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PubMed1996

Rotavirus infection in infants as protection against subsequent infections.

BACKGROUND: Rotavirus is the leading cause of severe diarrhea in infants. To provide a base line for assessing the efficacy of rotavirus vaccines, we evaluated the protection that is conferred by natural rotavirus infection. METHODS: We monitored 200 Mexican infants from birth to two years of age by weekly home visits and stool collections. A physician assessed the severity of any episodes of diarrhea and collected additional stool specimens for testing by enzyme immunoassay and typing of strains. Serum collected during the first week of life and every four months thereafter was tested for antirotavirus IgA and IgG. RESULTS: A total of 316 rotavirus infections were detected on the basis of the fecal excretion of virus (56 percent) or a serologic response (77 percent), of which 52 percent were first and 48 percent repeated infections. Children with one, two, or three previous infections had progressively lower risks of both subsequent rotavirus infection (adjusted relative risk, 0.62, 0.40, and 0.34, respectively) and diarrhea (adjusted relative risk, 0.23, 0.17, and 0.08) than children who had no previous infections. No child had moderate-to-severe diarrhea after two infections, whether symptomatic or asymptomatic. Subsequent infections were significantly less severe than first infections (P=0.024), and second infections were more likely to be caused by another G type (P=0.054). CONCLUSION: In infants, natural rotavirus infection confers protection against subsequent infection. This protection increases with each new infection and reduces the severity of the diarrhea.

Antibodies, Bacterial↗
PubMed1989

Fungal and mycobacterial infections in patients infected with the human immunodeficiency virus.

Fungal and mycobacterial infections are among the most common opportunistic infections in patients infected with human immunodeficiency virus (HIV). Candida infections are the bell-wether of progression to symptomatic HIV infection and candida oesophagitis often marks the onset of the acquired immunodeficiency syndrome (AIDS). More than 80% of AIDS patients have candida disease. Candida infections remain local and respond to treatment but tend to recur. Cryptococcal infections initially affect few HIV positive patients but involve 10-30% with AIDS. Meningitis is the usual presentation and dissemination is common. Amphotericin usually produces improvement but cure is infrequent, and maintenance therapy is advisable. Mycobacteria cause intracellular infections increasing in parallel with immunodeficiency. Mycobacterium avium-intracellulare is predominant, occurring with other opportunistic pathogens causing systemic and local symptoms with high bacterial density in infected cells. Multidrug treatment is best, but the results are disappointing. Tuberculosis is prevalent in certain groups of patients. It often presents with atypical clinical and pathological features. Anti-tuberculous treatment is effective and prophylaxis should be considered. Endemic fungi with mycobacteria cause sporadic infections. Opportunistic infections are the lethal arm of HIV infection. Diligent diagnosis and persistent treatment offer benefit to HIV-infected patients.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Helicobacter pylori infection delays healing of ischaemia-reperfusion induced gastric ulcerations: new animal model for studying pathogenesis and therapy of H. pylori infection.

