non-HIV Infected Patients Research Articles

Evaluation of the performance of DiaSorin molecular Pneumocystis jirovecii-CMV multiplex real-time PCR assay from bronchoalveolar lavage samples

The aim of this study was to evaluate the performance of the DiaSorin Molecular PJ-CMV multiplex real-time PCR (PJ-CMV PCR) assay (DiaSorin Molecular LLC, USA) in bronchoalveolar lavage (BAL) samples compared to direct immunofluorescence assay (IFA) for the detection of Pneumocystis jirovecii and assess CMV and P. jirovecii co-infection rate in immunosuppressed patients with suspected pneumonia. A total of 125 BAL samples from immunosuppressed patients submitted for PJP-IFA were tested. Surplus samples were saved and further tested by using the PJ-CMV PCR assay. Among the 125 samples, P. jirovecii was detected in 31.2% (39/125) and in 40% (50/125) of the specimens using IFA and PJ-CMV PCR respectively. Eleven of the PJ-CMV PCR positive samples were negative by direct IFA for P. jirovecii. All samples positive by direct IFA were also positive by PJ-CMV PCR. Using the direct IFA as a gold standard, the PJ-CMV PCR sensitivity, specificity, positive predictive value and negative predictive value for detection of P. jirovecii were 100%, 87.2%, 78% and 100%, respectively. However, after reviewing the clinical diagnosis, the specificity and PPV increased to 100%. Of the 50 P. jirovecii samples positive by PJ-CMV PCR, 18 (36%) were also positive for CMV by the PJ-CMV PCR. The co-infection rate was found to be 37.5% (6/16) and 35.2% (12/34) in HIV infected and non-HIV infected patients. This study indicated that the DiaSorin Molecular PJ-CMV multiplex real-time PCR assay has higher sensitivity than direct IFA for detection of P. jirovecii and provides rapid detection of PJ and CMV infection in BAL samples.

Travel-associated STI amongst HIV and non-HIV infected travellers.

The incidence of sexually transmitted infections (STI) is increasing in Western countries whilst travel plays a major role in STI dissemination worldwide. However, there is no study distinguishing HIV-positive and HIV-negative travellers. We retrospectively evaluated the epidemiological, clinical and biological characteristics of the patients diagnosed with a travel-related STI between 2008 and 2016. We describe and compare the spectrum of STI diagnosed amongst HIV-positive and negative travellers. Overall, 163 travel-related STI were identified in 140 patients (89% male, 54% men having sex with men, 40% HIV-positive). Symptoms occurred during travel in 39% of them, otherwise the median time between return and symptoms' onset was 13days. Amongst the 84 HIV-negative travellers, the main STI were primary HIV infections (n = 36, 38%), Neisseria gonorrhoeae (NG) infections (17%) and primary herpes infection (14, vs 1.5% amongst HIV-positive travellers, P = 0.01). The regions of exposure to HIV were concordant with the known geographical distribution of HIV subtypes. Amongst the 56 HIV-positive travellers, the main STI were syphilis (43, vs 6% amongst HIV-negative travellers, P = 0.01), Chlamydia trachomatis (CT) infections (22, vs 13% amongst HIV-negative travellers, P = 0.08), NG infections (13%) and acute hepatitis C (12, vs 1% amongst HIV-negative travellers, P = 0.01), with a predominance of anal forms for both CT and NG infections. The spectrum of STI diagnosed in returning travellers is broad with important differences according to HIV status. In our setting, primary HIV infection was the leading STI in non-HIV infected patients, which suggests that pre-exposure prophylaxis may have a role in HIV prevention in at-risk travellers.

PrimeStore MTM and OMNIgene Sputum for the Preservation of Sputum for Xpert MTB/RIF Testing in Nigeria.

