RESUMEN
Invasive infection and extraintestinal complications are rarely caused by Plesiomonas shigelloides, a waterborne bacterium implicated in gastroenteritis. Recent evidence from several reports suggests its importance in causing opportunistic infections in immunocompromised hosts. We report a case of P shigelloides bacteremia and epididymo-orchitis in a patient with HIV infection and chronic hepatitis C. This case illustrates a novel site of involvement by P shigelloides and underscores its role as an opportunistic pathogen.
Asunto(s)
Bacteriemia/microbiología , Epididimitis/microbiología , Infecciones por Bacterias Gramnegativas , Infecciones por VIH/complicaciones , Orquitis/microbiología , Plesiomonas , Hepatitis C/complicaciones , Humanos , Masculino , Persona de Mediana EdadRESUMEN
UNLABELLED: The purpose of this study was to determine whether 201Tl retention in focal intracranial lesions can help distinguish central nervous system (CNS) lymphoma from toxoplasmosis and other nonmalignant CNS lesions in patients with acquired immunodeficiency syndrome. METHODS: Forty-nine patients who presented with focal lesions on CT and/or MRI had 201Tl brain SPECT studies (early and delayed image sets) performed shortly after admission. Early and delayed 201Tl uptake ratios were obtained for the positive studies, and the retention index of thallium was calculated (delayed/early target-to-background mean count ratio). RESULTS: Twenty-nine patients had foci of significantly increased 201Tl uptake on the early images in regions of corresponding CT/MRI lesions. Ten of these patients had biopsy-proven lymphomas. Another patient was found to have metastatic adenocarcinoma. Twelve additional patients had a response to radiation therapy or a clinical course consistent with lymphoma and six patients had a false-positive SPECT study. The early uptake ratio could not separate malignant from nonmalignant lesions. The 201Tl retention index in patients with lymphomas (1.18 +/- 0.16) was significantly higher than the retention index in adenocarcinoma (0.24) and in the six nonmalignant lesions (0.62 +/- 0.07). The lowest retention index in patients with lymphoma was 1.07, and the highest retention index in nonmalignant lesions was 0.70. Twenty patients showed no 201Tl uptake in the regions of CT/MRI lesions. Three of them had biopsies consistent with a benign etiology, and one patient was diagnosed with tuberculosis. Fifteen patients improved clinically on antitoxoplasmosis medications alone, and one patient had CNS lymphoma. The overall sensitivity of 201Tl brain SPECT was 96%. The specificity was 76% by counting all studies with abnormal 201Tl uptake, but it increased to 100% when the retention index was also considered. CONCLUSION: The retention index increases the specificity of 201Tl brain SPECT in human immunodeficiency virus patients. In the presence of abnormal early 201Tl uptake, it is essential to perform delayed imaging and calculate the retention index to distinguish nonmalignant lesions from lymphoma. The absence of 201Tl uptake on early images at the site of a CT/MRI abnormality excludes the diagnosis of lymphoma with a high degree of confidence and delayed imaging is unnecessary.
Asunto(s)
Encéfalo/diagnóstico por imagen , Neoplasias del Sistema Nervioso Central/diagnóstico por imagen , Linfoma Relacionado con SIDA/diagnóstico por imagen , Radioisótopos de Talio , Tomografía Computarizada de Emisión de Fotón Único , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Adulto , Encefalopatías/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Estudios Prospectivos , Sensibilidad y Especificidad , Factores de Tiempo , Toxoplasmosis Cerebral/diagnóstico por imagenRESUMEN
Pericarditis in patients with human immunodeficiency virus (HIV) infection may be asymptomatic or symptomatic, but is sometimes overlooked because of signs and symptoms of other organ system diseases. A case report of cardiac tamponade in a patient with acquired immunodeficiency syndrome (AIDS) is presented. To determine the incidence and causes of pericardial disease in patients with HIV infection, a review of the literature was conducted. Fifteen autopsy and echocardiographic series involving 1139 patients with HIV infection reveal that the average incidence of pericardial disease is 21%. Most cases are asymptomatic and without an identifiable cause. However, in those that are symptomatic, about two thirds are caused by infection or neoplasm; one third have an undetermined etiology. In the 66 published cases of cardiac tamponade in patients with HIV infection, 26% are caused by tuberculosis, 17% are purulent, and 8% are caused by Mycobacterium avium-intracellulare (MAI). Lymphoma and Kaposi's sarcoma are each responsible for 5% of the effusions. Less frequent causes of tamponade are Cryptococcus neoformans, cytomegalovirus, and Mycobacterium kansasii. Small asymptomatic pericardial effusions in patients with HIV infection do not require diagnostic evaluation. However, large symptomatic pericardial effusions should be investigated, because two thirds are caused by potentially treatable infections or neoplasms.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Taponamiento Cardíaco/etiología , Pericarditis/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Comorbilidad , Humanos , Incidencia , Masculino , Complejo Mycobacterium avium , Pericarditis/diagnóstico , Pericarditis/terapiaRESUMEN