OBJECTIVE: Helicobacter pylori (Hp) infection is a major risk factor of peptic ulcerations but studies on its pathogenicity are limited due to the lack of an adequate animal model. In this study we developed the new model of gastric Hp infection in rat gastric mucosa, with acute gastric erosions progressing into ulcers in animals subjected initially to ischaemia-reperfusion (I/R). DESIGN: I/R lesions were produced in rats by clamping the coeliac artery for 0.5 h followed by 1 h reperfusion and gastric inoculation with type I Hp strain (CagA and VacA positive) or type II Hp strain (CagA and VacA negative), obtained from fresh clinical isolates, or with vehicle (saline). Gastric secretion during recovery from I/R lesions was determined in a separate group of rats equipped with chronic gastric fistula to inoculate the animals with Hp and then to collect gastric juice for determination of gastric acidity and pepsin outputs as well as luminal content of somatostatin. METHODS: The animals were killed at 0, 3, 12 or 24 h and 3, 5, 10 or 15 days after Hp inoculation and the area of gastric lesions was determined planimetrically and gastric blood flow (GBF) was measured by the H2-gas clearance technique. The venous blood was withdrawn for measurement of plasma interleukin (IL)-1beta and tumour necrosis factor alpha (TNFalpha) by ELISA and plasma gastrin, luminal somatostatin by RIA and the mucosal expression of transforming growth factor (TGFalpha) was analysed using RT-PCR with specific primers. Gastric Hp infection was assessed by histology, rapid urease test and Hp culture. The effect of triple therapy with omeprazole, amoxycillin and tinidazole on Hp infection and ulcer healing was also determined. RESULTS: Ischaemia alone resulted in an immediate fall in GBF and almost complete suppression of gastric secretion but without any gastric lesions. When ischaemia was followed by 1 h of reperfusion, acute gastric erosive lesions immediately occurred, reaching a maximum at 12 h after I/R and progressing after 3 days to deeper gastric ulcers that disappeared after 15 days. In Hp-inoculated rats, the number of viable Hp colonies gradually increased, reaching maximum at day 10 with infection with type I and at day 15 with infection with type II Hp. At day 15 the difference in Hp colonization was not significantly different between the stomachs infected by type I and type II Hp. Inoculation, especially with the type I Hp strain, significantly delayed healing of I/R-induced acute lesions and accelerated their progression into deeper chronic ulcers. This effect was accompanied by a significant fall in GBF and a higher increment in plasma IL-1beta and TNFalpha levels. Gastric acid secretion, which was completely inhibited up to 12 h after I/R, returned to the control value 24 h upon completion of the I/R procedure. This return was delayed in Hp-infected rats and accompanied by a significant elevation of plasma gastrin and a decrease in luminal somatostatin. The immunoreactivity of TGFalpha and expression of TGFalpha mRNA determined by RT-PCR were well defined in intact gastric mucosa but were significantly decreased, especially in mucosa infected with type I Hp strain, at day 15 after I/R. The triple therapy which cured Hp infection completely abolished the delay in ulcer healing caused by Hp. CONCLUSIONS: (1) Gastric infection with the Hp strain expressing cagA and vacA encoded cytotoxins delays healing of I/R-induced acute gastric lesions due to an impairment of gastric microcirculation, and excessive proinflammatory cytokine release and suppression of anti-ulcer TGFalpha expression. (2) The I/R induced suppression of gastric acid secretion may contribute to the hypergastrinaemia as a secondary phenomenon and may account for the spread of Hp infection observed during the progression of acute erosions into chronic ulcers. (3) I/R induced gastric ulcers may be a useful model for studying the action of Hp infection on gastric ulcerogenesis in ischaemic stomach and for testing anti-Hp therapy.

Animals↗
PubMed2004

Infection with Toxoplasma gondii reduces established and developing Th2 responses induced by Nippostrongylus brasiliensis infection.

Oral infection of C57BL/6 mice with 100 cysts of the protozoan parasite Toxoplasma gondii results in the development of small intestinal Th1-type immunopathology. In contrast, infection with intestinal helminths results in the development of protective Th2-type responses. We investigated whether infection with the helminth Nippostrongylus brasiliensis influences the development of T. gondii-induced Th1 responses and immunopathology in C57BL/6 mice infected with T. gondii. Prior as well as simultaneous infection of mice with N. brasiliensis did not alter the course of infection with 100 cysts of T. gondii. Coinfected mice produced high levels of interleukin-12 (IL-12) and gamma interferon (IFN-gamma), developed small intestinal immunopathology, and died at the same time as mice infected with T. gondii. Interestingly, local and systemic N. brasiliensis-induced Th2 responses, including IL-4 and IL-5 production by mesenteric lymph node and spleen cells and numbers of intestinal goblet cells and blood eosinophils, were markedly lower in coinfected than in N. brasiliensis-infected mice. Similar effects were seen when infection with 10 T. gondii cysts was administered following infection with N. brasiliensis. Infection of C57BL/6 mice with 10 T. gondii cysts prior to coinfection with N. brasiliensis inhibited the development of helminth-induced Th2 responses and was associated with higher and prolonged N. brasiliensis egg production. In contrast, oral administration of Toxoplasma lysate prior to N. brasiliensis infection had only a minor and short-lived effect on Th2 responses. Thus, N. brasiliensis-induced Th2 responses fail to alter T. gondii-induced Th1 responses and immunopathology, most likely because Th1 responses develop unchanged in C57BL/6 mice with a prior or simultaneous infection with N. brasiliensis. Our findings contribute to the understanding of immune regulation in coinfected animals and may assist in the design of immunotherapies for human Th1 and Th2 disorders.

