Biomedical subjects

R Malinverni

Publications and source records attributed to R Malinverni.

At least 37 records · Page 2Linked to original sources

PubMed1998

Homograft failure in mycotic aortic aneurysm caused by Streptococcus pneumoniae.

Treatment of a rare Streptococcus pneumoniae mycotic aneurysm by homograft replacement failed in a 59-year-old patient because of persistent lobar pneumonia. Despite reoperation with replacement of the infected homograft by a fresh one, he finally died of septicemia. This case illustrates that homograft tissue may be infected per continuum and that extensive debridement of periaortic tissue-including major lung resection-and the use of muscle flaps may be necessary in certain circumstances.

Aneurysm, Infected↗

PubMed1998

[HIV-associated retinal microangiopathy and the development of AIDS-defined infections. The Bern Angiopathy Study].

BACKGROUND: HIV-associated retinal microangiopathy is understood as a sign of uveovascular barrier breakdown and associated with an increasing risk to develop opportunistic infections. Hence no controlled studies have been available, the underlying study was undertaken to validate this clinical impression. PATIENTS AND METHODS: HIV-positive patients with or without clinical signs of retinal angiopathy were included into this study and followed up longitudinally with fotodocumentation, laser-flare and, sporadically, fluorescein angiography to quantify the disturbance of their uveovascular barrier. The data were correlated to the CD4 cell counts and the development of opportunistic infections. RESULTS: 104 patients have been included into one of four groups: patients without signs over ocular vascular disease (group 1, n = 46), with newly diagnosed HIV-associated microangiopathy (group 2, n = 37), with angiopathy for more than six months (group 3, n = 16), and with viral retinitis (group 4, n = 5). We found no difference in the flare between patients with and without angiopathy (p = 0.3), but a significant increase after the development of retinitis (p < 0.001). In contrast, the presence and duration of angiopathy were associated with a reduction in CD4 cell counts (p = 0.03). Using fluorescein angiography, we found vascular occlusions on the capillary level without leakages corresponding to a not relevant disruption of the retinovascular barrier. CONCLUSIONS: In HIV-associated retinal microangiopathy, there exists no relevant disturbance of the uveovascular barrier. The association of angiopathy with a reduction of CD4 cells is more likely a sign of immuncomplex-associated rather than infectious etiology. The analysis of drug effects on the course of angiopathy during a recovery of the cellular immunity will provide further etiological information in the progress of this study.

AIDS-Related Opportunistic Infections↗

PubMed1998

Listeria monocytogenes causing solitary liver abscess. Case report and review of the literature.

The authors report on a case of a solitary liver abscess due to Listeria monocytogenes in a 53-year-old diabetic white male and review all published cases of solitary listerial abscesses of the liver. L. monocytogenes is a rare cause of solitary liver abscess which occurs in elderly patients with diabetes mellitus. The clinical signs are variable and often mimic malignancy, with epigastric pain, night sweats and weight loss. Prevalent features are poor control of glycemia, temperature up to 38.5 degrees C and elevated alkaline phosphatase. Optimal treatment includes percutaneous drainage of the hepatic abscess and antibiotic therapy with an aminopenicillin or trimethoprim/sulfamethoxazole. Outcome of the reviewed patients was favourable with no mortality and no relapse of the disease.

Anti-Bacterial Agents↗

PubMed1998

Didanosine plus stavudine with or without hydroxyurea in HIV-1-infected patients: 1 year follow-up. Swiss HIV Cohort Study.

A total of 144 human immunodeficiency virus (HIV)-infected patients (mean CD4 cell count, 367 cells/mm3) were included in a double-blind placebo-controlled trial testing the efficacy on surrogate markers of HIV progression of the combination didanosine (2',3'-dideoxyinosine or DDI) plus stavudine (2',3'-didehydro-2',3'-dideoxythymidine or D4T) with or without hydroxyurea. The primary end point was a reduction of HIV RNA levels to below 200 copies/ml after 12 weeks of treatment. The results showed that the triple combination was associated with a more profound decrease in HIV RNA with an increased proportion of patients with viraemia < 200 copies/ml. This effect persisted for the majority of the patients after a 48 week follow-up. In contrast, the increase in CD4 cell counts was less in patients treated with hydroxyurea because of lymphopenia, and adverse events were more frequent in hydroxyurea-treated patients. In conclusion, the addition of hydroxyurea consistently improved the antiviral activity of the didanosine/stavudine combination over a 48 week follow-up. Increased toxicity and decreased effect on CD4 cell counts might inspire caution.

