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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study evaluated Trypanosoma cruzi parasitemia in persons with chronic Chagas disease, compared the parasitemia in human immunodeficiency virus (HIV)-positive and -negative subjects, and, for HIV-positive subjects, analyzed the association between parasitemia and occurrence of acquired immunodeficiency syndrome-defining illnesses, CD4 cell counts, HIV loads, and antiretroviral therapy. In total, 110 adults with chronic Chagas disease (29 HIV positive, 81 HIV negative) were studied. T. cruzi parasitemia was evaluated by xenodiagnosis, blood culture, and direct microscopic examination of blood. T. cruzi parasitemia was detected significantly more frequently in HIV-positive than in HIV-negative subjects (odds ratio, 12.3; 95% confidence interval, 3.7-41.2). HIV-positive patients also had higher levels of parasitemia. No statistically significant association was seen between parasitemia and the variables of interest among the HIV-positive subjects.
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PMID:Trypanosoma cruzi parasitemia in chronic Chagas disease: comparison between human immunodeficiency virus (HIV)-positive and HIV-negative patients. 1219 28

Opportunistic diseases (OD) are the most common cause of death in AIDS patients. To access the incidence of OD and survival in advanced immunodeficiency, we included 79 patients with AIDS treated at Hospital Evandro Chagas (FIOCRUZ) from September 1997 to December 1999 with at least one CD4 count <or=100 cells/mm(3). The incidence of OD was analyzed by Poisson's regression, and survival by Kaplan Meier and Cox analysis, considering a retrospective (before CD4 <or=100 cells/mm(3)) and a prospective (after CD4 <or=100 cells/mm(3)) period, and controlling for demographic, clinical and laboratory characteristics. The confidence interval estipulated was 95%. Mean follow-up period was 733 days (CI = 683-782). During the study 9 (11.4%) patients died. Survival from AIDS diagnosis was a mean of 2589 days (CI = 2363-2816) and from the date of the CD4 count CD4 <or=100 cells/mm(3) was a mean of 1376 (CI = 1181-1572) days. Incidence of OD was 0.51 pp/y before CD4 <or= 100 cells/mm(3) and 0.29 pp/y after CD4 <or= 100 cells/mm(3). A lower number of ODs before CD4 < 100 cells/mm(3) was associated with lower incidence rates after CD4 <or= 100 cells/mm(3). AIDS diagnosis based on CD4+ counts <or= 200 cells/mm(3) was associated with lower incidence rates after CD4 <or= 100 cells/mm(3). Baseline CD4 counts above 50 cells/mm(3) (HR = 0.13) and restoration of baseline CD4+ counts above 100 cells/mm(3) (HR = 0.16) were associated with a lower risk of death. Controlling both variables, only restoration of baseline counts was statistically significant (HR = 0.22, p = 0.04). We found a very low incidence of OD and long survival after CD4 < 100 cells/mm(3). Survival was significantly associated with restoration of baseline CD4 counts above 100 cells/mm(3).
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PMID:Morbidity and survival in advanced AIDS in Rio de Janeiro, Brazil. 1221 8

Blood transfusion programs can minimize the risk of transfusing infected blood through three strategies: 1) recruiting and counseling voluntary donors who are at low risk of human immunodeficiency virus (HIV), 2) screening all donated blood for HIV and other infections transmitted by blood and safely disposing of infected blood, and 3) reducing the number of blood and blood product transfusions. Schools, universities, church groups, community centers, and workplaces provide opportunities for educating and recruiting people at low risk of HIV. Avoided should be paid donors; men and women who sell their blood are often at high risk of serious communicable diseases. All donated blood should be screened for HIV, hepatitis B, syphilis, and, depending on local disease patterns and resources, hepatitis C, Chagas' disease, and malaria. Donors should be informed of their HIV infection only after two tests have produced positive results. Because of the HIV "window period," during which antibodies are not yet detectable, a few infected blood units may be released. Where possible, blood substitutes such as saline or blood pre-collected from the patient should be used. Key to reducing the number of blood transfusions, however, is the prevention of anemia and pregnancy complications -- the indications for most transfusions.
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PMID:Strategies for safe blood. Reducing HIV transmission. 1229 28

Trypanosoma cruzi-like flagellates were incidentally noted in blood smears of a routinely monitored rhesus monkey experimentally infected with the simian immunodeficiency virus (SIV). Immunodeficiency in the course of the SIV infection reactivated a chronic infection of Chagas' disease that had been unnoticed when the macaque was imported to Europe. The animal developed no specific clinical symptoms of American trypanosomiasis, but histologically a chagasic myocarditis was detected. Analysis of the small subunit rRNA gene of the trypanosome identified the protozoan as T. cruzi.
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PMID:Reactivation of a Trypanosoma cruzi infection in a rhesus monkey (Macaca mulatta) experimentally infected with SIV. 1245 Feb 3

Chronic Trypanosoma cruzi infection can reactivate in patients with immunosuppression related to human immunodeficiency virus (HIV) infection, resulting in severe meningoencephalitis or myocarditis and high parasitemia. The effects of T. cruzi on HIV infection are unknown. We describe an HIV-infected patient with chronic Chagas' disease who experienced an asymptomatic T. cruzi reactivation characterized by the finding of the parasite in direct microscopic examination of blood. The patient's HIV viral load had increased simultaneously with the exacerbation of T. cruzi parasitemia and decreased to previous levels after successful antiparasitic treatment. This otherwise unexplained finding suggests that T. cruzi infection might up-regulate HIV replication, which may affect HIV disease progression. Asymptomatic reactivation of Chagas' disease has not been reported before. This could mean that the severe clinical manifestations related to the reactivation of trypanosomiasis are just the tip of the iceberg.
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PMID:Exacerbation of HIV viral load simultaneous with asymptomatic reactivation of chronic Chagas' disease. 1247 55