Animals↗
PubMed1991

HIV-I infection in perinatally exposed siblings and twins. The Italian Register for HIV Infection in Children.

In a multicentre study on perinatal HIV-I infection including 1493 children born from 1471 pregnancies to 1415 infected mothers, 22 twin pairs and 56 sibships (115 children) were recorded. The frequency of twin pregnancies was 1.5 (22/1471) and 3.9% (56/1415) seropositive women had more than one at risk pregnancy. In 18 twin pairs with a known infection status nine of the 36 children (25%) were infected. Discordance in infection status was present in only one (5.5%) dizygous pair. A high relative risk of infection (23.1) in a twin was observed when the other was infected. Infection was unrelated to gestational age, mode of delivery, or birth weight. Infection status was defined in 41 sibships (84 children including one first born twin pair and one third born child). When the first born was infected, 11/26 (42.3%) second born children were also infected, whereas this happened in only 2/16 (12.5%) second or third born children when the first born was uninfected. Two out of nine first born (22.2%) and 5/21 (23.8%) second born children prospectively followed up from birth acquired the infection. Results of this study demonstrate that neither twin nor second pregnancies are at increased risk of mother to child HIV-I transmission. Overall data suggest that non-casual factors in mother and/or child influence perinatal infection.

Diseases in Twins↗
PubMed1999

Immunohistochemical studies of productive rhesus cytomegalovirus infection in rhesus monkeys (Macaca mulatta) infected with simian immunodeficiency virus.

In humans infected with the human immunodeficiency virus (HIV), clinical disease due to human cytomegalovirus (HCMV) infection is one of the AIDS-defining diseases; HCMV is the most common opportunistic infection found postmortem. Histologically, the typical lesions are characterized by "owl's eye cells." In rhesus monkeys infected with simian immunodeficiency virus (SIV), comparable lesions are caused by an infection with the rhesus CMV (RhCMV). The aim of this study was to investigate the incidence of productive and latent RhCMV infection in monkeys infected with SIV macaques (SIVmac). Eleven SIVmac-infected rhesus monkeys, which were euthanatized after developing AIDS-like disease, and 11 clinically healthy and uninfected animals comprised the study. The monkeys were screened serologically for RhCMV by western-blot analysis. Immunohistochemistry was performed by an indirect immunoperoxidase technique with a polyclonal rabbit RhCMV-antiserum. Lesions characteristic of RhCMV-associated diseases were detected histologically. All animals were latently RhCMV-infected. Seven of eleven (63.6%) SIV-infected macaques were productively RhCMV infected according to immunohistochemistry. RhCMV antigen was identified in the gastrointestinal tract, the hepatobiliary system, the lungs, and the testicles. Two of these seven animals showed characteristic inflammatory lesions associated with productive infection. Consequently, the CMV prevalence in SIVmac-infected rhesus monkeys and human AIDS patients is comparable.

Animals↗
PubMed1994

Prophylaxis for opportunistic infections in patients with HIV infection.