Anti-HIV Agents↗

PubMed1998

[HIV epidemic].

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Adult↗

PubMed1998

[Prevention of opportunistic infections in HIV-infected adults].

Opportunistic infections have a major influence on morbidity and mortality in HIV-infected individuals. Prophylactic measures have to be introduced for each patient, corresponding to the stage of disease measured by CD4-lymphocyte count. They consist of exposure prophylaxis, vaccinations and especially chemoprophylaxis with antimicrobials. Some live vaccines are contraindicated in HIV infected patients. Pneumococcal vaccine for every patient and specific primary prophylaxis against pneumocystis carinii pneumonitis, cerebral toxoplasmosis and M. avium infection in patients with manifest immunodeficiency improve survival and quality of life of many patients. After most opportunistic infections, secondary lifelong antimicrobial prophylaxis is indicated. In future, indications of primary and secondary prophylaxis have to be redefined in the light of the new antiretroviral combination therapies.

AIDS-Related Opportunistic Infections↗

PubMed1998

[Decision guides for antiretroviral treatment in pregnancy].

HIV-infected adults can now be offered highly active antiretroviral combination therapies. Major advances in understanding the pathogenesis of HIV-infection have led to earlier onset of treatment during the course of HIV infection. Most of the new antiretroviral drugs are not approved for use in newborns and infants. Zidovudine monotherapy during pregnancy, during labor and for the newborn, has been shown to reduce vertical HIV transmission by almost 70%. Zidovudine monotherapy is at present considered obsolete for the treatment of HIV-infected adults. Thus, during pregnancy, both the interests of the HIV-infected mother and the fetus/newborn must be taken into account. Clinical data to solve this dilemma are not available. In general, standard antiretroviral treatment should not be withheld from pregnant HIV-infected women, but prescription has to be the result of careful discussion of the risks and benefits of such treatment during pregnancy. The final decision about treatment, whether primarily for the mother, to reduce vertical transmission or both, has to be taken by the pregnant women. This discussion and information must involve physicians with important experience in the treatment of HIV-infected patients.

Adult↗

PubMed1997

Impact of new antiretroviral combination therapies in HIV infected patients in Switzerland: prospective multicentre study. Swiss HIV Cohort Study.

OBJECTIVES: To examine trends in disease progression and survival among patients enrolled in the Swiss HIV cohort study during 1988-96 and to assess the influence of new antiretroviral combination therapies. DESIGN: Prospective multicentre study, with follow up visits planned at six monthly intervals. SETTING: Seven HIV units at university centres and cantonal hospitals in Switzerland. PATIENTS: 3785 men (mean age 35.0 years) and 1391 women (30.3 years) infected with HIV. 2023 participants had a history of intravenous drug misuse; 1764 were men who had sex with men; 1261 were infected heterosexually; and 164 had other or unknown modes of transmission. 601 participants had had an AIDS defining illness. RESULTS: During more than 15,000 years of follow up, there were 1456 first AIDS defining diagnoses and 1903 deaths. Compared with those enrolled during 1988-90, the risk of progression to a first AIDS diagnosis was reduced by 18% (relative risk 0.82 (95% confidence interval 0.73 to 0.93)) among participants enrolled in 1991-2, by 23% (0.77 (0.65 to 0.91)) among those enrolled in 1993-4, and by 73% (0.27 (0.18 to 0.39)) among those enrolled in 1995-6. Mortality was reduced by 19% (0.81 (0.73 to 0.90)), 26% (0.74 (0.63 to 0.87)), and 62% (0.38 (0.25 to 0.97)) respectively. Compared with no antiretroviral treatment, the risk of an initial AIDS diagnosis after CD4 lymphocyte counts fell to < 200 cells x 10(6)/1 was reduced by 16% (0.84 (0.73 to 0.97)) with monotherapy, 24% (0.76 (0.63 to 0.91)) with dual therapy, and 42% (0.58 (0.37 to 0.92)) with triple therapy. Mortality was reduced by 23% (0.77 (0.68 to 0.88)), 31% (0.69 (0.60 to 0.80)), and 65% (0.35 (0.20 to 0.60)) respectively. CONCLUSIONS: The introduction of antiretroviral combination therapies outside the selected patient groups included in clinical trials has led to comparable reductions in disease progression and mortality.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Familial transmission of a serious disease--producing group A streptococcus clone: case reports and review.

