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 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The association between self-reported clinical factors and recent HIV-1 seroconversion was evaluated in a prospective cohort of 4652 high-risk participants in the HIV Network for Prevention Trials (HIVNET) Vaccine Preparedness Study. Eighty-six individuals seroconverted, with an overall annual seroconversion rate of 1.3 per 100 person-years. Four self-reported clinical factors were significantly associated with HIV-1 seroconversion in multivariate analyses: recent history of chlamydia infection or gonorrhea, recent fever or night sweats, belief of recent HIV exposure, and recent illness lasting > or =3 days. Two scoring systems, based on the presence of either 4 or 11 clinical factors, were developed. Sensitivity ranged from 2.3% (with a positive predictive value of 12.5%) to 72.1% (with a positive predictive value of 1%). Seroconversion rates were directly associated with the number of these clinical factors. The use of scoring systems comprised of clinical factors may aid in detecting early and acute HIV-1 infection in vaccine and microbicide trials. Organizers can educate high-risk trial participants to return for testing during interim visits if they develop these clinical factors. Studying individuals during early and acute HIV-1 infection would allow scientists to investigate the impact of the intervention being studied on early transmission or pathogenesis of HIV-1 infection.
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PMID:The development and utility of a clinical algorithm to predict early HIV-1 infection. 1628 Jul 4

A-30-years old married man with HIV/AIDS wasting syndrome is being reported. The patient had history of injecting heroin with rampant sharing with his drug partners, weight loss, night sweats, productive cough, severe muscle wasting, chronic diarrhoea >30 days and fever > 30 days. This syndrome indicates the long-standing complication of HIV infection. Blood, sputum, CSF, faeces and urine routine and culture examination findings to rule out opportunistic infections were repeatedly negative. No malignant cells were found. HIV testing was positive. The CD 4 positive T-lymphocyte count was measured before and after six months of treatment. In the present case report, evaluation of the symptoms yielded no specific pathogen and had no evidence of opportunistic infections. He is being placed under observation with highly active antiretroviral therapy (HAART) along with nutritional support. He is improving clinically and immunologically by raising in the patient's CD4 count. Early antiretroviral therapy along with meticulous nutritional support is ideal to improve the quality of life of AIDS patients.
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PMID:HIV/AIDS wasting syndrome in Manipur - a case report. 1644 50

The global social, political and health emergency presented by the human immunodeficiency virus and the acquired immune-deficiency syndrome (HIV/AIDS) has also once again propelled tuberculosis (TB) into a global public health emergency. The examples I will use to show how activism and social mobilisation can assist in overcoming TB are primarily from my home country, South Africa. Despite significant differences in health systems, culture, politics and history, there are lessons that could be used to advocate for TB prevention, diagnosis, treatment and care globally. Our country experiences globally significant HIV and TB epidemics. I will return to the epidemiology of TB-HIV and the crisis of illness and death. Early in April 2005, one of my closest friends, Ronald Louw, a professor of law at the University of KwaZulu-Natal, a human rights lawyer and activist for more than 25 years, suffered a persistent fever and cough. While on sabbatical, he was taking care of his mother who had been diagnosed with cancer. He assumed his illness was stress-related and went to a doctor who diagnosed bronchitis. After 4 weeks' treatment with antibiotics, his illness was worse-he had a raging fever, night sweats and was becoming disoriented. He requested an HIV test. Within 24 hours Ronald Louw knew that he had been infected with HIV. His mother died on the same day. He also knew within 24 hours that his CD4 count was below 100. They could not diagnose his lung disease and concluded that it was Pneumocystis carinii pneumonia. Four weeks later his doctors diagnosed TB through a lung biopsy. Ronald Louw had been desperately sick under medical care with TB and HIV for more than 8 weeks. He died 3 days after receiving a definitive TB diagnosis, and a week after treatment for presumptive TB had commenced.
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PMID:Science and social justice: the lessons of HIV/AIDS activism in the struggle to eradicate tuberculosis. 1716 44

