Abe M. Macher

Congestive cardiomyopathy in association with the acquired immunodeficiency syndrome.

Infection with human immunodeficiency virus (HIV, or HTLV-III/LAV) results in global immune dysfunction and leads to a breakdown in the ability of the host to mount an immune response, thereby facilitating unremitting infections by predominantly opportunistic pathogens,1 2 3 4 with or without Kaposis sarcoma. These secondary events result in organ-system damage and in some cases in organ failure. To date, serious organ-system failure has been documented in the pulmonary, gastrointestinal, renal, and central nervous systems.4 5 6 Clinical cardiac involvement has received little attention except as a site of spread of Kaposis sarcoma.7 , 8 Recently, we observed three fatal cases of the acquired immunodeficiency syndrome .xa0.xa0.

Prevalent myocarditis at necropsy in the acquired immunodeficiency syndrome

The prevalence of myocarditis was retrospectively evaluated in 71 consecutive necropsy patients who died from acquired immunodeficiency syndrome (AIDS) between 1982 and 1986. Myocarditis was found in 37 cases (52%). Biventricular dilation at necropsy was present in seven cases (10%) and was accompanied by myocarditis in each case; fatal congestive heart failure occurred in four of these seven cases. Although viral, protozoan, bacterial, fungal and mycobacterial opportunistic pathogens were present in myocardial sections of 7 of 37 myocarditis cases, the etiology of myocarditis in the majority of these patients with AIDS remained idiopathic. Thus, myocarditis is a frequent finding at necropsy in patients with AIDS and may contribute to the development of biventricular dilation.

PCR and the Misdiagnosis of Active Tuberculosis

To the Editor: Noordhoek et al. (Dec. 30, 1993, issue)1 have raised serious questions1,2 about the reliability of the polymerase chain reaction (PCR) for the direct detection of Mycobacterium tuberculosis in clinical specimens. Nevertheless, commercial clinical laboratories continue to promote many PCR assays, even for use by correctional facilities. After a routine medical evaluation at the time of her entry into a state correctional facility, an asymptomatic 28-year-old woman had a 20-mm reaction to a purified-protein-derivative tuberculin skin test (Mantoux method). Her chest roentgenogram was normal. Three sputum specimens were collected on separate days for mycobacterial laboratory studies. Although .xa0.xa0.