Background: Xpert MTB/RIF (GX) for tuberculosis (TB) diagnosis is often located in reference laboratories, and sputum needs to be transported using a cold chain. Transport media to preserve sputum are available, but performance data under programmatic conditions are limited. Methods: Sputum samples were collected from patients with presumptive TB in Nigeria. One sputum was transported in a cold chain, tested immediately with GX and cultured. One sputum was swabbed and stored in PrimeStore-Molecular-Transport-Medium (Primestore), and the remainder was stored in OMNIGene-sputum (Omnigene), kept for seven days and tested with GX. Results: Of 248 patients, 63 were fresh-sputum culture-positive and 56 GX-positive (sensitivity 88.9%, 95% CI: 78.4–95.4%). Four of 185 culture-negative patients were GX-positive (specificity 97.8%, 94.6–99.4%). Omnigene GX and Primestore GX were positive in 56/62 (90.3%, 80.1–96.4%) and 49/62 (79.0%, 66.8–88.3%) culture-positive, respectively, and 1/185 (99.5%, 97.0–100.0%) and 3/185 (98.4%, 95.3–99.7%) were culture-negative patients. 14 Human Immunodeficiency Virus (HIV)-infected and 44 HIV-uninfected patients were culture-positive. Omnigene and Primestore detected 12/14 (85.7%, 57.2–98.2%) and 5/14 (35.7%, 12.8–64.9%) HIV-infected and 41/44 (93.2%, 81.3–98.6%) HIV-uninfected culture-positive patients. Interpretation: Omnigene stored and fresh sputum samples had similar GX results. The GX results of Primestore-stored samples were similar to those found in the fresh sputum of non-HIV infected patients, but GX-positivity was lower in HIV-infected patients. This was likely due to the lower amount of bacilli collected by the swab and transferred to PrimeStore.

NONRESOLVING PNEUMONIA: A RARE CASE OF PULMONARY CRYPTOCOCCOSIS IN AN IMMUNOCOMPETENT PATIENT

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Cryptococcus Neoformans is a serious fungal infection common to HIV, lung transplant, and otherwise immunocompromised patients. Infection in the immunocompetent (IC) host is rare. We present an IC patient with nonresolving pneumonia found to have a cryptococcal infection. CASE PRESENTATION: A 36-year-old Chinese female non-smoker, no past medical history with multiple Emergency Department (ED) visits in the past month for cough and shortness of breath treated with levofloxacin was referred to the ED again for outpatient findings of lung abscess on CT lung. Symptoms now included intermittent fevers, orthopnea, dyspnea on exertion, and weight loss. She endorsed cough with yellow sputum and small amounts of hemoptysis in the preceding days. Vitals, physical examination, and labs including CBC, BMP, lactate, and coagulation studies were unremarkable. CT Chest revealed large areas of consolidation in the RLL with multiple cavitary areas consistent with pneumonia with lung abscess. Admitted for necrotizing pneumonia, she received an empiric 7-day course of IV antibiotics. Blood and sputum cultures were negative, tuberculosis was ruled out via sputum. Viral testing revealed HIV negative with normal lymphocyte subset panels. Rheumatologic workup was unremarkable. Bronchoalveolar lavage samples stained positive for cryptococcus (Figure 1-3). Serum cryptococcal antigen titer was 1:128. There was no evidence of disseminated disease or CNS involvement on CT head or lumbar puncture. The patient was started on fluconazole with a plan for CT Chest in 6 months. DISCUSSION: Cryptococcus ranges from asymptomatic colonization to life threatening disseminated disease. Pulmonary infection with cryptococcus is uncommon in the IC patient. When present it is usually asymptomatic, but symptomatic disease can rarely occur. Because of this there is delay in treatment as symptoms may be present for days to weeks before the diagnosis is made. There are reports of disseminated infection leading to meningitis in an IC host(1)(2). In a retrospective study of disseminated cryptococcal infection in HIV noninfected patients mortality reached 63%(3). CONCLUSIONS: Our patient did not have any identifiable risk factors for Cryptococcus. It is not a disease isolated to HIV or immunocompromised patients. When assessing a patient with a nonresolving pneumonia it is crucial to have a broad differential. The life-threatening risk of pulmonary infection progressing to severe pneumonia with respiratory failure or extrapulmonic dissemination, particularly to the CNS, is why it is important to make a timely diagnosis and initiate appropriate treatment. Reference #1: Kerkering, TM, Duma, RJ, and Shadomy, S. The evolution of pulmonary Cryptococcus.Ann Intern Med. 1981; 94: 611-616 Reference #2: Chu HQ, Li HP, He GJ. Analysis of 23 cases of pulmonary cryptococcosis. Chin Med J (Engl) 2004;117:1425–1427 Reference #3: Chuang YM, Ho YC, Chang HT, Yu CJ, Yang PC, Hsueh PR. Disseminated cryptococcosis in HIV-uninfected patients. Eur J Clin Microbiol Infect Dis. 2008;27(4):307–310 DISCLOSURES: No relevant relationships by Ajay Adial, source=Web Response No relevant relationships by Trisana Cox, source=Web Response No relevant relationships by Rammohan Gumpeni, source=Web Response No relevant relationships by Asma Iftikhar, source=Web Response No relevant relationships by Tereza Izakovich, source=Web Response No relevant relationships by Priyank Trivedi, source=Web Response

