Olga V. Coronado

Cognitive and affective disorders associated to HIV infection in the HAART era: findings from the NeuroICONA study

Objective: To assess the natural story of HIV‐associated affective and cognitive disorders and the relationship with clinical, pharmacological, immunological and behavioural factors.

Fiavobacteriurrt spp. organisms as opportunistic bacterial pathogens during advanced HIV disease

OBJECTIVE To assess the role of Flavobacterium spp. infection in patients with HIV disease. METHODS Clinical charts of 2412 consecutive HIV-infected patients hospitalized in a 8-year period were retrospectively reviewed, to identify all cases of Flavobacterium spp. infections, and to evaluate their occurrence and outcome according to several epidemiological, clinical, and laboratory parameters. RESULTS Six patients out of 2412 (0.25%), developed Flavobacterium spp. complications: septicaemia in five cases, and pneumonia in the remaining patient, with F. meningosepticum and F. odoratum isolated in two cases and one case, respectively, and unnamed Flavobacterium spp. organisms in the remaining three cases. Flavobacterium spp. organisms were responsible for six out of 1939 overall episodes of non-mycobacterial bacterial diseases observed in our patient group (0.31%). All patients were severely immunocompromised, showing a prior diagnosis of AIDS, a mean CD4+ lymphocyte count of 64.2 (range 12-187) cells/microl, and a mean neutrophil count of 1.143 (range 700-1600) cells (range 700-1600) cells/microl. Antibiotic, corticosteriod, or cotrimoxazole treatment was carried out during the month preceding disease onset by three, two and five patients, respectively. Community-acquired and nosocomial Flavobacterium spp. disease were equally frequent, but the latter occurred with a significantly lower mean neutrophil and CD4+ cell count. Antimicrobial susceptibility assays showed complete sensitivity to ciprofloxacin, and variable resistance to ureidopenicillins, ceftazidime, imipenem, aztreonam, and aminoglycosides. An appropriate antimicrobial regimen obtained clinical and microbiological cure in all cases, in absence of related mortality or relapses. CONCLUSIONS Since only one episode of HIV-associated F. (Sphingobacterium) multivorum complication has been described to date, our series represents the largest one dealing with Flavobacterium spp. infection in the setting of HIV disease. Our experience suggests that Flavobacterium spp. organisms may play a pathogenic role in patients with advanced HIV disease, even when some commonly recognized risk factors are lacking (i.e. indwelling catheters, instrumentation, IV drug abuse), while a very low CD4+ lymphocyte count, leukopaenia-neutropaenia, and concurrent AIDS-related infectious complications may act as important predisposing factors. In view of the infrequent occurrence of these infections, early suspicion is essential for both clinicians and microbiologists facing immunocompromised patients at risk for invasive bacterial complications. Flavobacterium spp. organisms should be taken into consideration as nosocomial- or community-acquired opportunistic pathogens, due to their relationship with advanced immunodeficiency and their elevated resistance to many antimicrobial agents commonly used against Gram-negative bacterial pathogens.

Nosocomial Clostridium difficile-associated diarrhea in patients with AIDS: a three-year survey and review.

to treatment, with resolution of the diarrhea a mean of 7 days after A total of 985 stool samples from 312 patients were examined. antibiotic therapy was instituted. These patients were cured and During the survey period, 35 (11%) of the 312 patients with diar- remained asymptomatic during the follow-up period of 12 months. rhea were identified from the microbiology records as having cul- The drugs were well tolerated by all patients; there were no sigtures and cytotoxin assays positive for C. difficile. Twenty-six nificant adverse events. Despite initial treatment with metronidaepisodes of CDAD were identified in 19 (54%) of the 35 patients zole, five patients relapsed at a mean time of 18 days after treatment with AIDS. There were 13 men (68%) and 6 women (32%), and was discontinued. In these cases the diarrhea completely resolved the mean age was 29 years (range, 4‐43 years). AIDS was diag- after therapy with vancomycin or teicoplanin was instituted. nosed before the onset of CDAD in all cases. HIV infection was C. difficile causes a wide spectrum of disease in patients with acquired through intravenous drug abuse by eight patients (five AIDS, and CDAD may represent £12.5% of the diarrheas that males and three females), homosexual relations (five males), and occur in this patient population [1]. Although HIV infection itself heterosexual relations (three males and three females). The CD4 / is not considered an intrinsic risk factor for C. difficile infection, lymphocyte count was very low in most instances (median count, individuals infected with HIV appear to be at increased risk for 48/mm 3 ; range, 5‐115/mm 3 ). CDAD [1‐6]. The predisposing conditions for acquiring C. diffiNo cases of diarrhea were due to medications or concomitant cile disease include the use of antibiotics or antineoplastic agents, infection with protozoa, mycobacteria, viruses, or bacterial patho- gastrointestinal procedures or surgery, prolonged hospitalization, gens. Endoscopic examinations were performed for 11 patients; and severe underlying disease that may increase host susceptibility evidence of severe colitis was present in eight of these patients, to infection. Patients with AIDS frequently require recurrent and and the presence of pseudomembranous colitis could be confirmed prolonged hospitalization, leading to colonization with nosocomial by histology for three other patients. Presenting complaints in- microorganisms including C. difficile. The frequent exposure of cluded watery diarrhea (85% of patients), abdominal pain (90%), these patients to prolonged or multiple courses of antibimicrobial fever (80%), nausea (60%), weakness (65%), and bloody diarrhea or anticancer chemotherapy may result in profound changes in the composition of endogenous bacteria in the alimentary tract, leading to the overgrowth of toxigenic C. difficile. A variety of antimicrobial agents have been linked with the

