Frequent Opportunistic Infection Research Articles

Clinical Findings of Pediatric HIV Infection in a Tertiary Center in Turkey.

Background:Paediatric HIV infection is different from the adult type of disease in many ways, including transmission routes, clinical findings and treatment strategies.Aims:To evaluate clinical data of paediatric patients with HIV disease.Study Design:Retrospective cross-sectional study.Methods:The charts of 22 paediatric patients diagnosed with HIV infection in our clinic during a 14 year period through 2001-2015 were retrospectively analysed. Clinical data, laboratory findings, treatment modalities and outcomes were recorded.Results:The mean age of diagnosis 61.9±49.2 months and the mean follow-up period was 60.3±37.5 months. Seven patients (31.8%) were foreigners and the most common transmission route was vertical transmission (n=16, 72.7%). The most common presenting symptom and the sign were history of recurrent upper respiratory tract infections (n=8, 36.4%) and lymphadenopathy (n=12, 54.5%), respectively. Recurrent pneumonia (n=6, 27.3%), prolonged fever (n=5, 22.7%), recurrent otitis media (n=4, 18.2%), and gastroenteritis (n=4, 18.2%) were other clinical symptoms. Other than bacterial sinopulmonary infections, tuberculosis was the most frequent opportunistic infection (n=3, 13.6%). Mortality occurred in two patients (9.1%).Conclusion:Although mostly vertically transmitted, HIV infection may be diagnosed throughout the childhood. Frequently encountered signs and symptoms may be the reason for doctor admission. High clinical suspicion together with detailed anamnestic data and physical findings constitute the basis for pediatric HIV diagnosis.

Cryptococcosis Neuro-Brain in 42 Patients at the University Hospital of Brazzaville

To describe epidemiological, clinical, therapeutic; and evolutionary aspects of Neuromeningeal Cryptococcus (NMC) at Brazzaville University Hospital and to find out factors associated to death. A descriptive and analytical retrospective study of NMC files in the infectious diseases department between January 1 and December 31, 2013. 973 patients were hospitalized, 42 NMC cases (4.3%) were compiled. The mean age was 40.2±10.4 years (17-64 years). The sex ratio M/F was 1.1. The majority (n=23) came from an urban area. HIV infection (n=37-88.1%) was the main point with an average of lymphocyte LTCD4 with 101.3±123.58/mm3. The average patient consultation time was 27.5±33.6. Fever (n=36, 85.7%), headache (n=11, 26.2%) and consciousness disorders (n=13, 31.0%) were the primary reasons for consultation. LCR was clear in 32 patients and neuromeningeal Cryptococcus was confirmed by CSF in all patients (n=42,100%). Treatment was fluconazole (800-2000 mg) in all patients. No adverse effects related to fluconazole were noticed. Six patients underwent lumbar puncture discharge and 23 patients (54.8%) were on antiretroviral therapy. The lethality was 74.0% (n=31), with no significant difference depending on the stage of immunosuppression and etiologic treatment. It was significantly higher in comatose patients with Glasgow ≤8. Neuromeningeal Cryptococcus is a frequent opportunistic infection in our service with high lethality. This shows how important is the prevention which implies the early management of HIV infection.

Pediatric HIV Infection in Togo: Situation of Child Care in the Central Region from 2008 to 2015