OBJECTIVE: To review the efficacy of chemoprophylaxis for opportunistic infections in persons infected with human immunodeficiency virus (HIV). DATA SOURCES: English-language articles on the prevention of HIV-related opportunistic infections were identified through MEDLINE (1985 to 1993) and through review of abstracts presented at the International Conferences on AIDS, the Interscience Conferences on Antimicrobial Agents and Chemotherapy, and the National Conference on Human Retroviruses and Related Diseases. STUDY SELECTION: Importance was assigned in descending order to controlled clinical trials, uncontrolled trials and retrospective studies, and prospective observational studies. DATA SYNTHESIS: Persons infected with HIV who are at risk for Pneumocystis carinii pneumonia should receive prophylaxis, preferably with trimethoprim-sulfamethoxazole. Alternative agents are aerosolized pentamidine, dapsone, and dapsone-pyrimethamine. Patients who are seropositive for Toxoplasma gondii may benefit from primary prophylaxis against toxoplasmosis using trimethoprim-sulfamethoxazole or dapsone-pyrimethamine. Life-long secondary prophylaxis is indicated for all patients previously treated for toxoplasmic encephalitis. Long-term suppressive therapy is required for all patients with cryptococcal meningitis and histoplasmosis, and many patients with recurrent mucosal candidiasis also benefit from long-term suppression. The role of primary prophylaxis of fungal infections, however, is uncertain. Rifabutin has been approved to prevent disseminated infection with Mycobacterium avium complex and is indicated for all patients with CD4 counts less than 100/mm3. Chemoprophylaxis with isoniazid for 12 months is indicated in all patients infected with HIV who have or are at high risk for M. tuberculosis infection. No effective primary prophylactic agent is available for cytomegalovirus disease, although several investigational drugs are being studied. Acyclovir is effective in decreasing recurrences of herpes simplex virus infection. The incidence of common bacterial infections is decreased by trimethoprim-sulfamethoxazole. Pneumococcal polysaccharide vaccine is recommended for adult patients infected with HIV, and Haemophilus influenzae type b conjugate vaccine is recommended for children infected with HIV. CONCLUSIONS: A growing number of infections related to the acquired immunodeficiency syndrome are preventable with currently available agents. Issues of drug interactions, toxicity, and cost-effectiveness will become increasingly important in the management of patients with advanced HIV disease.

AIDS-Related Opportunistic Infections↗
PubMed1999

[Seroepidemiology of Bartonella henselae infection in HIV-infected patients].

BACKGROUND: Bartonella henselae infections are closely related to numerous clinical infections of growing interest in Spain. Since immunosuppressed patients are a potential risk group for infection by this bacteria, the aim of the present was to study the seroepidemiology of B. henselae infection in a risk group (patients with HIV infection) and in a control group (donors). PATIENTS AND METHODS: In October, 1997, antibodies versus B. henselae were determined at different dilutions (cut off > or = 1:64) by immunofluorescence in 52 patients with HIV infection and 85 donors. An epidemiologic study included age, sex, smoking, alcohol intake, INVDA, HIV infection, AIDS stage, cutaneous anergy, CD4 lymphocyte count, antiretroviral treatment and chemoprophylaxis versus P. carinii. RESULTS: Nine of the patients with HIV infection (17.3%) and five donors (5.88%) presented titers > or = 1:64 with no significant differences (p = 0.06) (adjusted OR: 1.7; CI 95%: 0.34-8.54). Moreover, multiple logistic regression analysis did not show any risk or protection factor associated with B. henselae infection in patients with HIV infection. CONCLUSIONS: A high level of seroprevalence of antibodies versus B. henselae was observed in patients with HIV infection. No risk or protection factors associated with B. henselae infection in patients with HIV infection were found.

Adult↗
PubMed2003

Estimating the number of helminthic infections in the Republic of Cameroon from data on infection prevalence in schoolchildren.

INTRODUCTION: The prevalence of infection with helminths is markedly dependent on age, yet estimates of the total number of infections are typically based on data only from school-aged children. Such estimates, although useful for advocacy, provide inadequate information for planning control programmes and for quantifying the burden of disease. Using readily available data on the prevalence of infection in schoolchildren, the relation between the prevalence of infection in school-aged children and prevalence in the wider community can be adequately described using species-specific models. This paper explores the reliability of this approach to predict the prevalence infection in the community and provides a model for estimating the total number of people infected in the Republic of Cameroon. METHODS: Using data on the prevalence of helminthic infection in school-aged children in Cameroon, the prevalence of infection in pre-school children and adults was estimated from species-specific linear and logistic regression models developed previously. The model predictions were then used to estimate the number of people infected in each district in each age group in Cameroon. RESULTS: For Cameroon, if only the prevalence of infection in schoolchildren is used, the number of people infected with each helminthic species will be overestimated by up to 32% when compared with the estimates provided by the species-specific models. The calculation of confidence intervals supports the statistical reliability of the model since a narrow range of parameter estimates is evident. Furthermore, this work suggests that estimation of national prevalence of infection and the number infected will be enhanced if data are stratified by age; this model represents a useful planning tool for obtaining more accurate estimates. Estimates based on data aggregated from three geographical levels (district, regional, and national) show that summarizing prevalence data at the national level will result in biases of up to 19%. Such biases reflect differences in the geographical distribution for the prevalence of each species. DISCUSSION: Developing more accurate estimates requires a better understanding of the differences in the spatial heterogeneity of each species and also better methods of incorporating this information when making estimates.