Central Nervous System Cryptococcal Infections in Non-HIV Infected Patients.

Central nervous system (CNS) cryptococcosis in non-HIV infected patients affects solid organ transplant (SOT) recipients, patients with malignancy, rheumatic disorders, other immunosuppressive conditions and immunocompetent hosts. More recently described risks include the use of newer biologicals and recreational intravenous drug use. Disease is caused by Cryptococcus neoformans and Cryptococcus gattii species complex; C. gattii is endemic in several geographic regions and has caused outbreaks in North America. Major virulence determinants are the polysaccharide capsule, melanin and several ‘invasins’. Cryptococcal plb1, laccase and urease are essential for dissemination from lung to CNS and crossing the blood–brain barrier. Meningo-encephalitis is common but intracerebral infection or hydrocephalus also occur, and are relatively frequent in C. gattii infection. Complications include neurologic deficits, raised intracranial pressure (ICP) and disseminated disease. Diagnosis relies on culture, phenotypic identification methods, and cryptococcal antigen detection. Molecular methods can assist. Preferred induction antifungal therapy is a lipid amphotericin B formulation (amphotericin B deoxycholate may be used in non-transplant patients) plus 5-flucytosine for 2–6 weeks depending on host type followed by consolidation/maintenance therapy with fluconazole for 12 months or longer. Control of raised ICP is essential. Clinicians should be vigilant for immune reconstitution inflammatory syndrome.

The First Evidence of Cryptosporidium meleagridis Infection in a Colon Adenocarcinoma From an Immunocompetent Patient.

Objectives: The potential linkage between Cryptosporidium spp. infection and colorectal human cancer was suggested by limited reports showing higher prevalence of C. parvum and C. hominis in patients with colon cancer. Here we conducted research concerning presence of Cryptosporidium spp. in malignant tissue collected from patients with colorectal cancer.Methods: Cancerous colon tissue samples collected from 145 non-HIV infected patients with colorectal cancer were screened for Cryptosporidium spp. by immunofluorescence antibody test and genus-specific nested polymerase chain reaction followed by sequencing.Results: Screened pathogen was found in cancerous tissue originating from immunocompetent man with colon adenocarcinoma. Genotyping revealed presence of Cryptosporidium meleagridis. The presence of Cryptosporidium life cycle stages (oocysts and endogenous stages) in colon carcinoma tissue was confirmed by genus-specific FITC-labeling.Conclusions: Herein, we report on a C. meleagridis infection of a colon adenocarcinoma in an immunocompetent patient. This is the first report of C. meleagridis infection in the human colon and first evidence of active development of this species in cancer tissue.

Hiv and Lymphoma: from Epidemiology to Clinical Management.

Patients infected with human immunodeficiency virus (HIV) are at increased risk for developing both non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). Even if this risk has decreased for NHL after the introduction of combination antiretroviral therapy (cART), they remain the most common acquired immune deficiency syndrome (AIDS)-related cancer in the developed world. They are almost always of B-cell origin, and some specific lymphoma types are more common than others. Some of these lymphoma types can occur in both HIV-uninfected and infected patients, while others preferentially develop in the context of AIDS. HIV-associated lymphoma differs from lymphoma in the HIV negative population in that they more often present with advanced disease, systemic symptoms, and extranodal involvement and are frequently associated with oncogenic viruses (Epstein-Barr virus and/or human herpesvirus-8). Before the introduction of cART, most of these patients could not tolerate the treatment strategies routinely employed in the HIV-negative population. The widespread use of cART has allowed for the delivery of full-dose and dose-intensive chemotherapy regimens with improved outcomes that nowadays can be compared to those seen in non-HIV infected patients. However, a great deal of attention should be paid to opportunistic infections and other infectious complications, cART-chemotherapy interactions, and potential cumulative toxicity. In the context of relatively sparse prospective and randomized trials, the optimal treatment of AIDS-related lymphomas remains a challenge, particularly in patients with severe immunosuppression. This paper will address epidemiology, pathogenesis, and therapeutic strategies in HIV-associated NHL and HL.

