Montserrat Sala

Qt prolongation and Torsades de Pointes in patients infected with human immunodeficiency virus and treated with methadone

Four patients infected with human immunodeficiency virus receiving antiretroviral treatment and high doses of methadone (>200 mg/day) presented with several syncopal episodes. A significant prolongation of the QTc interval was detected in all of them, and in 3 patients, > or =1 episode of Torsades de Pointes was recorded. The sequence of events in these cases suggests that high doses of methadone caused QT prolongation and provided the substrate for syncope and Torsades de Pointes.

Epidemiological and clinical features, response to HAART, and survival in HIV-infected patients diagnosed at the age of 50 or more

BackgroundOver the last years, the mean age of subjects with HIV infection and AIDS is increasing. Moreover, some epidemiological and clinical differences between younger and older HIV-infected individuals have been observed. However, since introduction of HAART therapy, there are controversial results regarding their response to HAART. The aim of the present study is to evaluate epidemiological and clinical features, response to HAART, and survival in elderly HIV-infected patients with regard to younger HIV-infected patients.MethodsA prospective cohort study (1998–2003) was performed on patients from Sabadell Hospital, in Northeast of Spain. The cohort includes newly attended HIV-infected patients since January 1, 1998. For the purpose of this analysis, data was censured at December 31, 2003. Taking into account age at time of diagnosis, it was considered 36 HIV-positive people aged 50 years or more (Group 1, G1) and 419 HIV-positive people aged 13–40 years (Group 2, G2). Epidemiological, clinical, biological and therapy data are recorded. Statistical analysis was performed using Chi-squared test and Fisher exact test, Mann-Whitney U test, Kaplan-Meier, Log Rank test, and Two-Way ANOVA from random factors.ResultsG1 showed higher proportion of men than G2. The most common risk factors in G1 were heterosexual transmission (P = 0.01) and having sex with men or women (P < 0.001). G1 and G2 show parallel profiles through the time regarding immunological response (P = 0.989) and virological response (P = 0.074). However, older people showed lower CD4 cell counts at first clinic visit (P < 0.001) and, eventually, they did not achieve the same counts as G2. G1 presented faster progression to AIDS (P < 0.001) and shorter survival (P < 0.001).ConclusionOlder patients have different epidemiological features. Their immunological and virological responses are good. However, older patients do not achieve the same CD4 cell counts likely due to they have lower counts at first clinic visit. Thus, it is essential physicians know older HIV-infected patients features to consider the possibility of HIV infection in these patients with the aim of treatment would not be delayed.

Seroprevalence of Bartonella spp. infection in HIV patients in Catalonia, Spain

BackgroundAlthough the first clinical descriptions of Bartonella infection were associated with immunocompromised patient with bacillary angiomatosis, we currently know that this organism is directly involved in diseases affecting a large number of patients, regardless of their immune status. Cat scratch disease, hepatic peliosis, and some cases of bacteraemia and endocarditis, are directly caused by some species of the genus Bartonella. The purpose of this study was to determinate the prevalence of IgG antibodies against Bartonella henselae and B. quintana in HIV patients and to identify the epidemiological factors involved.MethodsSerum samples were collected from HIV patients treated at Hospital de Sabadell. Antibodies to B. henselae and B. quintana from 340 patients were examined by indirect immunofluorescence assay (IFA). Significance levels for univariate statistical test were determined by the Mann-Whitney U test and χ2 test.ResultsOf 340 patients, 82 were women and 258 men, with a median age of 42.21 ± 10.35 years (range 16–86 years). Seventy-six (22.3%) patients reacted with one or more Bartonella antigens. Of all the factors concerning the seroprevalence rate being studied (age, sex, intravenous drugs use, alcohol consumption, CD4 levels, AIDS, HCV, HBV, residential area), only age was statistically significant.ConclusionA high percentage of HIV patients presents antibodies to Bartonella and is increasing with age.

Micobacteriosis genitourinaria: estudio retrospectivo de 45 casos en un hospital general

Introduccion La tuberculosis genitourinaria (TGU) es la afeccion extrapulmonar mas frecuente tras la pleural y ganglionar. Dada su escasa sintomatologia clinica su diagnostico y tratamiento son, a menudo, tardios. Metodos Estudio de las caracteristicas clinicas, epidemiologicas y evolutivas de los pacientes diagnosticados de TGU en nuestro centro los ultimos 10 anos. Se han incluido los pacientes con cultivo de Lowenstein positivo, en orina o en muestras de biopsies o con estudio anatomopatologico compatible con tuberculosis. Los casos de tuberculosis multifocal, Lowenstein positivo sin clinica urinaria ni alteraciones radiologicas se consideraron micobacteriuria. Resultados Se han analizado 45 pacientes (el 62% hombres con una edad media de 49,4 anos). En el 33% coexistia enfermedad de base (14 infectados por el virus de la inmunodeficencia humana). Se diagnosticaron de tuberculosis renal 26 pacientes (57%), 5 (11%) de orquiepididimitis y 14 (31%) se catalogaron como micobacteriuria. La sintomatologia mas frecuente fue sindrome miccional (60%), dolor lumbar (44%) y hematuria macroscopica (12%). La tincion de Ziehl fue positiva en el 38% de los casos. El urocultivo fue positivo para otros germenes en 9 pacientes (20%). La urografia intravenosa oriento el diagnostico en 28/32 casos (87,5%). El intervalo medio de sintomas previos al diagnostico fue de 15 meses. La curacion sin secuelas se logro en el 60%. Se indico cirugia en 10 casos. Conclusiones Se debe incrementar el grado de sospecha de TGU ante sindromes urinarios de repeticion. La menor utilizacion actual de la urografia frente a otras pruebas de imagen y el hallazgo de otros germenes en el urocultivo pueden retrasar el diagnostico.

