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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rapidly fatal cryptococcal meningitis has existed in central Africa for more than 30 years, mainly in the lower area of the Congo River basin. Cases have been reported in that area since 1953, especially among young patients during the 1950s. People with AIDS in central Africa also often have cryptococcosis, and it is possible that earlier clinical reports of encephalitis were actually fatal cases of AIDS in young Africans. Before the advent of AIDS in Europe, fatal cases of infection with Cryptococcus neoformans resembling acute meningitis were rare and nonexistent in young adults. The available evidence suggests that HIV may have originated in central Africa, where it had long remained in a specific, but unknown and overlooked habitat. Cryptococcosis infection, cryptococcosis in the Congo River basin, the historical presence of HIV, and HIV in Haiti and among Haitians are discussed.
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PMID:The historical question of acquired immunodeficiency syndrome in the 1960s in the Congo River basin area in relation to cryptococcal meningitis. 954 2

This report presents the first case described in the English literature of dual infection with Cryptococcus neoformans and Streptococcus pneumoniae in the cerebrospinal fluid of an AIDS patient. The patient was a 32-year-old, HIV-positive South African woman who had been diagnosed with disseminated tuberculosis 5 months prior to the index admission. Her chief complaints at presentation were abdominal pain, chronic diarrhea, and vaginal discharge, suggesting a diagnosis of pneumonia and pelvic inflammatory disease. Persistence of confusion led to a lumbar puncture; gram-positive and budding yeasts were observed and subsequent India-ink staining revealed capsulated yeast typical of C. neoformans. S. pneumoniae and C. neoformans were cultured 24 and 48 hours, respectively, after incubation. The woman died within 24 hours of hospital admission, precluding further investigation. It is presumed that this woman already had disseminated cryptococci at the earlier presentation, but was incorrectly diagnosed as having tuberculosis. The finding of pneumococci, in the absence of inflammatory cells in cerebrospinal fluid, suggests the terminal event was fulminant pneumococcal meningitis in the setting of chronic cryptococcal meningitis. This case supports the importance of performing both the Gram- and India-ink stains and cryptococcal antigen test on cerebrospinal fluid specimens from immunocompromised patients, even when biochemical and cellular parameters are normal.
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PMID:Meningitis due to a combined infection with Cryptococcus neoformans and Streptococcus pneumoniae in an AIDS patient. 957 Jun 64

Central Nervous System (CNS) is very common site of the opportunistic infections in patients with AIDS. Patients, who died because of AIDS have described pathology of CNS in 80% in autopsy series. Toxoplasmic encephalitis (TE) is the most common infection in the course of AIDS, and it touches 25-50% of the HIV-infected people. The treatment of TE is very difficult, but relapses are very often and primary and secondary prophylaxis of TE is necessary. Fungal infections (particularly cryptococcal meningitis) are very unpopular in immunocompetent patients; in HIV-infected people Cryptococcus neoformans is the cause of the 30% of encephalitis. Viral and bacterial encephalitis, they are not very common in AIDS patients.
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PMID:[Central nervous system infections in patients with AIDS]. 963 48

A HIV-positive patient presented with cryptococcal meningitis that was not detected by cerebrospinal fluid (CSF) latex antigen and direct microscopy. The diagnosis was confirmed by culture of the CSF and subsequent urine culture, both of which yielded an apparently acapsular strain of Cryptococcus neoformans. After 19 months the patient relapsed and capsulated yeasts were observed on this occasion on direct microscopy of the CSF. The latex antigen test was strongly positive. Culture again yielded an apparently acapsular isolate. Retrospective culture of all isolates obtained from this patient in sterile CSF resulted in the formation of capsules. This was confirmed by the requirement of normal non heat inactivated serum for neutrophil-cryptococcus attachment to occur in vitro. Although antigen and direct microscopy are frequently relied upon to diagnose cryptococcal meningitis, a negative result does not exclude the condition.
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PMID:Microscopy and latex antigen negative cryptococcal meningitis. 966 48

A natural history cohort (NHC) of HIV-1-infected subjects and HIV-negative controls was established in rural Uganda in 1990. By the end of 1996, 440 participants had enrolled in the cohort: 107 prevalent cases, 108 incident cases, and 225 HIV-negative controls. The authors report the causes of death among HIV-infected cohort members over the 6-year period ending December 1996. Causes of death were determined by reviewing the premorbid clinical and laboratory findings, as well as from information obtained from relatives. All study clinic staff are blind to the HIV serostatus of participants in the NHC. 78 deaths occurred over the 6-year study period: 63 deaths among HIV-positive cases (53 prevalent and 10 incident cases) and 15 deaths among HIV-negative controls. 56% of prevalent cases, 9% of incident cases and 7% of controls died. Of the 55 HIV-positive cases with enough data to establish cause of death, 52 were determined to have HIV-associated deaths, of whom 48 died in World Health Organization stage 4 illness. Main causes of death were wasting syndrome (31%), chronic diarrhea (22%), cryptococcal meningitis (13%), and chest infection (11%).
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PMID:Causes of death in a rural, population-based human immunodeficiency virus type 1 (HIV-1) natural history cohort in Uganda. 975 28