Acute Renal Failure in Hospitals in Togo: Comparative Analysis of HIV Positive Patients and HIV Negative Patients

Introduction: Human Immunodeficiency (HIV) is a risk factor often associated with the occurrence of Acute Renal Failure (ARF). Objectives: To describe the profile of Acute Renal Failure (ARF) in HIV-infected patients and compare them to non-infected patients. Patients and Methods: It was a prospective study from January 2018 to February 2019 that took place in the nephrology, infectious diseases and internal medicine departments of the Sylvanus Olympio University Hospital Center in Lome (Togo). Results: The prevalence of ARF in HIV-infected patients was 48.07%. HIV-infected patients had an average age of 46.9 ± 11.6 years (p = 0.36) compared to 44.0 ± 20.4 years for non-HIV infected patients. Female sex was predominant in the HIV-infected population with a sex ratio H/F of 0.6 (p < 0.0001) versus 2.9 for the non-infected. The reasons for admission were such as fever (28%), digestive disorders (56%) were more common in HIV-infected patients than non-infected patients (11.1%, 37%). Infected patients had more diarrhea than non-infected patients (24% versus 7.4%) with p = 0.01. They showed more signs of infections than uninfected patients (40% versus 18.5%) with P = 0.02. HIV infection was known before admission in 96% of cases. Patients whose HIV was known before admission had hypertension (16.7%), diabetes (12.5%) and CD4 count < 200 (/mm3) in 50% of cases. HIV infected patients had more anemia (52.0% versus 22.2%) with p = 0.002. Conclusion: No deaths were recorded in the HIV-infected group.

Disseminated Histoplasmosis Due to Histoplasma capsulatum var. duboisii in a Non-HIV Patient in Togo: A Case Report

Background : Histoplasmosis is a fungal infection due to Histoplasma capsulatum . We report a case of disseminated African histoplasmosis in an HIV uninfected patient in Togo. Case Report : A 35-year-old woman was admitted in dermatology for disseminated nodular lesions and left shoulder pain for 4 months. On examination, there were firm or softened nodular lesions with torpid ulceration and translucent molluscoid-like papules disseminated on the face, trunk, and limbs. There was also a painful swelling of the left shoulder, with an impotent upper limb. Histology showed an acanthotic epidermis discretely keratotic. In the dermis, there were granulomas with giant cells, histiocytes and polymorphonuclear cells around largely altered yeasts. The presence of Histoplasma capsulatum var. duboisii was confirmed by direct microscopic examination. Chest X-ray showed a left minimal abundance pleurisy. Shoulder x-ray showed heterogeneous lysis of the left humeral head and a large osteopenia of bones associated with left scapulo-humeral dislocation. The medical treatment was based on itraconazole (400mg/day) for 4 months relieved by fluconazole (450 mg/day) with good evolution after 4 months. Conclusion : A disseminated form of African histoplasmosis can be observed in non-HIV infected patients. The prognosis depends on the precocity of the diagnosis and the treatment.