Invasive group A streptococcus (GAS) infections are emerging diseases; however, person-to-person transmission of invasive GAS producing life-threatening infection has been observed rarely. We report a small intrafamilial cluster of life-threatening GAS infections. A previously healthy 47-year-old father developed necrotizing fasciitis of the neck. Two days later, his 16-year-old daughter developed streptococcal angina, pneumonia, and pleural empyema. Both patients had signs of streptococcal toxic shock syndrome. Pulsed field gel electrophoresis revealed that the M6 strains of GAS isolated from the father and daughter had identical patterns. Cases of person-to-person transmission of invasive GAS infection reported in the literature are also reviewed.

Adolescent↗

PubMed1996

[Aminoglycosides in the treatment of infectious endocarditis].

The role of aminoglycosides in the treatment of infective endocarditis is well established. The combination of a beta-lactam with an aminoglycoside shortens the treatment of endocarditis due to penicillin-sensitive streptococci (MIC < or = 0.1 micrograms/mL) when compared to beta-lactams alone. Patients at higher risk (e.g. with prosthetic valves, clinical duration of symptoms > 3 months) should be treated with penicillin for 4 weeks in combination with an aminoglycoside for 2 weeks. Once-daily dosing (ODD) of aminoglycosides can be recommended in penicillin-sensitive streptococcal endocarditis. The treatment of endocarditis due to streptococci relatively and/or highly resistant to penicillin requires combined treatment with penicillin plus an aminoglycoside for a longer duration. At present ODD of aminoglycosides cannot be recommended. Enterococcal endocarditis requires combined treatment for 4 to 6 weeks. Based upon experimental data, ODD of aminoglycosides appears to be markedly inferior to q 8 h dosing. Enterococcal isolates should be screened for high-level resistance to streptomycin and gentamicin. Gentamicin is the preferred agent if susceptibility testing is not performed. Aminoglycosides are administered during the initial 3 to 5 days of treatment for staphylococcal endocarditis on native valves in order to shorten the duration of bacteremia. For staphylococcal prosthetic valve endocarditis, aminoglycosides are administered for the initial 2 weeks of treatment. However, there are no reliable clinical data for methicillin-susceptible isolates to support this recommendation. In prosthetic valve endocarditis due to coagulase-negative staphylococci combination with an aminoglycoside appears to suppress the emergence of rifampin-resistant variants during treatment. There are no data on ODD of aminoglycosides in staphylococcal endocarditis. Right-sided staphylococcal endocarditis due to methicillin-susceptible staphylococci is adequately treated with a two-week course of a beta-lactam plus an aminoglycoside. This short regimen can be recommended for low risk patients, e.g. those without significant heart failure and vegetations < 2 cm3 and with an aminoglycoside-susceptible isolate.

Aminoglycosides↗

PubMed1995

Reactivation of Chlamydia pneumoniae lung infection in mice by cortisone.

To study persistent infection, reactivation of Chlamydia pneumoniae lung infection in mice was attempted by immunosuppression with cortisone treatment. Four-week-old Swiss-Webster mice were treated with cortisone acetate (125 mg/kg) every other day for a total of six doses, starting on day 28 after intranasal inoculation of C. pneumoniae AR-39. C. pneumoniae was recovered from the lungs in 6 of 13 animals after six doses of cortisone, while control animals given saline remained negative. C. pneumoniae DNA was detected by polymerase chain reaction in the 6 culture-positive mice and 2 of 10 controls. The presence of pathogen DNA in this animal model suggested viable organisms in a culture-negative state.