This piece of work covers thirteen (13) AIDS assistance programs sites over the period 1st Jan 2008 to 31st Dec 2015. The study is retrospective, descriptive and cross-sectional based on 292 clinical cases of HIV infected children aged between 0 and 14 years old. A regional committee was charged to validate antiretroviral treatment (ART) prescriptions on a weekly basis. We have also used data from the regional committee register. HIV infected children represent 5.1% of casework on ART. The average starting age for ART was 4.5 years (1-180 months) with a sex ratio (male/female) of 0.9. The clinical classifications according to WHO guidelines were: Stage III (52.3%) and Stage IV (20.3%). The most frequent opportunistic infections were: wasting (40.12%), digestive candida infection (29.0%), acute respiratory infections (22.8%) and skin diseases (17.9%). The HIV type 1 was detected on all of the children (100%). The average rate of CD4 at the beginning of the ART was 552.98 cells/mm3, leading to a severe immuno-suppression in many cases (44.8%). The initial ART was essentially Nevirapine+Lamivudine+Stavudine. HIV infections diagnosis are usually late in the Central Region of Togo and will therefore be improved by the UNAIDS 90-90-90 strategic plan by 2020, through various initiatives. These are: the Prevention of Mother to Child HIV Transmission (PMTCT), the Early Infection Diagnosis (EID) based on Polymerase Chain Reaction (PCR) and the Provider Initiated Testing and Counseling (PITC).

Pediatric HIV Infection in Togo: Situation of Child Care in the Central Region from 2008 to 2015

This piece of work covers thirteen (13) AIDS assistance programs sites over the period 1st January 2008 to 31st December 2015. The study is retrospective, descriptive, and cross-sectional based on 292 clinical cases of HIV infected children aged between 0 and 14 years old. A regional committee was charged to validate antiretroviral treatment (ART) prescriptions on a weekly basis. We have also used data from the regional committee register. HIV infected children represent 5.1% of casework on ART. The average starting age for ART was 4.5 years (1 - 180 months) with a sex ratio (Male/Female) of 0.9. The clinical classifications according to WHO guidelines were: Stage III (52.3%) and Stage IV (20.3%). The most frequent opportunistic infections were: wasting (40.12%), digestive candida infection (29.0%), acute respiratory infections (22.8%) and skin diseases (17.9%). The HIV type 1 was detected on all of the children (100%). The average rate of CD4 at the beginning of the ART was 552.98 cells/mm3, leading to a severe immuno-suppression in many cases (44.8%). The initial ART was essentially NEVIRAPINE + LAMIVUDINE + STAVUDINE. HIV infections diagnosis are usually late in the Central Region of Togo and will therefore be improved by the UNAIDS 90-90-90 strategic plan by 2020, through various initiatives. These are: the Prevention of Mother to Child HIV Transmission (PMTCT), the Early Infection Diagnosis (EID) based on Polymerase Chain Reaction (PCR) and the Provider Initiated Testing and Counseling (PITC).

Frequency and distribution patterns of opportunistic infections associated with HIV/AIDS in Uganda.

BackgroundWe conducted a study to assess the frequency and distribution patterns of selected opportunistic infections (OIs) and opportunistic cancers (OCs) in different geographical areas before and after HAART in Uganda.MethodsThis was a cross-sectional serial review of observation data for adult HIV positive patients (≥15 years) enrolled with the AIDS support organization (TASO) in Uganda covering the period from January 2001 to December 2013. Both AIDS defining OIs/OCs and non-AIDS defining OIs were analyzed. The study period was structured into three time periods: “pre- HAART” (2001–2003), “early-HAART” (2004–2008) and “late-HAART” (2009–2013). Descriptive statistics were used to summarize the data by time period, age, gender and geographical location. Chi squared test used to test the significance of the differences in proportions.ResultsA total of 108,619 HIV positive patients were included in the analysis. 64% (64,240) were female with median age of 33 years (IQR 27–40). The most frequent OIs before HAART were oral candida (34.6%) diarrhoeal infection (<1 month) (30.6%), geohelminths (26.5%), Mycobacterium tuberculosis (TB) (17.7%), malaria (15.1%) and bacterial pneumonia (11.2%). In early HAART (2004–2008), the most frequent OIs were geohelminths (32.4%), diarrhoeal infection (25.6%), TB (18.2%) and oral candida (18.1%). In late HAART (2009–2013), the most frequent OIs were geohelminths (23.5%) and diarrhoeal infection (14.3%). By gender, prevalence was consistently higher in women (p < 0.05) before and after HAART for geohelminths, candidiasis, diarrhoeal infection, bacterial pneumonia and genital ulcer disease but consistently higher in men for TB and Kaposi’s sarcoma (p < 0.05). By age, prevalence was consistently higher in older age groups (>30 years) before and after HAART for oral candida and TB (p < 0.05) and higher in young age groups (<30 years) for malaria and genital ulcers (p < 0.05). By geographical location, prevalence was consistently higher in Eastern and Northern Uganda before and after HAART for diarrheal infection and geohelminths (p < 0.0001).ConclusionsThe frequency and pattern of OIs before and after HAART differs by gender, age and geographical location. Prevalence of geohelminths and diarrhea infection(<1 month) remains high especially in Northern and Eastern Uganda even after HAART and should therefore be given special attention in HIV/AIDS care programmes in these settings.