2268. Clinical Difference of Mycobacterium haemophilum Infections Between HIV and Non-HIV-Infected Patients

Background Mycobaterium haemophilum has emerged as one of nontuberculous mycobacteria which caused localized and disseminated infections in immunocompromised patients. Infections caused by this pathogen were rarely diagnosed and reported because it can grow only in heme supplemented culture media.MethodsWe performed a case–control study at Siriraj hospital, the biggest tertiary care hospital in Thailand, to determine the clinical difference and treatment outcome of this infection between HIV-infected and non-HIV-infected individuals.ResultsFrom January 2012 to December 2017, there were 21 patients diagnosed with Mycobacterium haemophilum infections. Eight of them were HIV infected. Rest of the patients were non-HIV immunocompromised which SLE was the most common comorbidities (autoimmune diseases 6 patients, anti-IFN gamma auto Ab 2 patients, kidney transplant recipients 2 patients, diabetes mellitus 2 patients and nephrotic syndrome 1 patient). The most common clinical manifestation was cutaneous involvement (13 patients, 61.9%). The result revealed that HIV-infected patients were much younger in comparison with non-HIV-infected patients (mean age 39 ± 10 VS. 52 ± 14 years; P = 0.025). Disseminated infection was more common in HIV-infected patients (37.5% vs. 15.4%, P = 0.325) and three of eight HIV-infected patients (37.5%) had central nervous system involvement whereas none of non-HIV infected patients had it (P = 0.042). The prognosis was slightly worse in HIV-infected individuals (Unfavorable prognosis 27.5% in HIV-infected VS. 15.4% in non-HIV-infected patients; P = 0.325).ConclusionHIV infection is the most common immunocompromised condition related with Mycobacterium haemophilum infection. Central nervous system involvement is more common in HIV-infected patients.Disclosures All authors: No reported disclosures.

Prevalence of Adenoma and Advanced Adenoma in HIV Positive Patients Undergoing Screening Colonoscopy

Introduction: Highly Active Antiretroviral Therapy (HAART) has revolutionized the treatment of HIV. With increasing life expectancy in this population group, the incidence of non-AIDS defining cancers as well as cancer specific mortality has increased. It poses new questions about cancer screening and management in this cohort. Currently, HIV positive patients are considered average risk for screening colonoscopy as per guidelines. We aim to compare the adenoma detection rate (ADR) and advanced adenoma detection rate (AADR) among the HIV infected and non-HIV infected population undergoing screening colonoscopy.2765 Figure 1 No Caption available.Methods: A retrospective analysis of the medical records of the patients undergoing screening colonoscopy between 2006 and 2016 was performed. Recorded variables include age, race, gender, BMI, family history, past medical history, smoking history, alcohol history, quality of bowel prep, details of identified polyps, HIV status, number of years since the diagnosis of HIV, treatment details of HIV, CD4 count and viral load at the time of colonoscopy. Patients with past history of polyps, inflammatory bowel disease, family history of colorectal cancer and poor bowel preparation were excluded. Results: 250 subjects met the inclusion and exclusion criteria.121 patients composed the HIV positive patients (Gp 1) and the rest of 129 formed the control arm (non-HIV infected patients- Gp 2). Gp 2 was selected by a computer generated algorithm over the same time interval. ADR was 9.9% (12/121) in Gp 1 and 16.2% (21/129) in Gp 2. AADR was 4.1% (5/121) in Gp 1, compared to 3.87% (5/129) in Gp 2. Right sided adenomas accounted for 50% of total adenomas in Gp 1 and 42.8% in Gp 2. Other characteristics for the two groups have been summarized in Table 1. 67 of 121 HIV patients had their HIV care at our center with full available records. 64 out of these 67 patients had well controlled HIV, defined by viral load less than 200 copies/ml at the time of colonoscopy. ADR in well controlled HIV patients was 7.8 % (5/64; P= 0.121 compared to control) and AADR of 3.1% (2/64; p= 0.99 compared to control). Conclusion: ADR among HIV patient cohort was lower compared to non-HIV average risk population. Adenomas in HIV positive patients are more likely to be right sided. HIV status does not warrant high risk CRC screening, consistent with current guidelines. HAART potentially further reduces risk for colon cancer precursor lesions. Colonoscopy should be the preferred modality for screening in HIV positive patients.

