Quantitative cytomegalovirus DNA level in the blood and its relationship to cytomegalovirus retinitis in patients with acquired immune deficiency syndrome

OBJECTIVE: A pilot study was performed to determine whether relationships exist between changes in a quantitative solution hybridization assay for cytomegalovirus (CMV) DNA in the blood and development of CMV retinitis, development of nonocular CMV disease, or reactivation of pre-existing CMV retinitis lesions. DESIGN: Observational case series. PARTICIPANTS: Two groups of human immunodeficiency virus-infected patients: 10 CMV antibody-positive patients with CD4+ T-lymphocyte counts of less than 50 ml and no CMV disease at baseline and 11 patients with CMV retinitis but no extraocular CMV disease at baseline. INTERVENTION: Quantitative changes in leukocyte-associated CMV DNA levels were observed over time. Anti-CMV therapies were based on clinical findings only. MAIN OUTCOME MEASURES: Development of CMV end-organ disease or change in activity of pre-existing CMV retinitis lesions was measured. RESULTS: Among patients with no CMV disease at baseline, four had CMV disease develop during follow-up (three cases of CMV retinitis, one case of presumed CMV esophagitis); all had CMV DNA levels greater than 5000 genomes/ml before the onset of CMV disease. The remaining six patients had levels less than 5000 genomes/ml throughout follow-up (P = 0.05). Among patients with CMV retinitis at baseline, all whose CMV DNA blood levels rose more than tenfold had extraocular CMV disease or reactivation of CMV retinitis develop. Raised CMV DNA blood levels were not seen in every patient with clinical reactivation of CMV retinitis. CONCLUSION: Elevated or rising CMV DNA blood levels appear to be associated with the development of CMV disease in individuals with low CD4+ T-lymphocyte counts. In patients with CMV retinitis, rising levels appear to be associated with the development of extraocular CMV disease or reactivation of CMV retinitis. Conversely, reactivation of CMV retinitis also may occur in the absence of changes in CMV DNA blood levels. Further studies are warranted to determine whether changes in CMV blood levels can be used as a guide for preemptive therapy to prevent reactivation of CMV retinitis lesions or to help choose between local and systemic therapy for management of reactivations.     

Pleural disease and acquired immune deficiency syndrome

Patients with acquired immune deficiency syndrome (AIDS) do not frequently have pleural complications. However, pneumothorax is a troublesome complication of patients with AIDS. At some medical centres, more than 50% of patients with spontaneous pneumothorax have AIDS. Most patients with spontaneous pneumothorax and AIDS have Pneumocystis carinii infection and necrotic subpleural blebs. The pneumothoraces in these patients usually cannot be managed with tube thoracostomy alone. Patients who do not respond to tube thoracostomy are best managed with a Heimlich valve or with thoracostomy with stapling of blebs and pleural abrasion. Approximately 2% of human immunodeficiency virus (HIV)-positive individuals will have a pleural effusion. Parapneumonic effusions or empyema, tuberculosis and Kaposi's sarcoma are the three leading causes. P. carinii infection is frequently responsible for pulmonary infections, but is only occasionally responsible for a pleural effusion. Pleural effusions may also develop from non-Hodgkin's lymphoma (NHL). There is one relatively rare NHL that is associated with the Kaposi's sarcoma associated virus that produces a lymphoma confined to the body cavity.     

Introduction to the special series on acquired immune deficiency syndrome (AIDS).

Introduces the special series on acquired immune deficiency syndrome (AIDS). This special series is intended to provide an update of progress made so far and to identify promising questions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of endoscopic sinus surgery in patients with acquired immune deficiency syndrome

Pseudofolliculitis barbae, commonly referred to as "razor bumps" or "ingrown hairs," is a papular and pustular, foreign body inflammatory reaction that can affect any individual who has curly hair and who shaves. This condition is a particular nuisance to African-Americans. This report will discuss the causes of pseudofolliculitis barbae and present a systematic approach to treatment.     

Immunoreactivation of Epstein-Barr virus due to cytomegalovirus primary infection

Interleukin (IL)-6 plays a major role in the control of the survival and proliferation of myeloma cell lines and primary myeloma cells. The genes of the receptors of IL-6 have been cloned, and the major signaling pathways involved in gp130 IL-6 transducer activation have been identified. In addition, another five cytokines that activate the gp130 IL-6 transducer have been identified. We review the recent data on gp130 cytokines and gp130-mediated signal transduction, their involvement in myeloma cell biology, and we discuss the possible therapeutic applications of this knowledge.     

Toenail onychomycosis in patients with acquired immune deficiency syndrome: treatment with terbinafine

The samples of blood freshly taken from healthy men were gamma-irradiated with a dose of 10 Gy. It was shown that after the treatment the blood gained the capacity to emit secondary biogenic radiation. Emission lasted for some hours, passed through quartz-glass cuvette and was revealed by stimulating influence on biological detector (sprouting seeds).     

A case of acute eosinophilic pneumonia due to Sho-saiko-to

A 16-year-boy who had taken a common over-the-counter cold remedy containing Sho-saiko-to, presented with fever, severe cough, sputum and dyspena. Two days later, he was admitted because a negative density, pulmonary edema-like shadow was noted on chest X-ray. A diagnosis of drug-induced pneumonia was strongly suspected, because an arterial blood gas analysis showed severe hypoxemia and leukocytosis with eosinophilia, and the chest X-ray showed a diffuse negative density pulmonary edema like shadow bilaterally. The findings on microscopic examination of transbronchial lung biopsy specimens were compatible with eosinophilic pneumonia. The eosinophil percentage in the bronchoalveolar lavage fluid was high. The result of a lymphocyte-stimulation test was positive for Sho-saiko-to, and Sho-saiko-to-induced pneumonia was strongly suspected. The patient ceased taking the cold remedy, and prednisolone was given. The clinical symptoms, severe hypoxemia, and chest X-ray findings markedly improved. To the best of our knowledge, there have been no previous reports of acute eosinophilic pneumonia induced by Sho-saiko-to.     