Clinical Course, Radiological Manifestations, and Outcome of Pneumocystis jirovecii Pneumonia in HIV Patients and Renal Transplant Recipients.

BackgroundPneumocystis jirovecii pneumonia (PCP) is a frequent opportunistic infection in immunocompromised patients. In literature, presentation and outcome of PCP differs between patients with human immunodeficiency virus (HIV) infection and renal transplant recipients (RTRs).MethodsWe conducted a cross-sectional study of patients with PCP based on the HIV and renal transplant registries at our institution. Radiological and clinical data from all confirmed PCP cases between 2005 and 2012 were compared.ResultsForty patients were included: 16 with HIV and 24 RTRs. Radiologically, HIV patients had significantly more areas of diffuse lung affection (81% HIV vs. 25% RTR; p = 0.02), more ground glass nodules 5–10 mm (69% vs. 4%; p = <0.001) and enlarged hilar lymph nodes were found only in HIV patients (44%). Cough and dyspnea were the most common clinical signs (>80%) in both groups. Duration from illness onset to hospital presentation was longer in the HIV patients (median of 18 vs. 10 days (p = 0.02)), implying a less fulminant clinical course. Sixty percent of PCP cases in RTRs occurred >12 months after transplantation. Lengths of hospitalization, admission rates to the intensive care unit, and requirements for mechanical ventilation were similar. Outcome in both groups was favourable.ConclusionsWhile important differences in radiological presentation of PCP between HIV patients and RTRs were found, clinical presentation was similar. PCP only rarely presented with fulminant respiratory symptoms requiring ICU admission, with similar results and outcomes for HIV patients and RTRs. Early diagnosis and treatment is mandatory for clinical success.

High levels of plasma interferon gamma and +874T/A gene polymorphism is associated with HIV-TB co-infection

ObjectiveTuberculosis (TB) is one of the most frequent opportunistic infections in HIV patients leading to increased morbidity and death rate. This study was carried out to investigate the role of the cytokines IFN-γ and TNF-α level and their single nucleotide polymorphisms (SNPs) in HIV-TB co-infection. Methods247 HIV-TB (124 HIV-pulmonary TB, 123 HIV-extra pulmonary TB), 126 HIV positive individuals without tuberculosis and 129 healthy subjects (HS) were included to measure plasma levels of IFN-γ and TNF-α by sandwich ELISA and One way ANOVA statistical analysis was carried out among the groups. The SNPs of TNF-α-308 G/A, -238 G/A and IFN-γ+874 T/A were also investigated using amplification refractory mutation system polymerase chain reaction (ARMS-PCR). The frequencies between the groups were compared by Pearson’s chi square statistical analysis. ResultsPlasma IFN-γ and TNF-α were significantly elevated in HIV-TB and TB (p<0.05) as compared to those in HS group. There was significant association between IFN-γ+874 ‘A’ allele and AA genotype in HIV-TB groups compared to HS and HIV (p<0.05) and no such association was found for TNF-α-308 and -238. The plasma cytokine levels of TNF-α and IFN-γ reveals no significant association with levels of IFN-γ+874 T/A, TNF-α -308 G/Aand-238 G/A genotypes in any of the study groups. ConclusionIn conclusion, the present study revealed elevated plasma IFN-γ and its +874 ‘A’ allele are associated with HIV-TB co-infection indicating 1.6 times increased risk for TB susceptibility. Elevated TNF-α levels in TB and HIV-TB suggest its involvement in TB pathogenesis.