An HIV-1 seronegative man presented with odynophagia, dysphagia, diarrhea, tenesmus and a 50-lb weight loss. A large esophageal ulcer and a rectal fissure were identified endoscopically. Stool samples and biopsy specimens from the esophageal ulcer, duodenum, colon and rectum were negative for pathogens. Seronegative AIDS was suspected, and high levels of HIV-1 mRNA (> 242,000 copies/mL) were detected. The esophageal ulcer responded to oral steroids and the HIV-1 infection to highly active anti-retroviral therapy (HAART). The virus isolated from the patient and an HIV-1 seropositive, asymptomatic, female sex worker with whom he had recently terminated a one-year heterosexual relationship showed sequence homology, indicating her as the source of his virus. The unusual presentation of severe gastrointestinal disease in an HIV-1 seronegative man with HIV-1 viremia underscores the importance of including AIDS in the differential diagnosis of wasting syndrome (i. e., B-type symptoms such as fever, night sweats, weight loss) in patients who are HIV-1 seronegative but at risk for AIDS.
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PMID:Severe gastrointestinal disease due to HIV-1-seronegative AIDS. 1770 60

We present a 33-year-old HIV-positive man who presented with a two-year history of a non-itchy papular eruption, associated with night sweats, headaches, poor memory and weight loss. On examination, he had erythematous papular lesions with necrotic centres on the face, arms and torso with no systemic abnormalities. A skin biopsy eventually led to the diagnosis of papulonecrotic tuberculid, and treatment with quadruple therapy resulted in resolution of his rash and systemic symptoms. Papulonecrotic tuberculid is thought to be a immunological response to Mycobacterium bacillus components in a previously sensitized patient following haematogenous spread from a focus of infection elsewhere. Cultures from the skin are typically negative and there are no acid-fast bacilli seen, but mycobacterial DNA can be detected using polymerase chain reaction. This case is an example of the paradoxical activation of the immune system seen in patients with HIV. It highlights the importance of skin biopsy in patients with unexplained systemic symptoms and a rash, as the differential diagnosis can be wide in HIV.
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PMID:Papulonecrotic tuberculid in an HIV-positive patient. 1778 12

A 52-year-old patient presented himself with weight loss and night sweats. Laboratory analyses revealed a high sedimentation rate, elevated immunoglobulines and anaemia with sludge phenomenon. Differential diagnoses included Multiple Myeloma and Lymphoma. Having a risk constellation for HIV infection and just having recovered from oral thrush also made this diagnosis possible. Urinary analysis and chest x-ray were normal; however, CT-scan detected renal cell cancer with pulmonary metastases. Renal cell cancer is heterogeneous in presentation, symptoms are unspecific, therefore they are often discovered late when they have already metastasized. Paraneoplastic syndromes, e.g. hypercalcaemia or hypertension are not infrequent in renal cell cancer.
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PMID:[Weight loss and night sweats with unexpected tumor localization]. 1807 82

Human herpesvirus type 8 (HHV8), also known as Kaposi's sarcoma-associated herpesvirus, is a human gamma herpesvirus that underlies the pathogenesis of Kaposi's sarcoma, primary effusion lymphoma and multicentric Castleman's disease. We recently encountered two cases of HHV8-positive large B-cell lymphoma with features not previously described. The first patient was a 61-year-old immunocompetent man with an enlarged cervical lymph node containing scattered large, bizarre cells in a reactive background of lymphocytes, plasma cells and scattered regressed follicles resembling those of hyaline-vascular Castleman's disease. The appearance suggested classical Hodgkin's lymphoma, but the large cells were negative for CD15, CD30, CD20 and CD3, and positive for MUM1/IRF4, EMA, HHV8, EBER and dim IgM lambda. The second patient was a 59-year-old HIV-positive man who died after several weeks of fever, night sweats, anemia, thrombocytopenia, hepatosplenomegaly and multiorgan failure. At autopsy an intravascular large B-cell lymphoma that was positive for MUM1/IRF4, HHV8 and IgM lambda, and negative for CD20 and EBER involved multiple organs, including lung, heart, kidney, liver and spleen. On the basis of the histologic features in these two cases, the presence of HHV8 was unexpected. These cases expand the spectrum of lymphoproliferative disorders that can be associated with HHV8.
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PMID:HHV8-positive, EBV-positive Hodgkin lymphoma-like large B-cell lymphoma and HHV8-positive intravascular large B-cell lymphoma. 1928 57