Mycoplasma pneumoniae infection presenting as Stevens-Johnson syndrome: a case report

A case of Mycoplasma pneumoniae infection as a precipitating factor in Stevens-Johnson Syndrome is presented. As the dentist may well be the first to see this syndrome, it is appropriate to highlight the condition and this particular organism as an infective cause.     

Varicella zoster virus retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome

A 10-year-old girl with lupus vulgaris following single BCG vaccination is reported. She had a 15 x 20 cm painless lesion covering her left shoulder, axilla, triceps and biceps region. PPD test was positive. Histopathological picture was identical to lupus vulgaris.     

Induction of feline acquired immune deficiency syndrome by feline leukemia virus: immuno- and neuroendocrine dysfunctions

Young cats, when chronically infected with feline leukemia virus (FeLV), developed feline acquired immune deficiency syndrome (FAIDS). The syndrome was associated with a sequence of dysfunctions in the hypothalamic-pituitary-gonadal (HPG) and the immune system, manifested in the reduction of luteinizing hormone-releasing hormone (LHRH), follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone in blood plasma. The average FSH and LH (in plasma or lymphocyte), testosterone, and LHRH concentrations in the 20 FeLV-infected cats were measured by radioimmunoassay. The results were compared with those of the 12 control cats that were not FeLV-infected. Four weeks after infection, the plasma LHRH concentration in the infected cats showed a 43% reduction. Five to six weeks after infection, the content of FSH and LH in lymphocyte was reduced by 50% and 28%, respectively, whereas, the plasma FSH and LH was reduced by 52% and 42%, respectively. A significant reduction in testosterone content was detected at Week 11 of infection. The onset of the immuno- and neuroendocrine dysfunctions in FAIDs cats followed this sequence: hypothalamus, lymphocyte, pituitary, adrenal gland, and gonads. Indirect immunofluorescence assay showed the presence of FeLV cytoplasmic antigens in the fibers of the hypothalamic preoptic region and the Leydig cells. The possible causal relationship between the dysfunction of the lymphocyte and HPG systems and the presence of FeLV was discussed.     

Social stress results in altered glucocorticoid regulation and shorter survival in simian acquired immune deficiency syndrome

From early in the AIDS epidemic, psychosocial stressors have been proposed as contributors to the variation in disease course. To test this hypothesis, rhesus macaques were assigned to stable or unstable social conditions and were inoculated with the simian immunodeficiency virus. Animals in the unstable condition displayed more agonism and less affiliation, shorter survival, and lower basal concentrations of plasma cortisol compared with stable animals. Early after inoculation, but before the emergence of group differences in cortisol levels, animals receiving social threats had higher concentrations of simian immunodeficiency virus RNA in plasma, and those engaging in affiliation had lower concentrations. The results indicate that social factors can have a significant impact on the course of immunodeficiency disease. Socially induced changes in pituitary-adrenal hormones may be one mechanism mediating this relationship.     

A case of respiratory muscle weakness due to cytochrome c oxidase enzyme deficiency

BACKGROUND: Cytologic evaluation of abnormal nipple secretion is a well-established method for the rapid diagnosis of breast carcinoma in females. However, less attention has been focused on male patients presenting with nipple discharge. CASE: A case of intraductal carcinoma of the male breast was diagnosed by nipple discharge cytology alone. CONCLUSION: This report illustrates the usefulness of nipple discharge cytology in the diagnosis of early breast carcinoma in males.     

Chemotherapy accelerates the development of acquired immune responses to Schistosoma haematobium infection

Treatment of 41 Schistosoma haematobium-infected children, 5-16 years old, with the drug praziquantel induced a switch from a predominantly IgA-specific antibody response to a predominantly IgG1 response within 12 weeks. A cross-sectional survey suggests that the same switch occurs naturally, but over several years, as children age (n = 251). The switch may be driven by alterations in cytokine levels in response to the release of antigens by dead or damaged parasites. Adults are more resistant to schistosome infection than children, and the switch to an "adult" response suggests that praziquantel treatment may have an immunizing effect, with benefits extending beyond a transient reduction in levels of infection.     

HIV myelopathy as the presenting symptom of acquired immunodeficiency syndrome

INTRODUCTION: Spinal lesions in the acquired immunodeficiency syndrome (AIDS) occur in 22% of all neurological complications, although their occurrence as the first sign of the disease is very uncommon. First place amongst the myelopathies described as associated with HIV is taken by vacuolar myelopathy, followed by the myelites. CLINICAL CASE: We studied a 65 year old homosexual man who had previously been free of symptoms and signs of HIV infection. He was seen for progressive paraparesia which had begun some days previously, followed by altered sense of position and of vibration. Complementary tests showed that the patient was a carrier of HIV antibodies in high titre (P-24) with a high viral load of 907 x 1,000 copies RNA/ml. Testing with evoked potentials showed changes compatible with involvement of the sensory pathways of the spinal cord. After treatment with dexamethasone there was obvious improvement with partial recovery of his symptoms. CONCLUSIONS: The neurological condition described was compatible with vacuolar type myelopathy due to HIV, appearing in the initial stages of the illness and coinciding with a marked increase in the viraemia. Although necropsy is necessary for confirmation of the diagnosis, more and more evidence is being found on which to base clinical suspicion. We discuss various hypotheses regarding possible pathogenic mechanisms arising in these circumstances.