute retinal necrosis

We conducted a review to investigate the prevalence of human immunodeficiency virus (HIV), or acquired immunodeficiency syndrome (AIDS), in patients with herpes zoster ophthalmicus, as well as the incidence of acute retinal necrosis after herpes zoster ophthalmicus. All charts of patients seen at our institution between 1987 and 1992 with a primary diagnosis of herpes zoster ophthalmicus were reviewed. Of 112 patients with herpes zoster ophthalmicus, 29 (26%) had HIV or AIDS. All these patients were younger than 50 years at the time of diagnosis. Five of 29 (17%) immunocompromised patients had acute retinal necrosis after herpes zoster ophthalmicus. No acute retinal necrosis was identified in the nonimmunocompromised patients after herpes zoster ophthalmicus. We recommend that all patients younger than 50 years who have herpes zoster ophthalmicus at initial examination be tested for HIV. Additionally, HIV-infected patients should be monitored closely after herpes zoster ophthalmicus for development of acute retinal necrosis. Long-term oral prophylactic as well as initial high-dose intravenous acyclovir may be appropriate in HIV-infected individuals with herpes zoster.     

Neuroleptic malignant syndrome in the acquired immunodeficiency syndrome

Patients infected by the human immunodeficiency virus are predisposed to many infectious and noninfectious complications and often receive a variety of drugs. Furthermore, they seem to have a particular susceptibility to idiosyncratic adverse drug reactions. It is therefore surprising that only a few cases of the neuroleptic malignant syndrome have been described in patients with the acquired immunodeficiency syndrome. A high index of suspicion is required to diagnose the neuroleptic malignant syndrome in these patients, as its usual manifestations, including fever and altered consciousness, are frequently attributed to an underlying infection.     

Optic neuromyelitis and bilateral acute retinal necrosis due to varicella zoster in a patient with AIDS

Agrobacterium tumefaciens strain 1D1609 is reported here as the first field isolate from alfalfa (Medicago sativa L.). Unlike well-characterized A. tumefaciens strains such as C58 and Ach5, strain 1D1609 is highly virulent on alfalfa and has a distinctive host range. Interestingly, strain 1D1609 is naturally resistant to kanamycin and spectinomycin. The Ti plasmid in strain 1D1609 is an octopine-type; thus, tumors formed by strain 1D1609 synthesize octopine, which is utilized by the bacterium as a sole carbon source. Reciprocal exchange of Ti plasmids between strains 1D1609 and C58 showed that both chromosomal and Ti plasmid genes in strain 1D1609 contribute specifically to tumor formation on alfalfa. In addition, the nondormant CUF101 alfalfa cultivar from which strain 1D1609 was isolated was significantly more susceptible to all Agrobacterium strains tested than was the dormant Agate cultivar.     

Human microsporidiosis in the acquired immunodeficiency syndrome

BACKGROUND AND OBJECTIVE: Photodynamic therapy (PDT) using 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) for sensitization is a promising treatment for carcinoma in situ and diffuse premalignant changes of the bladder. We studied the biodistribution of PpIX in a range of tissues with oral and intravesical routes of administration of ALA and compared the photodynamic effects on bladder and skin. STUDY DESIGN/MATERIALS AND METHODS: Normal Wistar rats were given oral or intravesical ALA and PpIX levels in the liver, kidney, skin, and bladder measured by fluorescence microscopy on tissue sections. At the time of maximum PpIX levels, the bladder and skin on the back were illuminated with light at 630 nm and the PDT effects compared. RESULTS: PpIX fluorescence in the urothelium after 200 mg/kg given intravesically was comparable to that found after 100 mg/kg orally. The ratio of PpIX levels between the urothelium and the underlying muscle was the same for both routes of administration, although there appeared to be more selectivity of urothelial PDT necrosis after intravesical administration. Skin photosensitization was greater after oral ALA, the epidermal PpIX level being three times higher than after intravesical administration for comparable urothelial levels and the PDT effect being more marked. CONCLUSIONS: Intravesical instillation is preferable to oral administration of ALA for PDT ablation of the urothelium of the rat bladder without damage to the underlying tissue layers and for minimizing skin photosensitivity. The technique is now ready for clinical trials.     