Pulmonary alveolar proteinosis can be associated with various microorganisms and Pneumocystis jirovecii is one of them, especially in AIDS patients. Authors present the case of a 30-year-old man treated with corticosteroids for idiopathic pulmonary fibrosis, having restrictive ventilatory disfunction and bilateral perihilar interstitial infiltrates, ground-glass opacity on CT of the lungs. Rapid extension ofpulmonary a bnormalities (over a month) to peripheral reticular lesions and presence of fever were considered as Hamman-Rich syndrome. He was admitted to Clinical Hospital of Infectious Diseases and Pneumophtisiology Dr.V.Babes from Timisoara during 5-13 XII 2008 for prolonged fever, night sweats, weight loss, progressive dyspnea, marked hypoxemia, tachycardia. Diagnosis of AIDS was quickly established on two positive ELISA tests, T helper cell count (CD4 = 3 cells/mm3, CD8 = 480 cells/mm3, CD4/CD8 = 0.01) and viral load (200,000 copies/ml). Treatment was started with trimethoprim-sulfamethoxazole, fluconazole, corticosteroids but the patient died. Postmortem pathological examination showed pulmonary alveolar proteinosis and showed P. jirovecii. Pulmonary changes caused by HIV can mimic idiopathic pulmonary fibrosis and HIV may become the new "great imitator". Although the number of subjects infected with HIV is increasing, failure to recognize this immunodeficiency state is still encountered. HIV infection must be kept in mind in the differential diagnosis of each case of prolonged fever.
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PMID:[AIDS patient with pneumocystosis and pulmonary alveolar proteinosis]. 1963 66

This was an eight year (2000-2007) retrospective study of tuberculosis in patients admitted to the UMMC. A total of 131 cases were analyzed. Malays constituted the most cases, (43%), followed by Chinese (22%), Indians (17%) and others (18%). The majority of cases were within the 21-60 year old age group, which constituted 69.5% of the total. Males were more commonly affected (65%). Most cases were reported among Malaysians (83%). The majority of patients were unemployed (39%), followed by housewives (10%), laborers (9%), students (8%), shop assistants (7%), and other occupations (27%). The most common presenting complaints were prolonged productive cough, night sweats, fever, anorexia, weight loss (57%), hemoptysis (34%), and undifferentiated symptoms, such as prolonged diarrhea and dysphagia (9%). Sputum was positive for acid-fast bacilli (AFB) in 89%, but only 69% of cases had abnormal chest radiographs. The majority of patients (65%) developed no complications. The most common complications were pleural effusion, pneumothorax and pulmonary fibrosis. The majority of patients (82%) suffered either from diabetes mellitus, hypertension, ischemic heart disease or all 3 conditions. Regarding risk factors for tuberculosis, two were HIV positive and two were intravenous drug users. The majority of the patients (85%) did not complain of any side effects from their anti-tuberculosis treatment. Among those who did complain of side effects, the most common were nausea and vomiting (41%), drug induced hepatitis (37%), blurring of vision (11%) and skin rashes (11%). Two cases of death were reported.
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PMID:Tuberculosis: an eight year (2000-2007) retrospective study at the University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. 2057 21

Introduction. We report a rare presentation of Castleman's disease in a hepatitis C-positive patient and present a short review of treatments described in other similar case reports and studies. Case Presentation. A 46-year-old male with untreated hepatitis C and a 16-year history of intravenous drug use presented with pleuritic chest pain and bony pain in the knee, hip, and lower back, on a background of unexplained weight loss of 40 kilograms, fevers, night sweats, and repeated infections over the last two years. Examination discovered tender hepatomegaly, a warm right knee effusion, and painless lymphadenopathy. The patient was reactive to Epstein Barr virus and cytomegalovirus; however, HIV and HHV-8 viral testing was negative. Osteomyelitis of vertebrae T8-T11 and septic arthritis of the knee were found on investigation. A lymph node biopsy revealed histology suggestive of plasmacytic Castleman's disease. The patient is to commence rituximab treatment. Conclusion. Castleman's disease continues to present in novel ways, which may lead to difficulties in clinicopathologic diagnosis. A growing body of evidence suggests larger studies are required to determine the best treatment for multicentric Castleman's disease, particularly in patients with a concomitant disease, including hepatitis C.
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PMID:Multicentric Castleman's Disease in a Hepatitis C-Positive Intravenous Drug User: A Case Report. 2157 63


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