[HIV-infected children become adolescents: the Pavia's experience].
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Adolescent↗
Biomedical subjects
G Michelone
Publications and source records attributed to G Michelone.
Unusual extracranial complications of otitis media in a young HIV patient: retropharyngeal and Mouret's abscess.
Since the introduction of antibiotic therapy, the incidence of intra- and extracranial suppurative complication of acute and chronic purulent otitis media has sharply decreased. In particular, reports of laterocervical abscesses secondary to this disorder are quite rare, not more than twenty cases of Bezold's or Mouret's abscesses having been reported in the literature during the last ten years. The authors present a case of retropharyngeal and Mouret's abscess developed as a consequence of acute purulent otitis media in a young Aids patient. True otologic manifestations of Aids are rare while the incidental association of otologic disease with Aids is more common. The development of complication in the present case is favoured by the patients severe immunodepression.
Abscess↗
Percutaneous renal biopsy utilizing ultrasonic guidance and a semiautomated device.
Percutaneous renal biopsy is a fundamental diagnostic technique in urology and nephrology, recently refined by real-time ultrasonic guidance. The technique described in this article is a biopsy method employing real-time ultrasonic guidance and a semiautomated device. The new device has been constructed to improve percutaneous biopsy technique and to obtain more perfect specimens. This technique was successfully performed in 20 patients undergoing renal biopsy. Diagnostically satisfactory material containing an average of ten glomeruli per specimen was obtained. The results obtained with the new device Biopty Bard have been compared with the results obtained from the same number of biopsies performed with the traditional technique.
Adult↗
Clinical and microbiological characteristics of symptomatic vulvovaginal candidiasis in HIV-seropositive women.
OBJECTIVES: To evaluate the clinical and microbiological characteristics of symptomatic vaginal candidiasis in Human Immunodeficiency Virus (HIV)-seropositive women attending a gynaecologic outpatient clinic for sexually transmitted diseases (STDs). DESIGN: Vaginal, rectal and oral specimens from cases and controls were cultured for Candida spp. SUBJECTS: Eighty-four consecutive HIV-seropositive and 384 HIV-seronegative women with clinical signs of vulvovaginitis. SETTING: A gynaecological out-patient clinic in Pavia, Italy. RESULTS: The overall prevalence of vaginal candidiasis was 61.9% (52/84) in the cases and 32.3% (124/384; p < .001) in the controls. After adjustment by logistic regression analysis for confounding factors (age at first intercourse, lifetime sex partners, new partner/s in the last 6 months, type of contraceptive used), HIV-seropositive patients were at higher risk for both Candida albicans (odds ratio = 2.5; 95% confidence interval 1.31-4.69; p = 0.006) and Torulopsis glabrata vaginitis (OR = 3.5; 95% CI = 1.05-11.60; p = 0.04) than controls. HIV-seropositive subjects had also increased rates of oral and rectal colonisation with Candida spp. Finally, the time to recurrence of vaginal infection was significantly shorter in HIV-seropositive patients than controls and was correlated with the severity of HIV-induced immunodepression. CONCLUSIONS: Vulvovaginal candidiasis is very common in HIV-seropositive women and its prevalence is correlated with the immunological status of the host. These patients have higher frequencies of Torulopsis glabrata vaginal infection and are more prone to recurrence than HIV-seronegative controls.
AIDS-Related Opportunistic Infections↗
Frequency and significance of drug resistance in vulvovaginal candidiasis.
The rates of non-albicans species and susceptibility to the main antimycotic drugs were evaluated in a series of 472 cultures of vulvar or vaginal specimens positive for Candida species. Torulopsis glabrata was associated more frequently than C. albicans with recurrent vulvovaginal candidiasis (18/40 vs. 72/379; p = 0.003, chi 2 test). As evaluated by the results of susceptibility testing, C. albicans isolates were uniformly sensitive to the antifungals tested, whereas 7.5% (3/40) of T. glabrata strains were resistant to imidazole derivatives. All these patients had a history of repeated antimycotic treatments. Previous antimycotic therapies in susceptible individuals could cause a selection of non-albicans species, especially T. glabrata, which is occasionally resistant to the commonly used antimycotic drugs.
AIDS-Related Opportunistic Infections↗
Recurrent Histoplasma capsulatum pneumonia: a case report.