Helicobacter pylori prevalence in acquired immunodeficiency syndrome

Helicobacter pylori is consistently reported with high prevalence in HIV-negative patients with chronic gastritis and active ulcer disease. This study is an evaluation of the prevalence of H. pylori in AIDS patients, and the association with chronic gastritis, erosions, and ulcer disease. Seventy-three AIDS patients referred for the evaluation of gastrointestinal symptoms underwent upper endoscopy and antral gastric biopsy. Histologic gastritis was diagnosed and degree of activity graded on hematoxylin-eosin stain. H. pylori organisms were identified by acridine orange stain. A single pathologist evaluated the biopsy specimens. H. pylori was found in 15% (11 of 73) of AIDS patients. Histologic chronic active gastritis was evident in 94.5% (69 of 73) of the study group. H. pylori was identified in 15.9% (11 of 69) of biopsy specimens with histologic chronic active gastritis. The organism was more common in biopsy specimens with a higher grade of activity in the chronic gastritis. Endoscopic erosions or ulcers were noted in 11 patients (seven gastric, four duodenal). H. pylori was present in 18% (2 of 11) of AIDS patients with erosions or ulcers. The prevalence of H. pylori in AIDS patients with histologic chronic active gastritis is much lower than the prevalence previously reported for HIV-negative patients with similar pathology. The low prevalence observed does not implicate H. pylori as the causal agent in most chronic active gastritis in the AIDS population. Impaired acid secretion may reduce colonization of gastric mucosa and explain the low rate of H. pylori observed.     

Cryptococcal chorioretinitis and acquired immunodeficiency syndrome

To evaluate the effect of education in children with chronic defaecation problems, a prospective 6-week intervention study was designed. A total of 54 children (5-14 years) underwent an education programme, with demystification of symptoms and advice about diet and toilet training. The present treatment was continued. After 6 weeks, children with persistent problems received biofeedback training with a follow up of 1 year. The intervention programme was successful in 8 children (15%). Biofeedback training was successful in 49% of the remaining group after 1 year. CONCLUSION: A total of 15% of the children with chronic defaecation problems seen at a referral centre could surprisingly be helped by a simple education programme with, demystification and toilet training. Further studies evaluating treatment in children with defaecation problems should account for the primary effect of these measures.     

Liver toxoplasmosis and acquired immunodeficiency syndrome

We report two rare cases of acute toxoplasmic hepatitis in patients that were serum positive for Human Immunodeficiency Virus (HIV) infection. Although Toxoplasma gondii is the main causative agent in infections of the central nervous system (CNS) in patients with AIDS and is known to cause widely disseminated infection in this clinical setting, few reports exist documenting involvement of the liver in these patients.     

Neurogenic bladder in patients with acquired immunodeficiency syndrome

We have performed a urodynamic study on 3 patients with acquired immunodeficiency syndrome (AIDS), presenting with a neurogenic bladder. The first patient had an ascending myelitis of probable herpetic origin, the second patient had a cerebral abscess caused by Toxoplasma gondii, and the third patient had an AIDS dementia complex. The urodynamic study showed an areflexic detrusor in the first 2 patients, and a hyperreflexic detrusor in the third patient.     

Imaging of ORL diseases in acquired immunodeficiency syndrome

More than 50% of patients with acquired immunodeficiency syndrome (AIDS) present a lesion affecting parotid gland, lymph nodes, paranasal sinuses, pharyngo-larynx or temporal bone. In about 20% out of cases affected patients present different head and neck lesions at the time of evaluation. Most often, clinical examination and endoscopy are sufficient to perform diagnosis and to manage the disease. Imaging studies (CT or MRI) are indicated when the nature of the disease is unknown or when a map of the process is mandatory for therapeutic approach. Some imaging features are strongly suggestive of HIV infection: parotid cysts associated with hyperplasia of the nasopharynx and cervical lymph nodes enlargement; labyrinthitis and multinevritis; and head and neck squamous cell carcinomas in non alcoolo-tobacco addicted patients. Such diseases suggest the need for knowledge of the patient's seropositivity status.     

Mycobacteremia in patients with the acquired immunodeficiency syndrome

BACKGROUND: Bacillemia is a key event in the pathogenesis of tuberculosis. Although current evidence indicates that Mycobacterium tuberculosis bacteremia is rare in patients seronegative for the human immunodeficiency virus, it has been increasingly reported in patients with the acquired immunodeficiency syndrome (AIDS). OBJECTIVE: To determine clinical and laboratory characteristics of patients with AIDS and tuberculosis with and without bacillemia. METHODS: Fifty patients with AIDS with clinical suspicion of disseminated mycobacterial disease were prospectively selected. Three consecutive blood samples were collected for culture using a standardized protocol. RESULTS: Mycobacterium was isolated from any body site in 42 patients (84%). Bacillemia was detected in 30 (71.4%) of these 42 patients: 11 (28.2%) caused by Mycobacterium avium-intracellulare complex and 19 (71.8%) caused by M tuberculosis. Blood culture was the only method used to confirm the diagnosis in 5 (15%) of the 33 tuberculosis cases. Tuberculosis in patients with AIDS developed with nonspecific insidious symptoms, a remarkable elevated alkaline phosphatase level, and without the classic miliary radiological pattern. We could demonstrate 2 previously unrevealed clinical characteristics of bacteremic tuberculosis in patients with AIDS: a shift to the left in the white blood cell count and abdominal lymph node enlargement. In patients with tuberculosis, the in-hospital mortality rate was higher among patients with bacillemia, although the posttreatment survival rate was comparable. CONCLUSIONS: Blood culture is a valuable tool to confirm the clinical diagnosis of disseminated tuberculosis in patients with AIDS and can distinguish patients with characteristic clinical findings and outcome. Abdominal ultrasonography may be an additional helpful tool to identify these patients.     