Adolescent↗
PubMedDate not supplied

A new rat infection-heart transplant model: effect of infection on graft survival studies.

Considerable progress has been made in survival rates of heart transplant recipients; however, infections continue to be a major cause of death after transplantation. Although infection itself appears to cause immunologic suppression in some nontransplantation studies, the lack of an infection-transplant animal model has limited further investigation of this observation. We evaluated the utility of a heterotopic rat infection heart-transplant model by studying the effect of infection and limited administration of two immunosuppressive agents, cyclosporine and FK506, on allograft rejection and survival. Lewis rats received ACI heart allografts, and intraperitoneal infection was induced by cecal ligation. Infection was confirmed by blood and ascitic fluid cultures. Results showed that graft survival was slightly, but significantly, higher (p < 0.05) in group II (transplantation with infection) when compared to the control group I (transplantation only). Histologic rejection scores were less (p < 0.05) in group II 6 days after transplantation. The second phase of the study compared the effect of infection after transplantation in rats given a 1-week course of cyclosporine or FK506, which were discontinued after the induction of infection. Although the cyclosporine group had prolonged survival when compared to the FK506 group (p < 0.05), the respective infection groups receiving immunosuppression revealed no significant difference in allograft survival or histologic rejection scores when compared to the control groups. In this preliminary study, infection without immunosuppression resulted in a slight, but statistically significant, increase in allograft survival and reduced acute cellular rejection. In those groups receiving immunosuppressive agents, no additive immunosuppressive effect was attributable to bacterial infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Effect of Eimeria tenella infection on the production of Salmonella enteritidis-contaminated eggs and susceptibility of laying hens to S. enteritidis infection.

Experiments were conducted to determine the effect of Eimeria tenella infection on the production of Salmonella enteritidis-contaminated eggs and susceptibility of egg-laying hens to S. enteritidis infection. The dose of sporulated oocysts of E. tenella used in the present study was 2 x 10(5) per chicken. When hens were infected with 10(6) colony-forming units (CFU) of S. enteritidis, E. tenella infection resulted in a significant increase (P < 0.05) of S. enteritidis contamination in the shells of fresh eggs but not in the egg contents of fresh eggs and stored eggs. Significant effects of coccidial infection on the contamination of eggs (shells and contents) were not observed when hens were infected with 10(4) CFU of S. enteritidis. Surface-disinfected eggs pooled within each week from individual chickens infected with 10(4) CFU of S. enteritidis and E. tenella showed significantly (P < 0.05) more S. enteritidis contamination in eggshells, but not in egg contents, than did those from hens infected with S. enteritidis alone. Coccidial infection resulted in a significant increase of S. enteritidis in the cloacal swabs of hens infected with 10(4) CFU of S. enteritidis. In all the experiments, chickens infected with S. enteritidis and E. tenella showed significantly higher positive rates and counts of cecal S. enteritidis than did chickens infected with S. enteritidis alone. No significant differences of S. enteritidis-positive rates in ovary, oviduct, liver, and spleen were noted whether the hens were infected with a combination of E. tenella and S. enteritidis or with S. enteritidis alone.

Animals↗
PubMed2003

Usefulness of Gram stain for diagnosis of lower respiratory tract infection or urinary tract infection and as an aid in guiding treatment.