EPIDEMIOLOGY OF NONTUBERCULOUS MYCOBACTERIUM FROM AN INNER-CITY PHILADELPHIA HOSPITAL IN PATIENTS WITH HIV

SESSION TITLE: Chest Infections 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: MAC is the most common pathogen of Nontuberculous Mycobacterium (NTM) that is known to cause disease in HIV infected individuals. However, patients with MAC and other NTM species are at greatest risk of developing disease as CD4 cell counts fall below 50 cells/mm3. This study was done to help determine the incidence of NTM in inner Philadelphia in those with known HIV infections and the risk of disease at the CD4 level. METHODS: We conducted a retrospective study of patients with known HIV infection who had a AFB culture positive from 2016 to 2017. Patients with blood cultures or tissue biopsy positive for NTM were concluded to have disease; respiratory disease was considered if they met ATS guidelines: 1. chest radiograph or, in the absence of cavitation, chest high-resolution computed tomography; 2. Positive cultures from sputum samples or one bronchial wash; and 3. Exclusion of other disorders, such as TB. The data was collected from cultures at Hahnemann University Hospital in Philadelphia. This was an IRB study. RESULTS: From 2016-2017, there were 87 total patients who were NTM culture positive of which 26 had HIV/AIDS and 22 were determined to have NTM infections. The average age was 46, out of the 22 patients 14 were males and 8 females, and 20 were black and 2 were white. There were 16 patients who had respiratory disease with the most common NTM being MAC in 14 cultures, and there were 3 other cultures which grew M. chelonae, M. bolletii or M. litoral. 7 patients were found to be bacteremic with 6 being MAC positive and 1 growing M. abscesses; and 4 patients had NTM infection of a GI source with all 4 growing MAC. 5 of the 7 patients with NTM bacteremia also had growth in respiratory or GI cultures. The average CD4 count for those with respiratory infections was 130, not including one patient with a CD4 level of 1362. Those who were or also had bacteremia had an average CD4 count of 36. The average CD4 count of those with a GI source was 6. There were several patients who had multiple sources of NTM culture positivity. CONCLUSIONS: HIV infected patients are at an increased risk of disease from MAC compared to other NTM species in non-HIV infected patients. Patients with CD4 counts <50 cells/mm3 can be at higher risk of disseminated and GI disease; however those with higher CD4 counts are still at risk of respiratory disease. CLINICAL IMPLICATIONS: Based on the demographics of this study, in Philadelphia, black patients are at the greatest risk of NTM disease most likely secondary to . Patients with HIV/AIDS should be assessed for NTM infections even if their CD4 counts are >100 cells/mm3. DISCLOSURES: No relevant relationships by Ekamjeet Randhawa, source=Web Response No relevant relationships by Michael Stephen, source=Web Response

Diagnosis and treatment progress of acquired immunologic deficiency syndrome-related lymphoma

Malignancy is one of the most important complications of acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) infection and destruction of host CD4-positive T lymphocytes. Lymphoma ranks first in AIDS-related malignancies. The clinical features of lymphoma patients infected with HIV are different from non-HIV infected patients. The host immune condition in anti-lymphoma chemotherapy also needs to be considered. This paper reviews the clinical characteristics of AIDS-related lymphoma and the attention in anti-lymphoma therapy according to the latest international research findings and related guidelines. Key words: Acquired immunologic deficiency syndrome; Lymphoma, AIDS-related; Diagnosis

Radiological Findings of Pulmonary Tuberculosis in Patients with and Without HIV Infections

Introduction: Radiological manifestation of pulmonary tuberculosis in HIV positive patients is different with HIV negative patients. We aim to determine the differences in chest radiological findings of Pulmonary Tuberculosis among HIV and non-HIV infected patients in HTAA. Materials and method: A retrospective study was conducted in Chest Clinic, Hospital Tunku Ampuan Afzan, Kuantan Pahang. There were 101 chest radiographs with sputum smear-positive retrieved and reviewed. Socio-demographic status and chest radiographs findings were documented and analyzed. Results: Of the 101 patients, 12 patients were HIV positive. Of the 89 HIV negative patients, 96% had consolidation change on chest radiograph, in contrast with HIV positive patients, only 4% among them had this appearance and this is statistically significant (p value less than 0.05). Mediastinal lymphadenopathy is significantly higher (17%) in HIV positive patients compared to HIV negative patients (1%). Normal chest radiographs were more common in HIV positive patients (33%) as compared to HIV negative patients (2%). Conclusion: HIV positive patients with pulmonary tuberculosis exhibit different radiological manifestation on chest radiograph when compared to HIV negative patients.