The epidemiological, clinical and therapeutical findings are described in a case of recurrent pulmonary histoplasmosis due to Histoplasma capsulatum. The patient, a bulldozer-operator, worked in Africa for a long period in extremely dusty conditions without any protection. Three different episodes of H. capsulatum pneumonia recurred during eighteen months after his return from Africa. A full dose treatment by Amphotericin B failed to eliminate disease recurrence on three occasions. The high concentration of airborne H. capsulatum spores inhaled could have been the main cause of the difficulty obtaining a rapid sterilization of the microorganism by Amphotericin B and disease recurrence. The late start of the treatment or the unexplained ability of some persons to develop repeated infections even with normal immunological parameters could be another explanation for the reported phenomenon.
Adult↗
Recurrent vaginal candidiasis. Results of a cohort study of sexual transmission and intestinal reservoir.
Yeast cultures from the oral cavity, vagina and rectum were obtained from 125 women experiencing an acute episode of recurrent candidal vaginitis. To investigate the role of sexual transmission, oral, penile and ejaculate cultures were also prepared from all the male sexual partners. The rates of oral and rectal Candida species colonization in the women were 36% (45/125) and 44.8% (56/125), respectively. The male partners' oral cavities were positive in 23.2% (29/125) and the penile coronal sulcus and seminal fluid in 16% (20/125) and 14.4% (18/125), respectively. The susceptibility of the isolated species to the main antimycotic drugs was ascertained with the agar diffusion method. Therapy in the women and the colonized sexual partners was carried out, eliminating the microorganism from every positive site. Control cultures were obtained two weeks after the completion of therapy, and follow-up was continued for one year. The overall clinical and microbiologic cure rate in the study group was 72% (95/125). The rate of relapse was not influenced by the treatment of Candida colonization of the female intestinal tract. The recurrence rate after treatment in the couples in which the man harbored yeast (oral cavity, penile coronal sulcus, seminal fluid) was lower (15.8% vs. 44.8%, P = .0019) than that recorded in the couples without sexual partner involvement. The identification and treatment of the male sexual partner's Candida colonization seems important in the prevention of recurrent vulvovaginitis.
Antifungal Agents↗
[Vancomycin and "red man's syndrome". Presentation of a clinical case].
This paper describes a case of "Red man's syndrome" in a patient with staphylococcal sepsis. The patient was initially treated with intravenous Vancomycin and afterwards with Teicoplanin. The adverse reaction appeared immediately after the start of pharmacological treatment.
Drug Eruptions↗
[Performance of echo-guided renal biopsy using a new semi-automatic instrument].
Percutaneous renal biopsy is a fundamental diagnostic technique in clinical nephrology, recently refined by real-time ultrasonic guidance. The technique described in this paper is a biopsy method employing real-time ultrasonic guidance and a semi-automated device. This technique has been successfully performed in 10 patients undergoing renal biopsy. Diagnostically satisfactory material containing an average of 9 glomeruli for specimen was obtained.
Adult↗
Antifungal chemoprophylaxis in cancer children: a prospective randomized controlled study.
We report a prospective, randomized, controlled study of antifungal chemoprophylaxis in forty immunocompromised children with hematologic malignancies, receiving respectively itraconazole, ketoconazole, amphotericin-B and no prophylaxis. Fungal isolates from patients' saliva or stools were obtained from 19/40 patients (Candida albicans from 15 patients). Disseminated infection was never observed. Fungal isolates were significantly less frequent in the ketoconazole group of patients vs any other group. Systemic antifungal chemoprophylaxis with ketoconazole appears more effective even than the recently introduced itraconazole.
Adolescent↗
Fluconazole vs amphotericin B: "in vitro" comparative evaluation of the minimal inhibitory concentration (MIC) against yeasts isolated from AIDS patients.