Disparities in the Magnitude of Human Immunodeficiency Virus-related Opportunistic Infections Between High and Low/Middle-income Countries: Is Highly Active Antiretroviral Therapy Changing the Trend?

Opportunistic infections (OIs) cause significant morbidity/mortality in human immunodeficiency virus (HIV)-infected individuals globally. Disparities between high-income countries (HICs) and low/middle-income countries (LMICs) in the magnitude of HIV-related OIs in pre-highly active antiretroviral therapy (HAART) populations was reviewed, and HAART-induced decline in OIs was further compared between the two settings. Studies published in English from onset of HIV epidemic up to December 2013 were searched in PubMed, Google, Google Scholar, and African Journal online. An article was included if (a) the study was conducted in HIC or LMIC, (b) the age of the participants was ≥12 years, (c) the HAART status of the participants was stated, and (d) various types of OIs were investigated. In predominantly pre-HAART populations, the incidence and prevalence of overall HIV-related OIs in HIC ranged from 5.5 to 50.0 per 100 person-years (PY) and 27.4-56.7%, respectively. In LMIC, the respective overall incidence and prevalence of OIs were 12.2-93.9 per 100 PY and 32.0-77.7%. Pneumocystis jirovecii pneumonia, candidiasis, Cytomegalovirus disease, Mycobacterium avium complex disease, and Kaposi's sarcoma were the most frequent OIs in HICs while tuberculosis, candidiasis, chronic diarrhea, and cryptococcosis were predominant in LMICs. The introduction of HAART led to substantial reduction in the incidence of OIs with more impressive percentage decline in HICs (43-97%) compared to 30-79% in LMICs. Disparities in the magnitude of HIV-related OIs between HICs and LMICs are evident both in the pre-HAART and post-HAART era. Efforts to optimize HAART-induced decline in HIV-related OIs should become a global health priority irrespective of prevailing socioeconomic circumstances.

DIFICULTĂŢI DE DIAGNOSTIC LA UN COPIL CU INFECŢIE HIV ŞI AFECTARE PULMONARĂ

Diagnosis of pulmonary lesions in HIV infected children can be challenging. If in adults to obtain sputum samples to support the diagnosis of pulmonary tuberculosis is relatively easy, establishing diagnosis in children can be more difficult. Pulmonary tuberculosis is the most frequent opportunistic infection in HIV infected patients from low and middle income countries and therefore it is one of the first suspected etiology in cases with abnormal chest X ray. However, in case of an interstitial pneumonia, especially in children, it is important to take in consideration also other etiologies. We present the case of a 2 year old girl, diagnosed with HIV infection during a recurrent episode of parotiditis. Even if the initial clinical aspect and laboratory exam suggested a pulmonary tuberculosis, the supposition was not confirmed. The pulmonary disease was most probable a lymphocytic interstitial pneumonia in a HIV infected child with high positive titers of IgG anti Epstein Barr virus.

Progressive multifocal leukoencephalopathy: current treatment options and future perspectives.

Progressive multifocal leukoencephalopathy (PML) is a rare but debilitating and frequently fatal viral disease of the central nervous system, primarily affecting individuals with chronically and severely suppressed immune systems. The disease was relatively obscure until the outbreak of HIV/AIDS, when it presented as one of the more frequent opportunistic infections in this immune deficiency syndrome. It attracted additional attention from the medical and scientific community following the discovery of significant PML risk associated with natalizumab, a monoclonal antibody used for treatment of relapsing-remitting multiple sclerosis. This was followed by association of PML with other immunosuppressive or immunomodulating drugs. PML is currently untreatable disease with poor outcomes, so it is a significant concern when developing new immunotherapies. Current prophylaxis and treatment of PML are focused on immune reconstitution, restoration of immune responses to JC virus infection, and eventual suppression of immune reconstitution inflammatory syndrome. This approach was successful in reducing the incidence of PML and improved survival of PML patients with HIV infection. However, the outcome for the majority of PML patients, regardless of their medical history, is still relatively poor. There is a high unmet need for both prophylaxis and treatment of PML. The aim of this review is to discuss potential drug candidates for prophylaxis and treatment of PML with a critical review of previously conducted and completed PML treatment studies as well as to provide perspectives for future therapies.