A retrospective Comparison of Oral and Intravenous Routes of Trimethoprim-sulfamethoxazole for the Treatment of Pneumocystis Jiroveci Pneumonia in Non-HIV Infected Patients

A retrospective Comparison of Oral and Intravenous Routes of Trimethoprim-sulfamethoxazole for the Treatment of Pneumocystis Jiroveci Pneumonia in Non-HIV Infected Patients

Rapid Clinical Score for the Diagnosis of Tuberculous Meningitis: A Retrospective Cohort Study.

Objective:The aim of our study was to retrospectively validate a previously described rapid clinical score (RCS) in distinguishing tuberculous meningitis (TBM) from viral meningitis (VM) in people who are at increased risk of tuberculosis, as well as from cryptococcal meningitis (CM) in HIV-infected patients.Methods:We performed a retrospective study of patients admitted with a diagnosis of aseptic meningitis between January 2012 and December 2015, to a referral hospital for infectious diseases. The variables included in RCS were duration of symptoms before admission, neurological stage, cerebrospinal fluid (CSF) to blood glucose ratio, and CSF protein. We included in this retrospective study 31 patients with definite or probable TBM including 14 HIV-infected patients, 62 HIV-noninfected patients with VM, and 18 HIV-infected patients with CM.Results:The sensitivity of RCS to distinguish TBM from VM was 96.7%, with a specificity of 81.1% and the area under the receiver operating characteristic (ROC) curve was 0.949 (0.90–0.99). When all four criteria from the RCS were present, the specificity increased at 100%. In HIV-infected patients, the sensitivity and specificity of RCS in differentiating TBM from CM were 86.6% and 27.7%, respectively, and the area under the ROC curve was 0.669 (0.48–0.85).Conclusion:This easy-to-use RCS was found to be helpful in differentiating TBM from VM, with a better sensitivity than molecular amplification techniques and a relatively good specificity. However, the RCS was not useful to differentiate between TBM and CM in HIV-infected patients.

Réaction paradoxale à la fin du traitement antituberculeux chez le sujet immunocompétent

The features of paradoxical reactions (PR) that occurred in non-HIV infected patients are rare and not well known. The authors reported the case of a 21years old, non-immunocompromised, and HIV negative patient treated for disseminated tuberculosis. PR occurred after 8months after initiation of antituberculous treatment. PR presented as left cervical lymphadenopathy, pulmonary, pleural, costal and spinal location of the tuberculosis. The antituberculous drugs were prolonged. Patient's clinical symptoms improved initially. However, left inguinal lymphadenopathy appeared after 20months of antituberculous therapy. Inguinal lymph node biopsy revealed tuberculous lymphadenitis. The patient has a good compliance to the treatment. The patient was continued on same antituberculous treatment for a total of 28months. The cervical and inguinal lymphadenopathy disappeared and CT scan showed regression of thoracic, abdominal, costal and spinal lesions. PR during antituberculous treatment must be considered after exclusion of other causes. No consensus on the therapeutic management of this entity has been developed to date.

The effect of HIV infection on the surgical, chemo- and radiotherapy management of breast cancer. A prospective cohort study

IntroductionBreast cancer is the most common cancer of women in the world. Twenty-five percent of people living with the human immunodeficiency virus (HIV) reside in South Africa. The coincidence of breast cancer and HIV infection is therefore common in South Africa. There is a perception that systemic and local surgical complications are more common in HIV-infected patients, and that these patients tolerate chemo- and radiotherapy poorly. AimThe aim of the study was to determine the effect of HIV infection on the management of breast cancer by comparing HIV-infected to -noninfected patients. The outcomes of surgery and adjuvant/neoadjuvant therapy were examined in these groups. MethodThe study was performed at the Steve Biko Academic Hospital, Pretoria, South Africa, during 2009–2014. Patients scheduled for surgery for breast cancer were recruited prospectively and their HIV status was determined. All patients were managed according to standard guidelines for breast cancer. Patients were followed up for 30 days and local and systemic surgical complications documented. Completion or non-completion of courses of chemo- and radiotherapy, and reasons for non-completion were documented. HIV-infected and -noninfected patients respectively were grouped, and compared statistically. ResultsOne hundred and sixty patients (31 HIV-infected) were included. The frequency of surgical complications did not differ significantly between HIV-noninfected and infected patients (p = 0.08), more occurring in the HIV-noninfected patients. The risk ratio of HIV infection for surgical complications was 0.20 and the odds ratio 0.23. The completion of courses of chemo- and radiotherapy did not differ between the HIV-infected and –noninfected patients. Twenty-five of 27 HIV-infected patients (93%) and 100 of 113 HIV-noninfected patients (94%) completed their courses of chemotherapy (p = 0.68). Twelve of 14 HIV-infected patients (86%) and 40 of 41 HIV-noninfected patients (98%) completed their courses of radiotherapy (p = 0.16). ConclusionThese results suggest that HIV-infected patients with breast cancer do not experience more treatment-related complications and can be treated according to standard guidelines.