UNLABELLED: This study sought to assess whether 201Tl brain SPECT can significantly reduce the time required for the differential diagnosis of primary central nervous system (CNS) lymphoma and cerebral toxoplasmosis in patients with AIDS. METHODS: Eighteen patients who presented with focal lesions on CT or MRI, or both, underwent 201Tl brain SPECT shortly after admission and before a CT-guided stereotactic brain biopsy. Early and delayed 201Tl uptake ratios were obtained for patients with positive 201Tl study results, and the retention index of 201Tl was calculated. RESULTS: Ten patients had 11 foci of significantly increased 201Tl uptake in regions of corresponding CT/MRI lesions. Five of these patients had biopsy-proven lymphomas, one of them in two separate foci. Another patient was found to have metastatic adenocarcinoma. Three patients had a clinical course and response to radiation therapy consistent with lymphoma, and study results in another patient were considered falsely positive. Of nine patients with no 201Tl uptake in regions of CT/MRI lesions, two had biopsy findings consistent with a benign etiology, and the other seven improved clinically on antitoxoplasmosis medications alone. The overall sensitivity of 201Tl brain SPECT was 100%, and specificity was 90%. The 201Tl retention index in patients with lymphomas was significantly higher than that in patients with adenocarcinomas and nonmalignant lesions (1.35 +/- 0.16 versus 0.24 and 0.56, respectively). CONCLUSION: Thallium-201 brain SPECT is a sensitive and specific method for rapid differential diagnosis of CNS lymphoma and toxoplasmosis in patients with AIDS. The 201Tl retention index is useful in differentiating CNS lymphomas from other malignant and nonmalignant pathologies.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Neoplasias del Sistema Nervioso Central/diagnóstico por imagen , Linfoma Relacionado con SIDA/diagnóstico por imagen , Radioisótopos de Talio , Tomografía Computarizada de Emisión de Fotón Único , Toxoplasmosis Cerebral/diagnóstico por imagen , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/parasitología , Adulto , Biopsia/métodos , Encéfalo/patología , Neoplasias del Sistema Nervioso Central/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Linfoma Relacionado con SIDA/diagnóstico , Imagen por Resonancia Magnética , Masculino , Sensibilidad y Especificidad , Factores de Tiempo , Tomografía Computarizada por Rayos X , Toxoplasmosis Cerebral/diagnósticoRESUMEN
Two commercially available synthetic fiber filters were studied for their effectiveness at removing white cells (WBCs) from AS-1-preserved red cells (RBCs) stored less than or equal to 14 days. In all, 65 filtrations were performed. An automated microprocessor-controlled hydraulic system designed for use with cellulose acetate fiber filters was employed to prepare filtered RBCs before release for transfusion. Studies were also carried out on polyester fiber filters, which are designed to be used in-line during transfusion. Residual WBCs were below the accurate counting range of Coulter counters and of conventional manual chamber counts. An isosmotic ammonium chloride RBC lysis method, plus a modified chamber counting technique, permitted a 270-fold increase over the number of WBCs counted by the conventional manual method. For the polyester fiber-filtered products, residual WBCs per unit were not affected by speed of filtration, prior length of storage, or mechanical tapping during filtration. The effectiveness of WBC removal (mean 99.7%), total residual WBCs (means, 4.8 and 5.5 x 10(6], and RBC recovery (mean, 93%) was the same for both filters. The majority of residual WBCs were lymphocytes. WBC removal and RBC recovery were strikingly superior to results reported with nonfiltration methods.
Asunto(s)
Adenina , Conservación de la Sangre/instrumentación , Separación Celular/instrumentación , Filtración/instrumentación , Glucosa , Leucocitos , Manitol , Cloruro de Sodio , Recuento de Células Sanguíneas/instrumentación , Recuento de Células Sanguíneas/métodos , Conservación de la Sangre/métodos , Transfusión Sanguínea/instrumentación , Transfusión Sanguínea/métodos , Separación Celular/métodos , Celulosa/análogos & derivados , Transfusión de Eritrocitos , Filtración/métodos , Humanos , PoliésteresRESUMEN
A highly sensitive enzyme-linked immunosorbent assay (ELISA) technique was observed for serological detection of antibodies against platelets. A covalently bound to Sepharose CL-4B was used to enrich sera in the IgG3 subclass of antibodies. The ELISA procedure as applied to detect anti-platelet antibodies in patients with herpes or rubella viral infections and in patients with idiopathic thrombocytopenic purpura (ITP). Twenty-eight sera from 13 thrombocytopenic patients showed high levels of anti-platelet antibodies. Two splenectomized patients in remission became negative for anti-platelet antibodies. Seventy-four sera from patients with serological diagnosis of herpes group viral infections comprising 10 cases of cytomegalovirus, nine cases of varicella or zoster, six cases of herpes simplex and four cases of Epstein-Barr virus were examined for the presence of anti-platelet antibodies. Except for two patients with varicella and zoster and one patient with rubella infection, all cases examined showed positive titres of anti-platelet antibodies. Sera from a group of 51 healthy controls were evaluated for anti-platelet antibodies. Forty-nine (96%) were negative (less than 40), whereas the other two were only slightly positive.