Coinfection of the nervous system by two distinct nonviral organisms is uncommon and often undiagnosed. Medical teaching emphasizes that a single pathologic process should be sought; however, in the presence of severe immunocompromise this approach may not hold true. We describe seven HIV-1 seropositive patients with cryptococcal meningitis, three of whom had a proven nervous system infection with a second organism: concurrent tuberculous meningitis, a tuberculoma, and the first documented case of cryptococcal meningitis and neurosyphilis.
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PMID:Dual infective pathology in patients with cryptococcal meningitis. 978 66

The introduction of highly active antiretroviral therapy (HAART) has reduced dramatically the incidence of mucosal candidiasis and cryptococcosis in AIDS patients. Fluconazole is the drug of choice for candidiasis. The duration of antifungal treatment is based on response, but typically 7 to 14 days are required for oropharyngeal forms and up to 21 days for esophageal disease (200 the first day and 100 mg thereafter). Resistant candidiasis tends to occur in persons with advanced HIV disease and previous fluconazole therapy who have been noted to result in clinical improvement with HAART. HAART must be considered the therapy of choice for refractory candidiasis. The preferred treatment for cryptococcal meningitis includes two weeks induction treatment with amphotericin B (0.7 mg/kg/d IV) with or without flucytosine (25 mg/kg qid) followed by 8 weeks of fluconazole (200-400 mg PO qd). Long-term maintenance therapy with fluconazole (200-400 mg PO qd) is required to prevent relapses. In patients with elevated intracranial pressure who had focal neurologic deficits or mental status changes, serial lumbar punctures should be performed. In refractory cases the immediate placement of CSF drains must be considered.
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PMID:[Infections by Candida and cryptococci]. 985 17

This study was designed to compare the effectiveness of fluconazole vs. itraconazole as maintenance therapy for AIDS-associated cryptococcal meningitis. HIV-infected patients who had been successfully treated (achieved negative culture of CSF) for a first episode of cryptococcal meningitis were randomized to receive fluconazole or itraconazole, both at 200 mg/d, for 12 months. The study was stopped prematurely on the recommendation of an independent Data Safety and Monitoring Board. At the time, 13 (23%) of 57 itraconazole recipients had experienced culture-positive relapse, compared with 2 relapses (4%) noted among 51 fluconazole recipients (P = .006). The factor best associated with relapse was the patient having not received flucytosine during the initial 2 weeks of primary treatment for cryptococcal disease (relative risk = 5.88; 95% confidence interval, 1.27-27.14; P = .04). Fluconazole remains the treatment of choice for maintenance therapy for AIDS-associated cryptococcal disease. Flucytosine may contribute to the prevention of relapse if used during the first 2 weeks of primary therapy.
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PMID:A comparison of itraconazole versus fluconazole as maintenance therapy for AIDS-associated cryptococcal meningitis. National Institute of Allergy and Infectious Diseases Mycoses Study Group. 1006 47

In 95 patients with HIV infection (76 males and 19 females), observed in 1993-1997, the structure of secondary diseases was studied. During this period 58 patients (61.1%) died. In the structure of secondary diseases represented by 14 nosoforms prevailed cytomegalovirus and candidal infections, tuberculosis, Kaposi's sarcoma, rarely--pneumocystis pneumonia, cryptococcal meningitis and toxoplasmosis.
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PMID:[The structure of the secondary diseases in HIV-infected patients in Russia]. 1009 16

To identify the risk factors for cryptococcal meningitis in patients with HIV disease we conducted a nested case-control study of 37 incident cases of cryptococcal meningitis and 74 controls, identified from a cohort of more than 2000 HIV-infected patients. Conditional logistic regression was used to study demographic and AIDS-related variables in addition to fluconazole and steroid use. No difference in demographic variables, HIV risk factors, or stage of AIDS was detected between cases and controls. Exposure to fluconazole for more than 90 days reduced the risk of cryptococcal meningitis by 82% (OR=0.18; 95% CI=0.04-0.85; p=0.03). We did not find a difference in steroid use between cases and controls for either the length or amount of steroid exposure (p=0.41). No difference in survival during follow-up in the clinic was observed by the log-rank test (p=0.74). Among the cases, a cryptococcal antigen was positive in more than 97% of the CSF or blood samples. CSF and blood cultures were positive in 81 and 44% of the samples, respectively. We conclude that demographic factors did not affect the risk of cryptococcal meningitis in an inner city United States population. While fluconazole use has a protective effect, steroid use was not associated with an increased risk of cryptococcal meningitis in HIV-infected patients.
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PMID:Risk factors for cryptococcal meningitis in HIV-infected patients. 1033 41


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