Pulmonary cryptosporidiosis in patients with acquired immunodeficiency syndrome

Several reports have showed Cryptosporidium species as a cause of intractable diarrhea and malabsorption in patients with acquired immunodeficiency syndrome (HIV). A case of chronic diarrhea in a drug addict woman associated with a symptomatic interstitial pulmonary infection due to Cryptosporidium parvum is described. This unusual C. parvum spread into the bronchial tree is underlined and a survey of the literature is made.     

Feline immunodeficiency virus infection--causative agent of an acquired immunodeficiency syndrome in cats

An ideal animal model for human immunodeficiency virus (HIV) infection in man should be caused by a genetically similar virus, it should cause as nearly identical clinical signs as possible, the pathogenesis of the resulting disease should be similar, and the model should be easily accessible to all researchers. Feline immunodeficiency virus (FIV) meets all these criteria. FIV is particularly useful as an animal model for investigation of the pathogenesis of lentivirus infections like cofactor studies, as well as for vaccine strategies, and drug testing in vitro and in vivo.     

Disseminated strongyloidiasis in a patient with acquired immunodeficiency syndrome

Seven patients developed recurrent hemarthroses following total knee arthroplasty. The average interval between arthroplasty and the first bleed was more than 20 months (range, 1-30 months). All seven required open synovectomy an average of 21 months (6-31 months) after arthroplasty. Follow-up evaluation averaged 44 months (19-60 months) and all had an excellent result without further bleeds. A prolific synovitis was seen in all cases, with histologic features revealing a chronic synovitis with fibrosis and hemosiderin staining. Entrapment of the proliferative synovial tissue between the components is postulated to be the etiology for these recurrent bleeds which averaged four per patient prior to synovectomy.     

Herpes simplex type 1 encephalitis in acquired immunodeficiency syndrome

PURPOSE: The judiciousness of open biopsy of lymph node mestastases in the neck is controversial. A retrospective review of treatment results at the University of Florida in patients who underwent excisional biopsy of a solitary metastatic neck node followed by radiotherapy was undertaken to determine whether the approach resulted in increased rates of regional and distant recurrence or wound complications. METHODS AND MATERIALS: Between October 1964 and September 1987, 41 patients were referred for radiotherapy after excisional biopsy of a solitary cervical node containing metastatic squamous cell carcinoma from a known mucosal site (19 patients) or unknown primary (22 patients) in the head and neck. None had known gross residual neck disease. The neck stage (based on N stage before surgery or size of the excised node) was unknown in seven patients, N1 in 15 patients, N2A in 18 patients, and N3A in one patient. All patients received radiotherapy to the neck and two had a planned neck dissection after radiotherapy. Doses to the nodal bed ranged from 5485 cGy to 8100 cGy (median, 6675 cGy). RESULTS: The probability of control of neck disease was 95% at both 5 and 10 years. Five-year probability of disease control above the clavicles was 90%. Distant metastasis occurred in 0 of 36 patients whose disease was controlled above the clavicles vs. 3 of 5 patients who suffered failure above the clavicles. CONCLUSION: Excisional biopsy of a solitary neck node followed by radiotherapy produced excellent regional control and no apparent increased rate of distant metastasis.     

Septic shock in patients with the acquired immunodeficiency syndrome

OBJECTIVE: To evaluate the prognosis of patients with septic shock admitted to an intensive care unit (ICU), according to their HIV serostatus. DESIGN: Retrospective study. SETTING: Medical ICU of a university hospital. PATIENTS: 76 patients with septic shock admitted to the same ICU, of whom 28 were HIV positive and 48 were HIV negative. MEASUREMENTS AND RESULTS: Severity scores, number and type of organ failures, and survival rates were assessed in the two groups of patients. Glasgow Coma Scale and general severity scores [Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score (SAPS)] were significantly worse in HIV-infected patients. The total number of organ failures was also higher in the HIV-positive group: 3.7 +/- 0.2 vs 3.1 +/- 0.2 in the HIV-negative group (p < 0.001). On day 28, 21 (46%) HIV-negative patients were dead compared to 26 (93%) patients in the HIV-positive group (p < 0.001). In the multivariate analysis, HIV infection was an independent risk factor for mortality, as were the SAPS score, use of mechanical ventilation, and the McCabe score. CONCLUSIONS: This study reports a considerable excess mortality in HIV-infected patients with septic shock. Although severity of illness was clearly much more pronounced in HIV-positive patients, retroviral infection was independently associated with death. Improving survival in HIV-positive patients with septic shock may require earlier diagnosis and treatment of the causative infection.