Animals↗

PubMed1995

Effects of two antibiotic regimens on course and persistence of experimental Chlamydia pneumoniae TWAR pneumonitis.

We studied the effects of two antibiotic regimens on the course of Chlamydia pneumoniae infection in the lungs of Swiss Webster mice. After intranasal challenge with isolates AR-388 (1.3 x 10(7) inclusion-forming units per mouse) and AR-39 (1.5 x 10(6) inclusion-forming units per mouse), groups of animals were treated with either doxycycline (10 mg/kg of body weight once a day for 3 days), azithromycin (10 mg/kg [single dose]), or saline. Responses were assessed by the isolation of organisms in cell culture, detection of TWAR DNA in lung tissues by PCR, and lung histology. Both regimens were effective in clearing infections induced by AR-388 (P = 0.02 and 0.007 for doxycycline and azithromycin, respectively) compared with controls. TWAR DNA was detected in 77 and 25% of culture-negative lungs 2 weeks after treatment of AR-388 and AR-39 infections, respectively. Histological changes showed interstitial pneumonitis and were similar over time for all groups. Single-dose azithromycin produced drug levels in lung tissues above the MICs for the test strains for a period three times longer than that of single-dose doxycycline. We concluded that short-term antibiotic regimens were successful for the treatment of experimental TWAR pneumonitis in mice. TWAR DNA was frequently recovered from lung tissues after apparently successful treatment.

Animals↗

PubMed1995

[Sense and nonsense in infection prevention following organ transplantation].

Incidence and severity of infectious complications in solid-organ transplant recipients depend on the epidemiological exposure of the patients to infectious agents and the degree of immunosuppression. The timetable for the occurrence of infections reflects this interaction: up to one month after transplantation, patients suffer from infections related to the surgical procedure. Prevention is provided by careful surgical technique and perioperative antibiotics. One to six months after transplantation is the critical period for severe opportunistic infections: herpes viruses, fungi, mycobacteria and protozoal infections. Cytomegalovirus (CMV) are by far the most important source of morbidity and mortality. Various preventive strategies for CMV disease are critically reviewed; at present, pre-emptive therapy is our choice. Finally, we discuss prophylaxis of specific infections due to toxoplasma, P. carinii and M. tuberculosis. The value of local experiences (epidemiological exposures of patients, immunosuppressive regimes and antirejection therapy) for the choice of preventive strategies cannot be overemphasized.

Anti-Bacterial Agents↗

PubMed1994

[Clinical aspects and diagnosis of infectious endocarditis].

The first step in the diagnosis of infective endocarditis is a high level of clinical suspicion. Only rarely are all the classic signs of infective endocarditis, namely fever, a new cardiac murmur, splenomegaly, anemia and embolic phenomena, found. Every organ system can be involved by embolic or immunologic complications. We have to look specially for manifestations in skin and mucosa, CNS, kidney, locomotor system and lungs. The clinical spectrum has changed over the last decades. More elderly patients, patients with prosthetic heart valves and i.v. drug users are affected. The traditional classification into acute and subacute infective endocarditis has been replaced by a classification based on the microbiological etiology or on the involved valve (native, prosthetic, left- or right sided). In particular, the clinical presentation of right-sided infective endocarditis differs from the left-sided one. A diagnosis of infective endocarditis has to be considered in every patient with unexplained fever or a multisystem disease. A definite diagnosis of infective endocarditis rests on a multidisciplinary approach that involves the clinician and the echocardiography and microbiology laboratories.

Adult↗

PubMed1994

Survival in HIV infection: do sex and category of transmission matter? Swiss HIV Cohort Study.