Anticandida Agents from a Tanzanian Plant Albizia anthelmintica

AbstractCandidiasis is one of the most frequent opportunistic infections in individuals with severe immunosupression and further development of resistance against the available antifungal drugs has created an alarming situation. This requires intensive drug discovery to develop new, more effective, affordable and accessible antifungal agents possessing novel modes of action. Albizia anthelmintica, which is ethno medically used to treat vaginal candidiasis in the Morogoro and coastal regions of Tanzania, on activity guided fractionation and subsequent purification resulted in the isolation and characterization of an isomer of methyl cyclitol (1) and six echinocystic acid saponins (2–7). Saponins 6 and 7 are new and being reported for the first time from nature. Among all the isolated compounds, 3‐O‐[α‐L‐arabinopyranosyl (1→2)][α‐L‐arabinopyranosyl (1→6)]‐2‐acetamido‐2‐deoxy‐β‐D‐glucopyranosyl echinocystic acid (4), 3‐O‐[α‐L‐arabinopyranosyl (1→2)] [α‐L‐arabinopyranosyl (1→6)]‐2‐amino‐2‐deoxy‐β‐D‐glucopyranosyl echinocystic acid (6) and 3‐O‐[β‐D‐glucopyranosyl (1→3)] [α‐L‐arabinopyranosyl (1→2)] [α‐L‐arabinopyranosyl (1→6)]‐2‐amino‐2‐deoxy‐β‐D‐glucopyranosyl echinocystic acid (7) and their combinations were active against the various strains of C. albicans with MICs ranging from 12.5 to 125 μg/ml.

Clinical profile of human immunodeficiency virus patients with opportunistic infections: A descriptive case series study.

Background:Human immunodeficiency virus (HIV) virus, causative agent in acquired immunodeficiency syndrome, is fast becoming a major threat in the Indian subcontinent, with an estimated 3.7 million persons being infected with HIV. HIV infection is complicated by various opportunistic infections (OIs) such as tuberculosis (TB), candidiasis, herpes zoster, Pneumocystis jirvoceii, cytomegalovirus (CMV) etc., This study carried out to know the clinical profile of HIV patients with OIs.Methods:A case series study was carried out at a tertiary care hospital in Bellary, Karnataka, India. A hospital based case series study was conducted among 164 HIV patients with OIs admitted to various wards as well as attending outpatient department at Vijayanagara Institute of Medical Sciences Hospital, Bellary during Jan 2013 to Nov 2013. Both primary and secondary data was collected to gather information on clinical profile. The statistical tests used were descriptive statistics and independent t test.Results:Among 164 patients, 29.3% were females and 68.3% males. High proportions of patients were observed in 28-37 years of age group and heterosexual route was the most common mode of transmission. TB (50%) is the most frequent OI followed by candidiasis (49%), pneumocystis (16%) and others. The mean CD4 cell count in TB was 237.02/mL and in candidiasis 189.07/mL. Low values were observed in promyelocytic leukemia (18.10/mL), CMV (18.5/mL) and in toxoplasmosis (73.1/mL).Conclusions:Respiratory system was the most common system involved by OIs and most of patients with OIs had CD4 T cell count below 200/mL, whereas there were no patients in the study with counts above 500/mL.