Community-acquired pneumonia due toStaphylococcus cohnii in an HIV-infected patient: Case report and review

Coagulase-negative staphylococci recently have been implicated as a cause of serious infections in immunocompromised individuals. An unusual case of community-acquired pneumonia due toStaphylococcus cohnii in an HIV-infected drug user is described. Results of a study conducted to examine the prevalence of infection due toStaphylococcus cohnii strains and their antibiotic-sensitivity patterns show a low frequency but a high morbidity. These results and a brief review of the literature emphasize the importance of these organisms and other staphylococcal species as emerging opportunistic pathogens in patients with AIDS.

Recurrent 'migrainelike' episodes in patients with HIV disease.

Recurrent transient neurological deficits have been described in human immunodeficiency virus (HIV)‐infected subjects, but their frequency, pathogenesis, and outcome are still unsettled.

Chron's disease, rare association with selective IgA immunodeficiency, and development of life-threatening bacterial infections

Life-threatening necrotizing fasciitis and relapsing Lemierre syndrome associated with Fusobacterium necrophorum septicaemia occurred in young adults with a moderate Chrons disease and a missed profound IgA deficiency. This unexpected association of a chronic bowel inflammatory syndrome with prominent IgA abnormalities and severe bacterial infection deserves careful attention by physicians faced with young patients with Chrons disease.

Tuberculous pericarditis and AIDS: Case reports and review

Pericarditis is one of the most common cardiac complications in the course of HIV disease. Opportunistic infections and neoplastic processes represent the most common etiology of pericardial disease. Pericardial tuberculosis is an uncommon condition, especially in developed countries. Two cases of tuberculous pericarditis in adult patients with AIDS occurred over a 12-month period at our clinic, which prompted a literature review of the published cases of tuberculous pericarditis in AIDS. Of note is that in the first patient pericardial effusion represented the AIDS-defining illness and was an expression of a disseminated tuberculous disease. The second patient developed a fatal pericarditis due to a multiple-drug resistant Mycobacterium tuberculosis infection.

AZT Plus Methotrexate in HIV-Related Non-Hodgkin's Lymphomas

AZT is a thymidine analogue useful in the treatment of AIDS. It has been demonstrated that this compound can possess a significant antineoplastic activity when combined with de novo thymidylate synthesis inhibitors, such as 5-fluorouracil (5FU) and methotrexate (MTX). Here we report a review of our data concerning the efficacy and tolerance of the combination AZT + MTX in HIV-related non Hodgkins lymphomas (NHL). Twenty-nine patients were treated, at weekly intervals, with three (patient 1 to 10) or six (patient 11 to 29) consecutive courses of MTX 1g/m2 and increasing doses of oral AZT (2, 4 and 6g/m2) with leucovorin rescue. Of 26 evaluable patients, a total (complete + partial) response rate of 77% was obtained. The median complete response duration was 16.8 months. There was one therapy-related death due to septic shock. Grade III-IV neutropenia was observed after 19% of the courses, but was prevented by G-CSF administration in 82/119 courses. Grade III-IV anemia was observed after 9% of the courses. In conclusion, the combination AZT + MTX was effective and well tolerated in our series of HIV-related NHL patients.

Pleurésie purulente à Streptococcus intermedius au cours de l'infection par le VIH

Summary Streptococcus intermedius is usually regarded as a normal commensal bacteria of the human mouth flora, the gastrointestinal tract, and the urogenital tract. The clinical spectrum of human diseases caused by S. intermedius mainly consist in a variety of suppurative infections, mostly reported in adult patients. This is probably the first reported case of pleural empyema caused by S. intermedius in an immunocompromised host, infected with HIV. This patient was successfully treated by antibiotherapy. Our case shows that S. intermedius should be considered as one of the potential pathogens involved in the development of pleural empyema, among HIV or AIDS. This report also underlines that regular dental care should be included in primary health care for individuals with HIV infection, because untreated oral infections can have a significant impact on the health and quality of life of these patients.

Toxoplasmic pancreatitis in a patient with AIDS

Summary The most common localization of Toxoplasma gondii infection in HIV-positive patients is the central nervous system; autoptic findings have revealed disseminated disease also. Clinical manifestations of severe gastrointestinal involvement, especially of the pancreas, have been rarely described. We report a rare case of toxoplasmic pancreatitis in a patient with AIDS. Few other cases have been described in the literature.