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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

HIV-infected patients who are on hemodialysis have a worse prognosis than noninfected patients who are on hemodialysis. Their outcome in the highly active antiretroviral therapy (HAART) era remains unclear. Outcomes in patients who were enrolled in the French Dialysis in HIV/AIDS (DIVA) cohort were determined in a 2-yr prospective follow-up. All HIV-infected patients who were on hemodialysis in France on January 1, 2002, were included and followed prospectively until January 1, 2004. Patients' survival was examined by Kaplan-Meier method, and mortality risk factors were examined using uni- and multicovariate analyses. Survival was compared with that of 584 hemodialysis patients who did not have HIV or diabetes and were enrolled in the French Dialysis Outcomes and Practice Patterns Study II (DOPPS II) in the same period (after standardization for the average age, gender, and ethnicity of the DIVA cohort). A total of 27,577 patients were receiving hemodialysis in France at the beginning of the study; 164 (0.59%) were infected with HIV, 72% were male, mean age was 44.8 +/- 10.9 yr, and 65% were black. The 2-yr survival rate was 89 +/- 2% and statistically indistinguishable from the survival of the French cohort extracted from the DOPPS II study. Significant mortality risk factors were low CD4 cell count (hazard ratio [HR] 1.4/100 CD4 cells per mm(3) lower), high viral load (HR 2.5/1 Log per ml), absence of HAART (HR 2.7), and a history of opportunistic infection (HR 3.7), the last two being independent (HR 2.6 and 3.6, respectively). Survival of HIV-infected patients who are hemodialysis has greatly improved. A prospective cohort of paired hemodialysis patients with and without HIV is required to compare better their mortality in the HAART era.
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PMID:Outcome and prognosis factors in HIV-infected hemodialysis patients. 1769 54

Chronic renal failure is a common sequel of renal inflammatory disease or diabetes mellitus. As a result of the immunosuppression that is induced by uremia, hemodialysis or posttransplant immunosuppressive medication, these patients are at a higher risk of opportunistic infections. Various viral, bacterial and mycobacterial infections have been reported. Tuberculosis is a common systemic opportunistic infection but reports of ocular involvement with pulmonary or disseminated tuberculosis are rare. We report the systemic and ocular findings in two postrenal-transplant patients with pulmonary or disseminated tuberculosis in whom detection of choroidal tubercles led to confirmation of the diagnosis in both patients and was the only specific premortem finding in one. Fundoscopy in this group of patients may help in the diagnosis of opportunistic tuberculosis, its earlier treatment and the consequent reduction of morbidity and mortality.
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PMID:Ophthalmoscopy in the early diagnosis of opportunistic tuberculosis following renal transplant. 1769 55

Cytomegalovirus (CMV) is one of the most important pathogens following solid-organ transplantation, and effective prevention of CMV infection is a priority. The long-term control of CMV infection is dependent, in part, on the development of CMV-specific T cells, and controversy exists regarding whether CMV prophylaxis may prevent this. Although preemptive therapy is beneficial for the prevention of CMV disease, monitoring of viral levels in the blood does not always reflect what is occurring in tissues. Persistent low-level CMV infection has been associated with indirect consequences, such as transplant-associated vasculopathy, posttransplantation diabetes, an increased risk of opportunistic infection, and graft rejection. The issues surrounding preventive strategies for CMV disease following solid-organ transplantation are reviewed. We argue that prophylaxis is more effective than preemptive therapy; extending the duration of prophylaxis to the period of less intense immunosuppression could protect patients from late-onset disease, as well as from the indirect effects of CMV infection.
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PMID:Improving outcomes for solid-organ transplant recipients at risk from cytomegalovirus infection: late-onset disease and indirect consequences. 1856 41

It has been known that diabetes mellitus impairs functioning of neutrophil, macrophage, cellular immunity, humoral immunity, and iron metabolism. In addition to them, diabetes-related angiopathy leads a patient to being at high-risk individual for several kinds of infectious diseases. Therefore, diabetes has been accepted as one of the important risk factors for invasive fungal infection. From the viewpoint of pathology, the present review describes both pathophysiology of immunosuppression induced by diabetes and histopathological characteristics of typical forms in invasive fungal infection when it occurred as an opportunistic infection; those are candidiasis, aspergillosis, and cryptococcosis. We wish to draw that pathophysiological explanation still remains obscuring of relationship between diabetes and invasive fungal infection.
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PMID:[Pathophysiology of invasive fungal infection in diabetic patients]. 1906

Trichosporonosis is rare but have been associated with a wide spectrum of clinical manifestation, ranging from superficial infection to severe deep-seated mycosis. Deep-seated trichosporonosis is a lethal opportunistic infection occasionally found in immunocompromised patients, particularly those who are neutropenic due to hematological diseases or cytotoxic therapy. Trichosporon asahii is considered the principal etiologic agent of non-Candida fungemia and disseminated trichosporonosis in Japan. It is necessary for a clinician to pay enough care as the lethal infections in immunocompromised host. Diabetic patients are also predisposed of trichosporonosis because of the impaired leukocyte function. I review the literature about trichosporonosis with the patients of diabetes mellitus.
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PMID:[Trichosporonosis]. 1906 6