During a prospective study of 8 months duration conducted in the Department of Internal Medicine and the Department of Pulmonary Diseases of the Academic Medical Centre, Amsterdam, Gram stainings of sputa and urine were performed for all patients whose clinical symptoms indicated an acute urinary tract infection or pulmonary infection. On the test request, the physician reported which antibiotic treatment he would prescribe if a microscopic examination was not available. The results of the Gram stain were discussed by the microbiologist with the physician, and the antibiotic therapy recommended by the microbiologist was recorded. This recommendation was compared with the antibiotic prescription noted in the patient record 1 day later. Two days after the results of final cultures and susceptibility tests became available, the patient record was again investigated for changes in the antibiotic regimen. Of 57 urine samples and 103 sputa, 27 and 85, respectively, were derived from patients with an infection of the urinary tract or respiratory tract. The results of the Gram stain confirmed the physician's suspicion 91% of the time for urinary tract infections and 81% of the time for pulmonary infections. In 67% of the patients with suspected lower respiratory tract infections and in 58% of patients with suspected urinary tract infections, the antibiotic treatment recommended on the basis of the results of the Gram stain differed significantly from the antibiotic treatment that the physician would have prescribed had a microscopic examination not been performed. The microbiologist's advice on antibiotic treatment was followed in 79% of the cases of respiratory tract infection and in 65% of the cases of urinary tract infection. The antibiotic treatment was adjusted to the final results of culture and antimicrobial susceptibility testing in 54% of the urinary tract infections and in 31% of the respiratory tract infections. The results indicate that the examination of sputa and urine in patients suspected to have an infection of the respiratory tract or urinary tract influences the antibiotic choice considerably.

Anti-Bacterial Agents↗
PubMed2000

Frequency of serological evidence of Bordetella infections and mixed infections with other respiratory pathogens in university students with cough illnesses.

Banked acute-phase and convalescent-phase serum samples from a previous study of respiratory illness in university students were examined for significant (>/=2-fold) increases in ELISA titers of IgA and IgG antibody to Bordetella pertussis filamentous hemagglutinin, pertactin, and fimbriae-2 and >/=4-fold titer increases to agglutinogens by agglutination. ELISA titers of antibody to pertussis toxin could not be determined because of technical problems. Chlamydia pneumoniae infections were diagnosed by culture or by a >/=4-fold increase in immunofluorescence assay titer or a single high titer (>/=512). Mycoplasma pneumoniae, influenza A and B, adenovirus, and respiratory syncytial virus infections were diagnosed by >/=4-fold increases in complement fixation titer or a single high titer (>/=64). There were 319 subjects with cough of >/=5 days' duration, and of these, 47 (15%) had significant increases in antibody to B. pertussis antigens; 26 (8%) had significant increases to fimbriae-2 or agglutinogens, indicative of B. pertussis infection, and 2 (1%) had evidence of non-B. pertussis bordetella infections. Seventeen (36%) had evidence of mixed infections or cross-reacting antibodies (influenza B infections, 5; adenovirus infections, 4; influenza A infections, 3; C. pneumoniae infections, 3; and M. pneumoniae infections, 2). Our findings suggest that bordetella infections are common in young adults with cough illnesses (incidence, 9%), and a surprising number of these are mixed infections with other respiratory pathogens.

Adenovirus Infections, Human↗
PubMed2004

Comparison of atovaquone and azithromycin with trimethoprim-sulfamethoxazole for the prevention of serious bacterial infections in children with HIV infection.

BACKGROUND: Trimethoprim-sulfamethoxazole (TMP-SMZ) has been used extensively for the prevention of Pneumocystis carinii (also referred to as "Pneumocystis jiroveci") pneumonia (PCP) and other opportunistic infections in human immunodeficiency virus (HIV)-infected children. Because the efficacy of TMP-SMZ for treatment of bacterial infections is limited, it is sometimes poorly tolerated, and there is risk of emergence of drug-resistant strains associated with widespread use, we evaluated a regimen that included atovaquone and azithromycin. METHODS: A randomized, double-blind, placebo-controlled trial was designed to determine whether atovaquone-azithromycin had equivalent efficacy to TMP-SMZ for the prevention of serious bacterial infections and to compare the long-term tolerance, PCP breakthrough rates, and nonserious bacterial infection rates among HIV-infected children aged 3 months to 19 years. Children qualified for PCP prophylaxis (on the basis of Centers for Disease Control and Prevention recommendations) were randomized to receive atovaquone-azithromycin or TMP-SMZ daily for >or=2 years. RESULTS: Data from 366 of the 369 eligible patients (median duration of follow-up, 3 years) showed that the estimated rates of serious bacterial infection-related events were lower among atovaquone-azithromycin recipients than among TMP-SMZ recipients (17.3 vs. 24.2 events per 100 patient-years; difference, 6.9 events per 100 patient-years; 95% confidence interval [CI], -0.22 to 14.12). Rates for all end points (serious bacterial infection, PCP, Mycobacterium avium complex infection, and serious and nonserious bacterial infection-related deaths) were 19.7 and 27.7 events per 100 patient-years, respectively (difference, 7.9 events per 100 patient-years; 95% CI, -0.28 to 15.54 events per 100 patient-years). The results marginally favored atovaquone-azithromycin therapy statistically. Atovaquone-azithromycin and TMP-SMZ therapies had similar adverse event profiles. CONCLUSIONS: We conclude that, in HIV-infected children, atovaquone-azithromycin is as effective as TMP-SMZ for the prevention of serious bacterial infections and is similarly tolerated.

