Dimas Hernández

Leishmania braziliensis causing visceral leishmaniasis in a patient with human immunodeficiency virus infection, identified with the aid of the polymerase chain reaction

This study describes a male patient with human immunodeficiency virus infection, grade IV-C (oropharyngeal moniliasis and Pneumocystis carinii pneumonia), associated with visceral involvement produced by Leishmania braziliensis which was identified by deoxyribonucleic acid hybridization after the polymerase chain reaction had been performed. The patient was treated with molgramostim in association with meglumine antimonate to enhance macrophage destruction of parasites.

Abnormal Expression of Galactosyl(α1→3) Galactose Epitopes in Squamous Cells of the Uterine Cervix Infected by Human Papillomavirus

This study describes the presence of alpha-galactosyl epitopes on 12 cervical biopsy samples with features of human papillomavirus infection (HPV) and different stages of cervical intraepithelial neoplasia. An avidin-biotin-peroxidase assay with a monoclonal antibody recognizing gal(alpha 1-->3)gal residues was strongly positive in 5 of 12 cases. None of the controls stained (p = 0.02). Immunostaining was intense in the areas with the highest viral load (koilocytes and keratinocytes) and absent in malignant foci. Immunostaining was also absent in normal exo- and endocervical epithelium of 12 controls with no features of HPV infection. A faint background staining in cases and controls was evident, but similar. These initial findings suggest that alpha-galactosyl epitopes are expressed in cervical squamous cells infected with HPV, turning them vulnerable to lysis by natural anti-alpha-galactosyl antibodies.

Primitive reflexes in a case-control study of patients with advanced human immunodeficiency virus type 1

Abstract This study estimated the frequency of nine primitive reflexes (PR) and assessed their possible clinical value in a group of patients with acquired immunodeficiency syndrome. We studied 78 patients with human inmunodeficiency type 1 (HIV-1) infection in WHO clinical stage 3 or 4 and 81 matched seronegative controls. All participants were examined using a standardized neurological examination and the Mini-Mental State Examination. Cognitive impairment and PR was found in 36% of patients but in none of the controls (P < 0.0001; logistic regression odds ratio: 14.7). Overall, PR were 2–36 times more frequent in patients with HIV-1 infection. This association was stronger for the glabellar, snout, Rossolimo, and digital signs. At least two PR were observed in 92% of patients vs. 8% of controls (P < 0.0001; 95% confidence interval: 68%–100%; logistic regression odds ratio: 10.8). These data support the association of PR with cognitive decline in patients with advanced HIV-1 infection without overt neurological disease. Larger follow-up studies with multivariate techniques are needed to identify which PRs are useful as indicators of HIV-1-associated cognitive/motor complex and minor neurocognitive disorders.

Kaposi Sarcoma Associated with Human Immunodeficiency Virus Infection

ABSTRACT: In the present study, 11 patients with epidemic Kaposi sarcoma were evaluated; 55% were in stage IV and 45% in stage II; in addition, 75% had systemic symptoms, 89% had tow total and T‐lymphocyte counts, and all of them had not only low T‐helper lymphocyte counts but also T‐helper/T‐suppressor ratios. The majority of patients (89%) had low proliferative responses with phytohemaggiutinin (PHA). Nine patients were treated with: alpha‐2 interferon (five patients), zidovudine (two patients), doxorubicin and zidovudine (one patient), and radiotherapy (one patient). There were only five patients with stable disease, three treated with alpha‐2 interferon, one with doxorubicin, and one with doxorubicin plus azidothymidine. Two patients (one with doxorubicin and one with doxorubicin plus zidovudine) needed lithium to increase leukocyte and platelet counts, in May 1989, 73% of patients were dead (median survival 8 ± 2 months), it is concluded that: (1) it is important to select the patients who have the best chance to improve with treatment; (2) the response with alpha‐2 interferon or monochemotherapy is low and there is no change in overall survival; (3) a low helper cell count, low T‐helper/T‐suppressor ratio, and low proliferative response with mitogens are features of poor prognosis; (4) toxicity with treatment was acceptable; and (5) lithium increased neutrophil and platelet counts.