Biomedical subjects
Publications and source records attributed to E Simón.
Fournier's gangrene represents an acute severe necrotizing inflammatory process affecting the scrotum and penis. We report the case of a patient with Fournier's gangrene as the presenting sign of HIV infection. The process began with balanitis and rapidly destroyed the penis. Aggressive medical and surgical management proved successful.
53 HIV-positive patients, 66% of them zidovudine-experienced, were randomized to receive monotherapy with zidovudine or sequential therapy with zidovudine, didanosine and zalcitabine. Clinical end points, CD4 cell count change, and analysis abnormalities showed better results with sequential therapy.
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In the last years significant advances in the knowledge of all aspects of HIV infection have happened. It is especially important that the new kinds of treatment against the virus have substantially improved the prognosis of the infection. The available antiretrovirals belong to three groups: nucleoside reverse transcriptase inhibitors, non nucleoside reverse transcriptase inhibitors, and protease inhibitors. We review the characteristics of the most recently developed drugs.
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OBJECTIVE: The incidence of Pseudomonas aeruginosa in HIV-infected patients has increased over the last years. We describe a case of pseudomonal breast abscess complicated with fatal septicemia in an AIDS patient. CASE REPORT: A 21-year-old woman was admitted for fever, chills, nausea, vomiting and pain in the breast. She had a swelling in the right breast of 3 days duration. HIV infection had been confirmed 6 years earlier. CD4 count was 2/mm3. Surgical drainage produced a blue-green purulent discharge which grew Pseudomonas aeruginosa on culture. Despite cloxacilin, then ceftazidime and amikacin, initial improvement was followed 2 weeks later by nodular pulmonary infiltration with cavitation. P. aeruginosa was recovered from sputum and blood cultures, but stepwise resistance developed and the patient died 3 months after admission. DISCUSSION: Breast abscesses are infrequent in nonlactating women. P. aeruginosa is rarely involved, even in HIV patients. Due to the risk of resistance, prompt administration of appropriate antibiotics is required.
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Fournier's gangrene is an uncommon but serious condition. It consists of a mixed bacterial infection of the skin, subcutaneous tissues and superficial fascia of the perineum and genitalia. Males are predominantly affected, and diabetes is a risk factor for its development. Early diagnosis and treatment are essential to prevent the disastrous consequences of this illness. Broad spectrum antibiotics and surgical removal of the damaged tissues are the mainstays of therapy.
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