[Visceral leishmaniasis in patients infected with HIV in the Barcelona area].
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Biomedical subjects
Publications and source records attributed to J Mallolas.
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The clinical, microbiological and echocardiographical features as well as the response to therapy of 19 cases of infective endocarditis (IE) caused by coagulase-negative staphylococci (CNS) are reported. Six patients had native valve IE, 11 had prosthetic valve endocarditis and 2 were associated with catheters in right cardiac chambers. In the group of native valve IE, 11 patients were heroin abusers and 4 had previous valvular disease. IE was left sided in 3 cases, mixed in 2 and right sided in 1. All CNS were methicillin-sensitive. The echocardiogram detected vegetations in 5 of the 6 cases. One patient required surgery and another died. In the group of prosthetic valve IE, 5 patients had early endocarditis and 6 had late endocarditis. A bioprosthesis was involved in 5 cases, a mechanical prosthesis in another 5, and an annuloplasty annulus in one. The involved prosthesis was aortic in 5 cases and mitral in 6. The echocardiogram detected vegetations in 3 cases (27%) and prosthetic dysfunction in 4. One patient had a relapse, 8 (73%) required valve replacement and 3 died. Although the greatest incidence of IE caused by CNS is found among patients with prosthetic valves, it can also be seen in patients with underlying valvular heart disease, drug abusers and patients with indwelling catheters in right cardiac chambers.
We report two cases of osteoarticular tuberculosis in heroin addict patients infected with human immunodeficiency virus. Both patients presented an inflammatory tumor in the anterior chest wall, with subacute onset; one patient had chondrosternal involvement and the other had chondrocostal involvement with a retrosternal pus collection. Diagnosis was established by needle aspiration of the tumor that gave raise to caseum. Ziehl-Neelsen stain was positive and Löwenstein-Jensen culture yielded Mycobacterium tuberculosis in both cases. The course was good after surgical debridement and tuberculous treatment for 6 months. We review the features of osteoarticular tuberculosis in drug addicts and patients infected with human immunodeficiency virus that in our environment mainly affects this population group. As in our geographical area, an increased incidence of both infections does exist and owing to the high prevalence of extrapulmonary and disseminated tuberculosis in those patients, it is expected that in a future time, the number of cases of tuberculosis will increase. Therefore, physicians must entertain a high degree of suspicion with the purpose of establishing an early diagnosis of these atypic presenting forms.
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To test the hypothesis that HIV infection can modify the clinical characteristics of tuberculosis, 65 consecutive cases of tuberculosis in HIV-seropositive patients diagnosed in Barcelona (Spain) were compared with 65 HIV-seronegative controls matched for age and sex. Thirty of the 65 cases were accepted as AIDS cases (August 1987 Centers for Disease Control criteria) only because of the tuberculosis. Among the cases 54 (83%) were parenteral drug addicts and 88% were males. The tuberculosis was pulmonary or pleural in 62 controls (96%) but in only 25 cases (39%; P less than 0.0001). Lymph nodes were involved in 25 cases (39%) and in none of the controls (P less than 0.0001). Disseminated forms of tuberculosis were present in seven cases (11%) and in no controls (P less than 0.007). Bone, joints and central nervous system involvement were also significantly (P less than 0.05) more frequent in cases. The treatment (isoniazid and rifampin for 6 months plus ethambutol and pyrazinamide during the first 2 months) was always effective. One relapse was detected after a median follow-up of 55 months in cases and none in controls after a median follow-up of 43 months. Twenty-five cases (39%) and 14 controls (22%) developed mild or severe side effects related to the treatment (P less than 0.004). In conclusion, most of the HIV-infected patients with tuberculosis were drug addicts with extrapulmonary or disseminated forms. A short course of treatment (6 or 9 months) may be enough but side effects were frequent.
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We studied two cases of disseminated tuberculosis with vertebral arch involvement in drug addicts seropositive for human immunodeficiency virus. The first patient developed a paraplegia while he was recovering from a meningeal tuberculosis. On the abdominal plain roentgenogram, the right transverse process of L-2 was absent, and a computed tomographic scan revealed destruction of the right vertebral arch together with a collection in the paravertebral area. The second patient had miliary tuberculosis and complained of lumbar pain. The radiologic findings were similar to those in the first case, but at the L-4 level.
Lymphocytic-cell subsets (T total, T helper, T suppressor-cells) have been studied with Monoclonal Antibodies (OKT-3, OKT-4, OKT-8) in 21 patients with Polymorphous light Eruption in inactive phase and have been compared with 13 controls. The results shvon normal cell figures (T total, helper and suppressor). However, when observing the ratio between T helper cells and T suppressor cells, a slight decrease in this ratio is appreciated, which would correspond to a relative increase of suppressor cells. These results are similar to those obtained for the inactive S. L. E. (9).
Patients affected by Waldenström's macroglobulinaemia may rarely present specific cutaneous manifestations. The violaceous plaques or tumours infiltrated by lymphoplasmocytoid cells, and the pink, translucent, shiny papules composed of deposits of hyaline monoclonal IgM possess definite clinico-pathological characteristics that may permit the diagnosis before any other data were available. The immunopathological and ultrastructural features of these lesions are described.
The cutaneous changes of the acute form of graft-vs-host reaction are described in two patients who underwent bone marrow transplantation for treatment of severe aplastic anaemia. One patient went on to develop a chronic reaction of the lichenoid type. Histopathology confirmed the presence of 'satellite cell necrosis' from the acute stage of the disease onwards. Direct immunofluorescence showed deposits of immunoglobulin (IgG, IgM), fibrinogen and complement on the necrotic keratinocytes, whilst the basement membrane was positive for C3. These findings suggest that humoral immunity as well as cellular immunity may play a part in the production of the rash.
Postovulation Dermatitis is a frequent clinical picture although it is not well known. Clinically a polymorphous eruption appears between than 8 or 10 day before menses. The Authors report three cases in which an complete immunological investigation was performed. They conclude that there is no objective evidence of the autoimmune pathogeny of this picture in spite of the clinical relationship between the dermatitis and the ovulation. Therefore they suggest that diseases should be described as "Postovulation Dermatitis" instead "Autoimmune Progesterone Dermatitis".