Neoplasia of plasma cells with atypical presentation and infection by the human immunodeficiency virus. A presentation of two cases.

Neoplasia of plasma cells acquires special clinical characteristics in patients infected by human immunodeficiency virus (HIV). These patients are much younger at the time of diagnosis, and when they are compared with the general population they show an atypical clinical evolution, with a greater frequency of solitary plasmacytomas, less evidence of a monoclonal plasmatic component, or greater aggressiveness of the neoplastic process. This paper provides the most significant data on two patients infected by HIV and diagnosed for plasma cell neoplasia. Recent pathogenetic hypotheses for plasma cell neoplasias that include immune alterations, chronic viral infections, and hyperexpression of cytokines exist in patients infected by HIV, and this could suggest that this type of neoplasia is another malignant haematological process associated with AIDS. Am. J. Hematol. 65:239–242, 2000.

Estudio de una serie clínica de pacientes infectados por el VIH mayores de 50 años

Introduccion La epidemiologia de la infeccion por el virus de la inmunodeficiencia humana (VIH) ha cambiado en los ultimos anos. Se observa un aumento de casos de infeccion en personas mayores de 50 anos, y el mecanismo de transmision mas frecuente es la via sexual. El objetivo de este estudio es analizar las caracteristicas epidemiologicas, clinicas y evolutivas de una serie clinica de pacientes infectados por el VIH mayores de 50 anos en el momento del diagnostico. Metodos Se estudiaron 165 pacientes infectados por el VIH mayores de 50 anos procedentes del Hospital Clinic de Barcelona y de la Corporacio Parc Tauli de Sabadell en el periodo comprendido entre 1985 y 2001. Resultados El 81% de los pacientes eran varones. La edad media en el momento del diagnostico fue de 58,4 anos. El 81,8% adquirieron la infeccion por via sexual. La media de CD4 iniciales fue de 216 cel./μl. El 45,2% de los pacientes presentaban una carga viral inicial entre 1.000 y 100.000 copias/ml y el 52,3% > 100.000 copias/ml. El 30,9% de los pacientes presentaban una enfermedad definitoria de sida en el momento del diagnostico. Las principales enfermedades oportunistas fueron la tuberculosis pulmonar, el sarcoma de Kaposi, la neumonia por Pneumocystis jiroveci (antes carinii) y el linfoma no hodgkiniano. El 32,7% murieron por sida. Conclusiones Las personas mayores de 50 anos que se infectaron por el VIH eran predominantemente varones y adquirieron la infeccion por via sexual. Existe una alta proporcion de pacientes que fueron diagnosticados por una enfermedad oportunista.

Bacillary angiomatosis caused by Bartonella quintana.

Abstract: Bacillary angiomatosis is a disorder of neovascular proliferation involving skin and lymph nodes of immunosuppressed patients. Bartonella henselae or Bartonella quintana have been inculpated as causative by direct culture or PCR amplification of DNA sequences. Here, we report the clinical evolution of a patient infected with human immunodeficiency virus (HIV) whose B. quintana infection was diagnosed by PCR.

Serosurvey of Rickettsia typhi and Rickettsia felis in HIV‐infected patients

Consistent with the effects of HIV on cell‐mediated immunity, an increased susceptibility to intracellular microorganisms has been observed. Rickettsiae are obligate intracellular microorganisms. The aim of this study was to examine Rickettsia typhi and Rickettsia felis infections in HIV+ population. Sera of 341 HIV+ patients were evaluated by indirect immunofluorescent assay. Age, sex, residential locality, risk behavior, stage according to criteria of the Center for Disease Control and Prevention, CD4+/CD8+ T cells, Hepatitis B antigen, and Hepatitis C serology were surveyed. Seroprevalences of R. typhi and R. felis infection were 7.6% and 4.4%, respectively. No associations were found between seropositivities and the assessed variables. Findings were similar to those obtained in healthy subjects from the same region.

Disseminated infection by Mycobacterium sherrisii and Histoplasma capsulatum in an African HIV-infected patient.

Mycobacterium sherrisii is a new species of opportunistic, slow-growing, non-tuberculous Mycobacterium closely related to Mycobacterium simiae that can currently be identified with the sequence of 16S rARN gene and the heat-shock protein 65. Few cases of patients infected by this Mycobacterium have been reported and all of them were associated with human immunodeficiency virus or other immunosuppressive conditions. Clinical management is complex, because there is not a clear correlation between the in vitro antibiotic susceptibility testing and the patients clinical outcome.

Osteítis infecciosa del pubis

Introduccion La osteitis infecciosa del pubis es una entidad poco frecuente que debe diferenciarse de su forma no infecciosa. Metodos Descripcion de cuatro casos de osteitis infecciosa del pubis diagnosticados en los ultimos 10 anos en nuestro centro. Resultados El diagnostico se establecio mediante clinica e imagen sugestiva junto con hemocultivos positivos (2/4) o por biopsia osea (2/4). La antibioticoterapia prolongada, con desbridamiento en caso de absceso, ofrecio resultados satisfactorios (4/4). Conclusion La osteitis infecciosa del pubis debe sospecharse en pacientes con dolor inguinal y factores predisponentes.