AIDS-Related Opportunistic Infections↗
PubMed2001

Correlates of opportunistic infections in children infected with the human immunodeficiency virus managed before highly active antiretroviral therapy.

BACKGROUND: Opportunistic infections (OIs) are an important cause of morbidity and mortality in children infected with HIV. However, few data are available regarding the overall prevalence, incidence and immunologic correlates associated with these diseases in the pediatric HIV population. The Pediatric AIDS Clinical Trials Group (PACTG) has conducted multicenter studies in HIV-infected children since 1988 and through these studies has collected prospective data on the immunologic and virologic status of study participants and recorded complications, including infectious diseases, related to HIV infection and its treatments. Therefore data were analyzed from across 13 PACTG studies, performed before treatment with highly active antiretroviral therapy was given, to determine the rates of various infectious complications and the immunologic correlates, specifically CD4 cell counts, associated with these diseases. RESULTS: OIs were tabulated from 3331 HIV-infected children who participated in 13 clinic trials undertaken before highly effective antiretroviral therapy was available. Five OIs occurred at event rates of >1.0 per 100 patient years (person years): serious bacterial infections, 15.1; herpes zoster, 2.9; disseminated Mycobacterium avium complex (DMAC), 1.8; Pneumocystis carinii pneumonia, 1.3; and tracheobronchial and esophageal candidiasis, 1.2. Six other OIs evaluated, cytomegalovirus (CMV) disease, cryptosporidiosis, tuberculosis, systemic fungal infections, toxoplasmosis and progressive multifocal leukoencephalopathy, occurred at event rates of <1.0 per 100 person years. Pneumonia (11.1 per 100 person years) and bacteremia (3.3 per 100 person years) were the most common bacterial infections. An AIDS-defining OI before entry was a risk factor for the development of a new OI during a trial. Bacterial infections, herpes zoster and tuberculosis occurred frequently at all stages of HIV infection; whereas DMAC, P. carinii pneumonia, CMV and other OIs occurred primarily in children with severe immunosuppression. CONCLUSIONS: The frequency of OIs in HIV-infected children in the pre-highly active antiretroviral therapy era varies with age, pathogen, prior OI and immunologic status. Analysis of CD4 counts at the time of DMAC, CMV and PCP provide validation for current prophylaxis guidelines in children > or =2 years old. This information on infectious complications of pediatric HIV will be especially valuable for contemporary management of HIV infection that is poorly responsive to highly active antiretroviral therapy.

AIDS-Related Opportunistic Infections↗
PubMed1996

Active HHV-6 infection in the lymph nodes of HIV-infected patients: in vitro evidence that HHV-6 can break HIV latency.