Efficacy of Extended Valganciclovir Prophylaxis in Preventing Cytomegalovirus Infection in Pediatric Kidney Transplantation

Cytomegalovirus (CMV) is one of the most frequent opportunistic infection in renal transplant (RTx) recipients. Valganciclovir (VGC) has been showed to be safe and highly effective in prophylaxis of CMV infection in RTx recipients. Recently, an increase in delayed onset CMV disease has been noted with some arguing that longer prophylaxis may decrease the late-onset disease. We retrospectively tested the hypothesis that extended term prophylaxis (ETP) of VGC for 12 months is more effective than short term prophylaxis (STP) of 6 months in preventing CMV infection and disease in pediatric RTx performed at the University of Florida from July 2003 to December 2010. In this period, all recipients underwent prospective CMV PCR (Polymerase Chain Reaction) monitoring and were maintained on similar immunosuppression. Eighty six patients received RTx during that period. All eligible subjects had to have at least 12 months of graft survival and 18 months of follow up, leaving 73 eligible subjects in final study group. CMV infection or disease occurred in 6/29 (20%) in the STP group vs 6/44 (14%) in the ETP group with no statistical significant difference (P= 0.42). Donor positive/recipients negative CMV serology status (D+/R-) were associated with a higher risk of CMV infection in both univariate and multivariate analysis (P=0.01). Anemia and Leucopenia directly associated with VGC were similar in both groups (P=0.58 and P=0.2 respectively). Biopsy-proven acute rejection was also non-significant in both groups (P=0.39). Although ETP for CMV from 6 months to 12 months is safe and has minimal adverse effect, it did not reduce CMV infection or disease. Further controlled studies in pediatrics age group are considered to compare longer versus shorter periods of prophylaxis and their impact on prevention of CMV infection, resistance, cost, and toxicity.

Efficacy of Extended Valganciclovir Prophylaxis in Preventing Cytomegalovirus Infection in Pediatric Kidney Transplantation.

Cytomegalovirus (CMV) is one of the most frequent opportunistic infection in renal transplant (RTx) recipients. Valganciclovir (VGC) has been showed to be safe and highly effective in prophylaxis of CMV infection in RTx recipients. Recently, an increase in delayed onset CMV disease has been noted with some arguing that longer prophylaxis may decrease the late-onset disease.We retrospectively tested the hypothesis that extended term prophylaxis (ETP) of VGC for 12 months is more effective than short term prophylaxis (STP) of 6 months in preventing CMV infection and disease in pediatric RTx performed at the University of Florida from July 2003 to December 2010. In this period, all recipients underwent prospective CMV PCR (Polymerase Chain Reaction) monitoring and were maintained on similar immunosuppression.Eighty six patients received RTx during that period. All eligible subjects had to have at least 12 months of graft survival and 18 months of follow up, leaving 73 eligible subjects in final study group. CMV infection or disease occurred in 6/29 (20%) in the STP group vs 6/44 (14%) in the ETP group with no statistical significant difference (P= 0.42). Donor positive/recipients negative CMV serology status (D+/R-) were associated with a higher risk of CMV infection in both univariate and multivariate analysis (P=0.01). Anemia and Leucopenia directly associated with VGC were similar in both groups (P=0.58 and P=0.2 respectively). Biopsy-proven acute rejection was also non-significant in both groups (P=0.39).Although ETP for CMV from 6 months to 12 months is safe and has minimal adverse effect, it did not reduce CMV infection or disease. Further controlled studies in pediatrics age group are considered to compare longer versus shorter periods of prophylaxis and their impact on prevention of CMV infection, resistance, cost, and toxicity.

A complementary tool for management of disseminated Histoplasma capsulatum var. capsulatum infections in AIDS patients

