Cerebral toxoplasmosis and prophylaxis for Pneumocystis carinii pneumonia.
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Biomedical subjects
Publications and source records attributed to G Sirera.
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BACKGROUND: The aim of the present study was to describe the spectrum of liver disease in isolated infection by the human immunodeficiency virus and in the acquired immunodeficiency syndrome as well as evaluate whether clinical and/or biological data exist to permit specific diagnosis in liver biopsy. METHODS: Liver biopsy was performed in 39 patients with the human immunodeficiency virus (34 via parenteral drug addicts), 22 of whom had established acquired immunodeficiency syndrome. RESULTS: In 29 cases (74%) a specific histologic diagnosis was obtained with the changes most frequently found being the presence of granulomas (11 patients), mainly in patients with stablished AIDS, and chronic active hepatitis non A non B (10 patients), specially in the cases with isolated infection by the human immunodeficiency virus. Obtaining of a specific diagnosis was associated with an increase in GOT and a decrease of the CD4 lymphocytes and the CD4/CD8 quotient (p = 0.002 in all cases). The existence of established AIDS or prolonged fever was associated with the finding of hepatic granulomas (p = 0.02 and p = 0.002, respectively). The increase in GPT, the absence of stablished AIDS and the absence of prolonged fever was associated to the presence of chronic active hepatitis (p = 0.01, p = 0.002 and p = 0.0002, respectively). CONCLUSIONS: In patients with infection by the human immunodeficiency virus liver biopsy provides diagnostic information in a high percentage of cases. The presence of established AIDS, prolonged fever, and hypertransaminasemia may point towards possible histologic diagnosis.
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Pulmonary Kaposi's sarcoma (KS) was diagnosed by pulmonary biopsy in a heterosexual parenteral drug abuser (PDA). The patient had previously been diagnosed of Pneumocystis carinii pneumonia and pulmonary tuberculosis. Thoracic computed tomography (CT) showed bilateral nodular lesions which were less apparent in conventional radiological study and which increased in size in spite of correct therapy. As cutaneous lesions suggesting KS subsequently appeared, the possibility of pulmonary KS was considered and confirmed by open biopsy. The rarity of a primarily pulmonary presentation of KS in a PDA, the difficulty in diagnosis owing to concomitant infective diseases and the diagnostic value of thoracic CT for the diagnosis of pulmonary KS are discussed.
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Patients with HIV infection were studied to assess the efficacy of octreotide, a somatostatin analogue, in the long-term management of refractory diarrhoea. Dosage of subcutaneous octreotide was increased progressively at 48 h intervals from 150 to 300, 750 and 1500 micrograms/day according to response. Twenty-nine patients, 21 with Cryptosporidium enteritis, one with Isospora belli enteritis and seven with no identifiable pathogen were selected for the study; four of these were excluded from the study because of death during the first month (two cases), abdominal pain and acute pancreatitis (one case each). Twenty-five patients were evaluable for response. Ten patients (four with Cryptosporidium enteritis, five without an identifiable pathogen and one with I. belli enteritis) achieved a complete response (40%) and nine cases (all with cryptosporidial enteritis) had a partial response (36%). Patients with higher weight and Karnofsky performance status and non-cryptosporidial enteritis had a better response to treatment. Mean durations of treatment and response were 4.2 +/- 4.2 and 4.4 +/- 4.5 months, respectively. In the absence of specific agents for cryptosporidial enteritis and HIV enteropathy, octreotide was found to be useful in the management of chronic diarrhoea in AIDS patients.
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