The Abbott Determine Rapid Syphilis TP assay is a treponemal test that can be used in resource-poor settings that lack laboratory facilities. However, this test has not been extensively evaluated. We measured its sensitivity and specificity by using stored serum specimens (n = 567) from all persons who tested Treponema pallidum hemagglutination assay (TPHA) positive (n = 250) or TPHA indeterminate (n = 17) in the year 2001 and the first 300 patients in 2001 who tested TPHA negative at the Evandro Chagas Research Institute in Rio de Janeiro, Brazil. This rapid assay was independently interpreted by three different observers. With TPHA results as the reference, sensitivity ranged between readers from 95.6 to 98.4% and specificity ranged from 97.3 to 95.7%. There was little interreader variability in the interpretation of results, with approximately 98% agreement for all reader combinations. Of samples from persons with human immunodeficiency virus (HIV) infection (n = 198), sensitivity was 96.9 to 99.2% and it was 94.4 to 96.3% among HIV-negative persons (n = 127). Specificity was 92.4 to 95.5% among HIV-positive persons and 97.2 to 100% among HIV-negative persons. We found this test to have high sensitivity and specificity and little interreader variability, indicating that it may be easily used in resource-poor settings without laboratory facilities. Further studies are needed using this test on whole blood and under the clinical conditions for which it is intended.
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PMID:Evaluation of the Determine Rapid Syphilis TP assay using sera. 1471 52

Recently, reactivation of Chagas disease (meningoencephalitis and/or myocarditis) was included in the list of AIDS-defining illnesses in Brazil. We report a case of a 52-year-old patient with no history of previous disease who presented acute meningoencephalitis. Direct examination of blood and cerebrospinal fluid (CSF) showed Trypanosoma cruzi. CSF culture confirmed the diagnosis. Serological assays for T. cruzi and human immunodeficiency virus (HIV) were positive. Despite treatment with benznidazol and supportive measures, the patient died 24 hours after hospital admission. In endemic areas, reactivation of Chagas disease should always be considered in the differential diagnosis of meningoencephalitis among HIV-infected patients, and its presence is indicative of AIDS.
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PMID:Chagasic meningoencephalitis: case report of a recently included AIDS-defining illness in Brazil. 1536 71

In common with other developed countries, the United States has placed a great deal of emphasis on blood safety. As a result of careful donor selection and the use of advanced tests, including nucleic acid testing (NAT), the risk of transmission of human immunodeficiency virus and hepatitis C virus has been reduced to about 1 in 1.5 million donations. NAT for hepatitis B virus has not been introduced, but nevertheless the risk is low. Attention recently has been focused on emerging infections. NAT for West Nile virus was implemented within 6 to 8 months of recognition of the need to prevent transfusion transmission of this newly introduced virus. Approximately 1000 potentially infectious donations were identified and removed from the blood supply during the 2003 season. Other emerging infections attracting attention include Chagas' disease, babesiosis, malaria, and variant Creutzfeldt-Jakob disease.
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PMID:Current safety of the blood supply in the United States. 1561 52

As a result of significant progress in reducing the risks of transfusion-transmitted viral infections, bacterial contamination of platelet components (1:2,000) and sepsis (1:50,000) are now the most frequent infectious complications of blood transfusions. Sepsis from bacterial contamination of red cell components is less frequent (1:500,000), because red blood cells, unlike platelet components, can be stored at refrigerated temperatures (1 degrees C-4 degrees C). Current risks for transfusion-transmitted viral diseases (per blood component transfused) are: human immunodeficiency virus, 1:2,135,000; hepatitis C virus, 1:1,935,000; hepatitis B virus, 1:205,000; and human T-lymphotropic viruses, 1:2,993,000. Transfusion-transmitted babesiosis has increased morbidity and mortality for splenectomized patients. Immunocompromised recipients are at increased risk of developing Chagas disease from blood contaminated by Trypanosoma cruzi. Reports of transfusion-related acute lunge injury and transfusion-associated graft-versus-host disease increase each year as physicians become increasingly aware of their varied clinical presentations. While strategies for preventing infections complications focus primarily on blood donor services, individual physicians can reduce risks to their patients by maintaining conservative "triggers" for transfusions, prescribing pharmacologic agents to reduce bleeding (antifibrinolytic drugs, serine protease inhibitors, fibrin sealants), and using epoetin alpha to reduce transfusion of red cells in selected patients.
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PMID:Risks of blood transfusion and their prevention. 1622 28

This study assessed the number of CD4 T lymphocytes, the parasitemia and serum levels of interferon gamma (IFN-gamma), tumor necrosis factor alpha (TNF-alpha), interleukin-1 (IL-1), IL-4 and IL-10 of patients infected by human immunodeficiency virus (HIV) and human immunodeficiency virus/Chagas' disease coinfection. CD4 T lymphocytes were low in the two groups of patients, although significantly lower in patients without Chagas' disease. Serum levels of IFN-gamma, IL-4 and TNF-alpha were significantly higher in patients with HIV/Chagas' disease. IL-4/IFN-gamma ratios were higher in patients with HIV/Chagas' disease, which showed a clear balance in favor of Th2-like cytokines in this group of patients. This Th2 balance was higher in patients with detectable parasitemia. We conclude that, although immunosuppression was observed, with CD4 T lymphocytes below 200/microm3, these patients did not display reactivation of T. cruzi infection and that a balance favorable to Th2 was associated with the presence of parasitemia.
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PMID:Cytokine serum levels in patients infected by human immunodeficiency virus with and without Trypanosoma cruzi coinfection. 1641 Sep 23


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