In South America, disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum (H. capsulatum), is a severe and frequent opportunistic infection in AIDS patients. In areas outside the USA where specific-Histoplasma antigen detection is not available, the diagnosis is difficult. With the galactomannan antigen (GM) detection, a test commonly used for invasive aspergillosis diagnosis, there is a cross-reactivity with H. capsulatum that can be helpful for the diagnosis of histoplasmosis. The aim of this study was to evaluate the GM detection for the diagnosis of disseminated histoplasmosis in AIDS patients. The performance of the GM detection was evaluated with serum collected in French Guiana where H. capsulatum is highly endemic. Sera from AIDS patients with disseminated histoplasmosis occurring from 2002 to 2009 and from control HIV-positive patients without histoplasmosis were tested with the GM detection and Histoplasma-specific antibody detection (IEP). In 39 AIDS patients with proven disseminated histoplasmosis, the sensitivity of the Histoplasma IEP was only 35.9% and was linked to the TCD4+ lymphocyte level. For the GM detection, the sensitivity (Se) was 76.9% and specificity (Sp) was 100% with the recommended threshold for aspergillosis diagnosis (0.5). The test was more efficient with a threshold of 0.4 (Se: 0.82 [95% CI: 0.66–0.92], Sp: 1.00 [95% CI: 0.86–1.00], LR+: >10, LR−: 0.18). This study confirms that the GM detection can be a surrogate marker for the diagnosis of disseminated histoplasmosis in AIDS patients in endemic areas where Histoplasma EIA is not available.

Extrapulmonary tuberculosis in HIV infected patients from the cohort of “Dr Victor Babeş” Hospital, Bucharest, Romania

The infection with Mycobacterium tuberculosis remains the most frequent opportunistic infection in HIV seropositive patients. In Romania the incidence of tuberculosis (TB) in general population is the highest in Europe with 70.9 per 10,000 inhabitants. We investigated the incidence of extrapulmonary tuberculosis in “Dr Victor Babes” Hospital cohort and its epidemiological, clinical and outcome particularities. We performed an observational retrospective study during 2003-2013 among the HIV infected patients from our cohort. We selected the patients with extrapulmonary tuberculosis. The data was obtained from the medical charts and outpatient records. From 280 cases of confirmed infection we found 55 cases of extrapulmonary tuberculosis. The HIV transmission route was parenteral in 72.55% (95%CI 58.75 to 87.40) of cases. The median age at TB diagnosis was 24 years (95%, CI 20.16 to 25.03) with male/female ratio of 1,21. At the time of TB diagnosis the median CD4 count was 87 cells/cmm (95% CI 72.87 to 131.31). The percent of patients with concomitant pulmonary and extrapulmonary localization was 57.7% (95% CI 40.79 to 72.78). The number of patients with recurrent TB was 17 and 5 had more than one extrapulmonary TB in the studied period. The most frequent extrapulmonary involvement was ganglionar 35/51 (69.7% 95% CI 54.91 to 79.74). The commonest manifestations were fever (57.5% 95% CI 40.79 to 72.78), weight loss (30% 95% CI 17.25 to 47.46) and adenopathy (24.2% 95% CI 12.60 to 41.25) and the median time from the onset to diagnosis was 4 weeks (95% CI 2.611 to 5.209). In 54.5% (95% CI 40.79 to 72.78) of cases the smear was positive, cultures were positive in 69.7% (95% CI 55.61 to 85.10) and in 30% (95% CI 17.25 to 47.46) of cases the diagnosis was made on histopathologic examination. In 45.5% (95% CI 32.50 to 64.78) we obtained an antibiogram that confirmed MDR TB in 11.5% (95% CI 2.37 to 24.34). All patients received treatment and 7.84% (95% CI 6.17 to 31.40) abandoned treatment and 11.76% (95% CI 2.37 to 23.4) died. Although the extrapulmonary involvement is not very frequent, the diagnosis can be challenging and can take a lot of time especially when it is difficult to obtain a specimen. In a febrile immunodepressed patient extrapulmonary TB should be always considered.

The prevalence of opportunistic infections and malignancies in autopsied patients with human immunodeficiency virus infection in Japan.