Fluconazole, a novel triazole antifungal drug, holds promise as a significant advance in the management of human fungal diseases. This new drug can be both orally and parenterally administered and is reported to be less toxic than other antifungal agents. The Authors studied the in vitro susceptibility of yeasts isolated from AIDS patients to this antimycotic drug, in order to evaluate if fluconazole's MICs were comparable to those of amphotericin B. A sample of 200 yeast strains (100 C.albicans, 20 C.parapsilosis, 20 C.tropicalis, 8 C.guilliermondii, 6 C.krusei, 6 C.pseudotropicalis, 24 T.glabrata and 16 Cr.neoformans) was tested. The results show an average MIC for amphotericin B (MIC90: 3.12 micrograms/ml) ten-fold lower than for fluconazole (MIC90: 100 micrograms/ml). However, C.albicans and Cr.neoformans presented the same MIC value (3.12 micrograms/ml) both for fluconazole and for amphotericin B, suggesting that fluconazole could represent a valid alternative to amphotericin B in the treatment of fungal infections caused by these two agents.
Acquired Immunodeficiency Syndrome↗
[Changes in the plasma levels of T3-T4 and TSH during surgical stress and anesthesia with isoflurane].
The authors describe the blood level changes of T3, T4 and TSH in 17 patients undergoing urological surgery and isoflurane anaesthesia. The data were statistically processed and showed that isoflurane, used as the only anesthetic agent in 1.5%-2% concentrations, is not sufficient to block hormonal changes of the hypothalamus-hypophysis-thyroid axis caused by surgical stress.
Aged↗
Mediterranean spotted fever in Lombardy: an epidemiological, clinical and laboratory study of 76 cases in the years 1977-1986.
This paper describes the epidemiological, clinical and laboratory features of 76 cases of Mediterranean spotted fever occurring during the years 1977-1986. The patients observed all lived in the Lombardy region of Italy, which is not located on the Mediterranean Basin. Our data show the highest prevalence of the disease, as reported by other authors, in southern regions of Italy, in the same years: 1979-1983. No differences were noted between age groups or sexes, and the late spring-summer seasonality was confirmed. The clinical signs and symptoms in our cases were those common to the disease. The microimmunofluorescence method was found to be more sensitive and specific than the Weil-Felix test for serological diagnosis. Finally, we showed that doxycycline and oxytetracycline both induce rapid remission of fever.
Adolescent↗
Itraconazole vs amphotericin B: in vitro comparative evaluation of the minimal inhibitory concentration (MIC) against clinically isolated yeasts.
Itraconazole is a triazole compound which, following several clinical trials, has begun to be used for therapy of mycotic infections. This new drug, with a broad-spectrum antifungal activity, can be orally administered. The Authors studied the in vitro susceptibility to amphotericin B and itraconazole of the following clinical isolates of pathogenic yeasts: 100 Candida albicans, 20 C. tropicalis, 20 C. parapsilosis, 8 C. guilliermondii, 6 C. pseudotropicalis, 24 Torulopsis glabrata and 16 Cryptococcus neoformans. Serial two-fold dilution, from 100 micrograms/ml to 0.04 micrograms/ml, of each drug were prepared in Yeast Nitrogen Base + Glucose 5%, after dissolving the itraconazole in dimethylsulfoxide (DMSO) and amphotericin B in 5% glucose solution. Amphotericin B (MIC90: 3.12 micrograms/ml) was found to have an average in vitro MIC six-fold lower than itraconazole (MIC90: 25 micrograms/ml). Thus, even though itraconazole is active, amphotericin B remains one of the most effective of the antifungal drugs.
Amphotericin B↗
HIV-infection in two premature babies after a transfusion from the same infected donor.
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Adult↗
[Incidence of mycotic infections in children with acute myeloblastic leukemia (AML)].
Opportunistic mycotic infections have a significant influence on the morbidity and mortality of children whose immune systems are depressed by the onset of AML. The present paper assesses the incidence of the pathogenic mycotic flora and the in vitro efficacy of the main antimycotic drugs. Candida was che most commonly encountered pathogen and its in vitro response to the polyenic antibiotics was good.
Amphotericin B↗
[Heterogeneous neurologic manifestations of AIDS in children].
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AIDS-Related Complex↗
[Clinical review of 3 cases of aspergillosis].
Three cases of aspergillosis observed in Pavia Infectious Disease Clinic in 1983-85 are described. The cases differed both in the site of the infection (lungs, bones and liver) and in the patients' basic immunological situation. The importance of mycological investigations during diagnosis is emphasised, though they should of course be flanked by instrumental examinations and blood chemical assays. The efficacy of specific treatment with amphotericin B combined with surgery and plasma exchange is also emphasised.
Adolescent↗