OBJECTIVE: To examine survival differences in HIV-infected individuals between the sexes and the categories of transmission. PATIENTS AND SETTING: Subjects assumed to have been infected by injecting drug use, by male homosexual contact or by heterosexual contact and enrolled in the Swiss HIV Cohort Study, a national multicentre cohort study of adult HIV-infected patients. METHODS: Kaplan-Meier lifetable and Cox regression analyses were performed (time 0 = date of study entry) and survivors were censored at their last follow-up visit. RESULTS: A total of 4428 patients (mean duration of follow-up, 2.1 years) were considered. At entry, men were older and had lower CD4+ counts than women (P < 0.0001). Homosexual men were the oldest group with the lowest CD4+ counts and the most advanced disease at study entry (P < 0.0001). Crude hazard ratios indicated a 28% lower mortality from all causes in women compared with men (P < 0.0001) and, among men but not in women, a 28 and 32% higher mortality in homosexuals and heterosexuals compared with injecting drug users (IDU) (P = 0.0002 and P = 0.008, respectively). After adjusting for differences at entry, the mortality difference between the sexes disappeared (P = 0.5) and differences across transmission categories were reversed. Mortality in homosexual men was an estimated 13% (P = 0.057) lower than in male IDU; mortality was 22% lower in heterosexual women than in female IDU (P = 0.098). In stratified analysis the increased risk in IDU was confined to subjects with CD4+ cell counts > 500 x 10(6)/l cells at study entry. CONCLUSIONS: These results indicate a uniform mortality risk across the sexes but indicate an increased risk in IDU without CD4+ cell depletion at entry, the latter probably attributable to causes not related to progression of HIV infection. This study underscores the importance of adjusting for prognostic factors when comparing survival between different patient groups.

Adult↗

PubMed1994

[Urinary tract infections in adults: old and current aspects].

Urinary tract infections are common clinical problems. Intense research in the last decade has led to improved knowledge about the pathogenesis, diagnosis and management of these infections. Virulence factors of uropathogenic E. coli have been well defined. Factors putting the host at increased risk of infections such as behaviour in women and men and genetic determinants in women such as blood-group secretor status have been elucidated. Several diagnostic studies have shown that in symptomatic women colony counts of > or = 10(2) CFU/ml [CFU = colony forming units] of urine usually indicate infection. Finally, optimal and cost-effective management of urinary tract infections is now well defined based on clinical studies. We review the management of urinary tract infections in adults taking into account recent research data and some of the still controversial issues.

Adolescent↗

PubMed1993

Visceral leishmaniasis after orthotopic liver transplantation: impact of persistent splenomegaly.

Visceral leishmaniasis was observed in a 50-year-old female liver transplant recipient 1 year following transplantation. Signs of active infection were low-grade fever, pancytopenia, persistent splenomegaly, positive cultures for leishmania in liver and bone marrow biopsy specimens, and newly positive leishmania serology. Following sequential therapy with pentavalent antimony and amphotericin B, blood values improved massively, bone marrow cultures became negative, and leishmania serology decreased. Secondary prophylaxis with fluconazole was instituted and the patient remains without signs of active infection 1 year after successful therapy.

Female↗

PubMed1993

Epstein-Barr virus infection in HIV-positive patients.

The relationship between Epstein-Barr virus (EBV) viral load in peripheral blood and HIV infection was determined in 103 HIV-infected patients. Epstein-Barr virus was detected by polymerase chain reaction in 75% of the patients, 21% of whom had the more uncommon EBV subtype 2. The highest levels of EBV were found in patients with 100-400 CD4+ cells/mm3 and not in those with more profound immunosuppression. An association was identified between EBV load and HIV proviral levels (p < 0.001), an IgM response to EBV early antigens (p < or = 0.01) and p24 antigenemia (p < 0.01 in patients with > 100 CD4+ cells), but not with other clinical or laboratory parameters. Combinations of different EBV and HIV parameters identified a subgroup of patients with a 2.2- to 4.8-fold risk of > or = 35% decline in CD4+ counts over six months. The association between EBV and HIV markers may reflect a significant pathogenic interaction between the two viruses.

Adult↗