Immunosuppression as a result of T- or B-cell dysfunction can be associated with a variety of illnesses as a result of the underlying disease or treatment causing the dysfunction, infection or, indeed, therapy. Immunodeficiency may be primary or secondary. Secondary causes of immune deficiency are more common and more frequently encountered during imaging. Immune deficiency can arise in patients with conditions such as leukemia and lymphoma; from infectious agents such as the human immunodeficiency virus (HIV); from the administration of drugs, including chemotherapy agents and steroids; and as a result of metabolic diseases such as renal failure and diabetes. A condition that often presents challenges in the interpretation of abnormal uptake within radionuclide imaging is the patient with HIV infection. This has been compounded in some ways by the introduction of highly active antiretroviral therapy and the advent of the immune reconstitution inflammatory syndrome. Imaging abnormalities are found in association with the underlying disease, eg, lymphoma, HIV which, on occasion, may be difficult to separate from an opportunistic infection. The primary value of radionuclide imaging and in particular (18)F-fluorodeoxyglucose-positron emission tomography is to rapidly establish the probable site of disease to direct biopsy or aspiration so that the underlying pathology can be confirmed. The value of single-photon emission computed tomography and positron emission tomography has been enhanced by the introduction of hybrid imaging so that the computed tomography element of the scan localizes the site of disease more accurately than imaging without the computed tomography. Interest in monitoring response to treatment of infection is increasing but care has to be taken as inflammatory uptake attributable to immune reconstitution inflammatory syndrome can be similar to a worsening of infective uptake and this can lead to misinterpretation of the effect of treatment. It is important for the imager to be aware of the effects of underlying treatments on functional imaging and therefore to have a full history of the disease and the drug treatments that the patient is taking.
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PMID:Opportunistic infection and nuclear medicine. 1918 2

Substantial work on the peripheral and central nervous system complications of HIV was presented at the 16th Conference on Retroviruses and Opportunistic Infections. Six studies of more than 4500 volunteers identified that distal sensory polyneuropathy remains common, ranging from 19% to 66%, with variation based on disease stage, type of antiretroviral therapy, age, and height. Eight studies of more than 2500 volunteers identified that neurocognitive disorders are also common, ranging from 25% to 69%, with variation based on stage of disease, antiretroviral use, diabetes mellitus, and coinfection with hepatitis viruses. Therapy-focused studies identified that resistance testing of cerebrospinal fluid (CSF)-derived HIV may improve management of people with HIV-associated neurologic complications, that poorly penetrating antiretroviral therapy is associated with persistent low-level HIV RNA in CSF, and that efavirenz concentrations in CSF are low but in the therapeutic range in most individuals. Neuroimaging reports identified that people living with HIV had abnormal findings on magnetic resonance imaging (gray matter atrophy, abnormal white matter), magnetic resonance spectroscopy (lower neuronal metabolites), and blood-oxygen-level dependent functional magnetic resonance imaging (lower cerebral blood flow). Other important findings on the basic neuroscience of HIV and diagnosis and management of neurologic opportunistic infections are discussed.
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PMID:Neurologic complications of HIV disease and their treatment. 1940 7

Phaeohyphomycosis is a distinct mycotic infection of the skin or internal organs caused by darkly pigmented (dematiaceous) fungi, which are widely distributed in the environment. Phaeohyphomycosis is most frequently an opportunistic infection in immunosuppressed patients (HIV, corticotherapy, transplant patients) or is frequently associated with chronic diseases and diabetes. The spectrum of the disease is broad and includes superficial infections, onychomycosis, subcutaneous infections, keratitis, allergic disease, pneumonia, brain abscesses and disseminated disease. Rarely, immunocompetent patients may be affected. We describe two new cases of subcutaneous phaeohyphomycosis in immunocompetent patients: in the first patient, the causative agent was Exophiala jeanselmei, a common cause of phaeohyphomycosis; and in the second, Cladophialophora carrionii, which could be identified by culture. Cladophialophora carrionii is mainly the aetiological agent of chromoblastomycosis and only rarely the cause of phaeohyphomycosis. The first patient was treated with surgical excision and oral itraconazole, and the second patient responded to oral itraconazole only. Lesions improved in both patients and no recurrence was observed at follow-up visits.
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PMID:Subcutaneous phaeohyphomycosis in immunocompetent patients: two new cases caused by Exophiala jeanselmei and Cladophialophora carrionii. 1981 14

Mucormycosis is an uncommon opportunistic infection by filamentous fungi that usually develops in immunocompromised patients. Most individuals have an underlying systemic disease, such as diabetes mellitus, malignancy, uraemia, burns, renal transplant recipients and those on corticosteroid and immunosuppressive therapy. Many cases of primary renal zygomycosis with lungs serving as the portal of entry have been reported from this region. We describe two autopsy cases of renal zygomycosis where bladder appeared to be the portal of entry for the fungus.
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PMID:Can ascending infection from bladder serve as the portal of entry for primary renal zygomycosis? 2053 26

Oral geotrichosis is an uncommon opportunistic infection caused by Geotrichum candidum, a habitual contaminant and component of the flora of various parts of the body. This communication reports both a 20-year retrospective study of clinically and mycologically proven cases of oral geotrichosis, and a prospective study of fungal oral flora in 200 individuals divided into two groups: normal individuals and individuals with associated conditions. Twelve patients with proven oral geotrichosis were included: 9 females and 3 males, with a mean age of 48.5 years; the associated conditions were diabetes mellitus (66.6%), leukemia, Hodgkin's lymphoma and HIV/AIDS infection. The oral geotrichoses showed three clinical varieties: pseudomembranous (75%), hyperplastic, and palatine ulcer. G. candidum was isolated in 11 cases and G. capitatum in one. Positive fungal cultures were obtained from the two groups, and 48% and 78% of cultures were positive, respectively, for Candida spp. In 2.8% and 6.33% of the cases, G. candidum was isolated, respectively, together with one strain of G. capitatum. Oral geotrichosis is an exceptional infection that clinically presents, and is treated, as oral candidiasis. G. candidum may be isolated from the oral flora of a small proportion of patients, either normal individuals or those with associated conditions.
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PMID:Oral geotrichosis: report of 12 cases. 2088 43


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