Clinical characteristics of severe pneumocystis pneumonia in children without human immunodeficiency virus infection

Objective To investigate the clinical parameters, risk factors, treatment and clinical outcomes of pneumocystis pneumonia(PCP) in children without human immunodeficiency virus(HIV). Methods Retrospective analysis was made for the clinical features, risk factors, treatment and prognoses of the non-HIV infected severe PCP patients hospitalized at Pediatric Intensive Care Unit(PICU) of Children's Hospital Affiliated to Capital Institute of Pediatrics. Results During April of 2010 to April of 2014, there were 10 cases of non-HIV infected severe PCP in PICU of Children's Hospital Affiliated to Capital Institute of Pediatrics.All of the patients had predisposing diseases, in which 3 cases had connective tissue diseases, 2 cases had acute leukemia, 3 cases had severe pneumonia and 2 cases had congenital immunodeficiency.The main clinical manifestations of those 10 patients were fever, cough, tachypnea and obvious dyspnea.All patients developed respiratory failure.The median value of Pediatric Critical Illness Score was 79.The median arterial oxygen pressure was 58 mmHg(1 mmHg=0.133 kPa). The median oxygenation index was 103 mmHg. The median alveolo-arterial oxygen partial pressure difference was 43.8 mmHg. The median CD4+ T-lymphocytes counts was 169×106/L. Eight patients on admission had mixed infection.Acute respiratory distress syndrome(ARDS) occurred in all of the patients, and 7 cases of them had multiple organ dysfunctions.All of the patients required ventilation support.The median day for invasive mechanical ventilation days was 11 and the median day for noninvasive ventilation days was 6.The pneumothorax occurred in 5 patients.All patients received trimethoprim-Sulfamethoxazole as initial therapy and Caspofungin treatment in combination in 7 cases of the patients.Six patients had nosocomial infection. The median time of PICU stay was 15.5 days.Six patients survived and the mortality was 40%(4/10 cases). Conclusions PCP is a kind of fatal diseases which occurred in patients with immunocompromised conditions and concurrent ARDS or multiple organ dysfunctions.Diagnostic suspicion and mechanical ventilation therapy with lung protective ventilation strategies may improve the clinical outcomes of non-HIV-infected PCP in children. Key words: Pneumocystis pneumonia; Acute respiratory distress syndrome; Treatment; Child

Comparison of partial splenic embolization in HIV infected and non-HIV infected patients with cirrhosis

ObjectiveThe aim of this study is to see whether it is effective for human immunodeficiency virus (HIV) infected patients conducted partial splenic embolization (PSE) and if there are differences in the effects of PSE between HIV and non-HIV patients. MethodWe retrospectively reviewed seven patients, three were HIV infected, the rest weren't. We compared the effects of PSE between the two groups using indices of hematologic indices and liver function. ResultIn HIV infected patients, WBC rose in all PSE procedure, RBC rose in 3 procedures. PLT increased in 2 procedures. ALT decreased in all patients, but the changes of ALB and AST were not obvious. In non-HIV infected patients, all the hematologic indices were increased, except one patient. ALT and AST were increased, the change of ALB was not obvious. ConclusionPSE do improve the hematologic indices and liver function in patients with HIV and hepatitis virus co-infected, but when compare with non-HIV infected patients included in our study, we haven't seen much differences in the effects.