BackgroundOpportunistic infections and malignancies such as malignant lymphoma and Kaposi sarcoma are significant complications of human immunodeficiency virus (HIV) infection. However, following the introduction of antiretroviral therapy in Japan in 1997, the incidence of clinical complications has decreased. In the present study, autopsy cases of HIV infection in Japan were retrospectively investigated to reveal the prevalence of opportunistic infections and malignancies.MethodsA total of 225 autopsy cases of HIV infection identified at 4 Japanese hospitals from 1985–2012 were retrospectively reviewed. Clinical data were collected from patient medical records.ResultsMean CD4 counts of patients were 77.0 cells/μL in patients who received any antiretroviral therapy during their lives (ART (+) patients) and 39.6 cells/μL in naïve patients (ART (−) patients). Cytomegalovirus infection (142 cases, 63.1%) and pneumocystis pneumonia (66 cases, 29.3%) were the most frequent opportunistic infections, and their prevalence was significantly lower in ART (+) patients than ART (−) patients. Non-Hodgkin lymphoma and Kaposi sarcoma were observed in 30.1% and 16.2% of ART (−) patients, and 37.9% and 15.2% of ART (+) patients, respectively. Malignant lymphoma was the most frequent cause of death, followed by cytomegalovirus infection regardless of ART. Non-acquired immunodeficiency syndrome (AIDS)-defining cancers such as liver and lung cancer caused death more frequently in ART (+) patients (9.1%) than in ART (−) patients (1.5%; P = 0.026).ConclusionsThe prevalence of infectious diseases and malignancies were revealed in autopsy cases of HIV infection in Japan. The prevalence of cytomegalovirus infection and pneumocystis pneumonia at autopsy were lower in ART (+) patients than ART (−) patients. Higher prevalence of non-AIDS defining malignancies among ART (+) patients than ART (−) patients suggests that onsets of various opportunistic infections and malignancies should be carefully monitored regardless of whether the patient is receiving ART.

CMV infection and glioma, a highly controversial concept struggling in the clinical arena

CMV infection and glioma, a highly controversial concept struggling in the clinical arena

Seroprevalence of and Risk Factors for Cytomegalovirus among HIV-Infected Patients at University of Maiduguri Teaching Hospital, Nigeria

Although the distribution of cytomegalovirus (CMV) infection has a wide regional variation, it is more common in Africa and Asia with high prevalence approaching 100% in some communities. CMV is a frequent opportunistic infection and major cause of morbidity and mortality among HIV patients with severe immunosuppression. It can be contracted from body fluid, including saliva, urine, blood, cervical secretions, and semen. CMV seropositivity is considered the best laboratory measure of past infection. We determined the prevalence of CMV and the risk factors associated with its acquisition in a population of HIV positive patients. Anti-CMV IgG seroprevalence was 100% among HIV infected subjects and 98.6% among controls. Having multiple sexual partners and traditional practices were identified as risk factors associated with risk of contracting CMV infection.

Spatial distribution of the human development index, HIV infection and AIDS-Tuberculosis comorbidity: Brazil, 1982-2007.

AIDS epidemic has given visibility to the incidence of tuberculosis, for being the most frequent opportunistic infection. It is known that individuals who are socially vulnerable are more susceptible to HIV transmission and tuberculosis as well. This study aims to conduct a geoepidemiological study on HIV/AIDS, AIDS-Tuberculosis co-infection and social vulnerability. This is an ecological study using incidence rates and the human development index to produce thematic maps and a descriptive analysis of epidemiology. The records of reported cases of HIV/AIDS from 1982 to 2007 were used, considering as cases of AIDS-Tuberculosis those records that were positively diagnosed with tuberculosis and those records with unknown diagnosis of tuberculosis, but showing compatible signs and symptoms with tuberculosis (fever, cough, cachexia and asthenia). The maps allowed the identification of areas with social differences and different patterns of incidence of HIV/AIDS and AIDS-Tuberculosis; regional differences were similar to those found by Josué de Castro, in 1940; regions with higher human development index values also showed higher incidence HIV/AIDS and AIDS-Tuberculosis. The prevention of HIV infection must be geographically specific, given socioeconomic and cultural differences. Although official records show decline in AIDS-TB co-infection, treatment of cases of HIV/AIDS should observe the occurrence of opportunistic diseases, which should be notified and/or updated.