Studies published previously by this laboratory have demonstrated that patients with AIDS have widely disseminated, active infections with HHV-6 at the time of their death. However, it remains unclear when in the course of the human immunodeficiency virus (HIV) infection the active HHV-6 infection first appears. To address this question, lymph node biopsies from 10 HIV-infected patients were analyzed for active human herpesvirus 6 (HHV-6) infections by immunohistochemical staining. Eight of the biopsies carried the histologic diagnosis of follicular hyperplasia; the other two were characterized as having follicular involution with histiocytosis and reactive lymphadenitis. In total, 10 of 10 (100%) of the lymph nodes studied contained cells productively infected with HHV-6; in contrast, three lymph nodes with follicular hyperplasia and four normal lymph nodes from patients not infected with HIV were negative for HHV-6 infection. Of special note, the absolute CD4+ lymphocyte counts of 75% (6/8) of the HIV-infected individuals included in these studies were > 200/mm3 at the time of their lymph node biopsy. The A variant of HHV-6 was found to be the predominant form of the virus present in the lymph node biopsies from all of these HIV-infected patients, and in vitro studies demonstrated that exposure of monocytic cells carrying latent HIV to HHV-6A resulted in massive upregulation of HIV replication from latency. Thus, active HHV-6 infections appear relatively early in the course of HIV disease, and in vitro studies suggest that the A variant of HHV-6 is capable of breaking HIV latency, with the potential for helping to catalyze the progression of HIV infections to AIDS.

AIDS-Related Opportunistic Infections↗
PubMed2002

Isolation of potential bacterial pathogens from the stool of HIV-infected and HIV-non-infected patients and their antmicrobial susceptibility patterns in Jimma Hospital, south west Ethiopia.

Diarrhea is a major clinical problem in HIV-infected patients. There is a need to monitor antimicrobial susceptibility patterns of enteric bacterial pathogens in order to ensure appropriate treatment and control of infections. The objectives of this study was to identify and determine the magnitude of potential enteric pathogens including Salmonella, Shigella, Campylobacter and other species in HIV-infected and HIV-non-infected patients with diarrhea, to evaluate the current antimicrobial susceptibility pattern of the clinical isolates and the association of enteric bacterial pathogens in HIV infected patients with diarrhea. A cross-sectional study was conducted from Feb-July 2001 on 372 consecutive HIV seropositive and seronegative patients presenting at Jimma hospital for different illnesses. Patients were selected based on their serological tests for HIV. Sample of faeces specimens were collected and inoculated onto standard culture media as well as onto Skirrow's medium for isolation of Campylobacter species. Salmonella and Shigella species were tested for antimicrobial susceptibility using disc agar diffusion technique recommended by Kirby-Bauer. Stool specimens were also smeared and stained by Zehl-Neelson staining technique for the identification of Mycobacterium species. Among the 99 HIV-infected patients with diarrhea, 25 (25.0%) of them had enteric bacteria among which 8(8.1%) were Salmonella, 4(4.0%) Shigella and 13(13.1%) Campylobacter species. Mycobacterium species were identified in 3(3.0%) of stool specimens obtained from HIV-infected patients with diarrhea and another 3 species were detected in HIV-infected patient without diarrhea. Salmonella species were isolated with higher prevalence in HIV-infected than in HIV non-infected patients. These Salmonella isolates were 100% susceptible to Amikacin, Gentamicin, Nalidixic acid and Kanamycin while Shigella isolates were 100% susceptible for Gentamycin and Kanamycin only. Unlike Salmonella, Shigella and Campylobacter species showed higher prevalence rates in HIV non-infected patients. Enteric bacterial pathogens account for about one fourth diarrhea in HIV infected patients in Jimma hospital. The finding of this investigation also confirmed earlier observations of wide spread resistance to the commonly used drugs in this region.

Acute Disease↗
PubMed1987

The epidemiology of nosocomial Pseudomonas cepacia infections: endemic infections.

Pseudomonas cepacia has recently emerged as an important nosocomial pathogen. We analyzed a national nosocomial infections database, the National Nosocomial Infections Surveillance (NNIS) system, to describe the epidemiology of endemic nosocomial P. cepacia infections. Between 1980 and 1985, the P. cepacia nosocomial infection rate was 2.4 per 100,000 patient discharges. During this period, there was a significant increase in the P. cepacia infection rate. The highest infection rate was reported from large medical school-affiliated hospitals. Over 90% of the infections were reported from medicine and surgery services. The most frequently reported site of infection was the lower respiratory tract (31%), followed by blood (20%) and the urinary tract (20%). Nosocomial P. cepacia infections are often associated with mortality, particularly when they involve the lung. These data confirm the hypothesis that P. cepacia is an emerging nosocomial pathogen and suggest that the epidemiology of endemic infections differs from that reported for epidemic infections.

Cross Infection↗