艾滋病合并马尔尼菲篮状菌病临床及药敏研究

目的通过研究艾滋病合并马尔尼菲篮状菌病患者的人口学及临床特征,以及马尔尼菲篮状菌的体外药敏试验及耐药率,为艾滋病合并马尔尼菲篮状菌病的防治提供理论依据。方法收集30例艾滋病合并马尔尼菲篮状菌病患者临床资料、临床标本,对培养阳性的标本进行体外药敏试验。分析艾滋病合并马尔尼菲篮状菌病患者临床特点、药敏实验结果、耐药情况。结果患者以青壮年男性、性接触传播、小学或初中文化,农民或无业人员为主,多数患者CD_4~+T细胞计数小于50 cells/μl,接受ART的患者CD4+T细胞平均数大于未接受ART者。马尔尼菲篮状菌对7种抗真菌药物耐药率从高到低依次为酮康唑(20.0%)、氟康唑(10.0%)、伊曲康唑(6.7%)、5-氟胞嘧啶(6.7%)、伏立康唑(3.3%)、卡泊芬净(0.0%)、两性霉素B(0.0%)。结论性活跃人群、低文化、低收入人群易患艾滋病,性接触为主要传播方式,艾滋病患者CD_4~+T细胞小于50 cells/μl时易患马尔尼菲篮状菌病。早期接受ART可促进患者免疫功能重建。艾滋病合并马尔尼菲篮状菌病患者建议首选两性霉素B、卡泊芬净进行抗真菌治疗,酮康唑、氟康唑、伊曲康唑、5-氟尿嘧啶、伏立康唑均有不同程度的耐药情况。     

合并艾滋病的恶性梅毒一例

【摘 要】 目的 报告1例以恶性梅毒为首发的艾滋病;探讨恶性梅毒的临床表现、诊断标准及治疗。方法：以恶性梅毒为首发的艾滋病病例报告并文献回顾。结论 根据血清学TPPA（+）、RPR 1:32（+）;严重的吉海氏反应及毒血症症状;特征性结节-溃疡性皮损表现及组织病理学改变;青霉素治疗反应良好;HIV抗体初筛及确诊试验阳性,血CD4+细胞数为136/ul, CD4+/CD8+为0.18,患者诊断为恶性梅毒、HIV感染-艾滋病期。对于合并艾滋病的梅毒患者推荐采用神经性梅毒的治疗方案同时给予HARRT抗HIV治疗。     

艾滋病并发恶性梅毒

报告1例艾滋病并发恶性梅毒.患者男,33岁.全身鳞屑性红斑、结节及破溃3个月.皮损组织病理检查:表皮棘层肥厚,表皮突延长,有较多的中性粒细胞移入表皮.真皮浅中层致密的淋巴细胞、组织细胞及浆细胞浸润;真皮层有明显的血管炎改变.实验室检查:血浆快速反应素试验(RPR)1:32;梅毒螺旋体颗粒凝集试验(TPHA)阳性;HIV抗体阳性.诊断:艾滋病并发恶性梅毒.     

伊曲康唑治疗体、股癣疗效观察

我们于1999年3月～9月,用伊曲康唑(斯皮仁诺)治疗277例体股癣,取得良好疗效,现报告如下. 1 资料与方法 1.1 临床资料 277例入选病例均为临床诊断为体股癣、真菌镜检阳性、同意接受治疗者.对唑类药物过敏、妊娠、哺乳及未采取避孕措施的育龄妇女、3个月内接受过全身抗真菌药物治疗、1个月内接受过外用抗真菌药物治疗者不入选.同时接受H2受体拮抗剂、环孢素、利福平、苯妥英钠、阿司米唑、西沙必利、特非那丁、咪达唑仑、皮质类固醇等药物者及患有肝、肾、血液病者,胃、十二指肠溃疡等患者亦不入选.     

艾滋病合并播散性马内菲青霉病1例

报告1例艾滋病合并播散性马内菲青霉病。患者女,31岁。因发热、咳嗽、乏力伴消瘦2个月入院。入院前半个月患者面部、躯干、上肢出现中央有凹陷或坏死的传染性软疣样皮损。入院后查人免疫缺陷病毒（HIV）抗体阳性。丹髓涂片、组织病理检查见细胞内外有大量酵母样细胞,部分中央有横隔（裂殖）;骨髓、皮损及淋巴结真菌培养均阳性（2℃和37℃双相培养）,经鉴定为马内菲青霉,25℃条件下培养为菌丝相,且有红色色素养产生,37℃条件下培养为酵母相。诊断：艾滋病合并播散性马内菲青霉病。确认后予以静脉滴注伊曲康唑,2周后发热消退,皮损缓解。     

艾滋病患者隐球菌性脑膜炎治疗后用伊曲康唑维持治疗

隐球菌性脑膜炎是艾滋病患者中一种常见的条件性感染。回顾性研究报道,在最初治疗完成后,复发率为50％至60％。本研究的目的是评价伊曲康唑400mg/d作为艾滋病患者中隐球菌性脑膜炎维持治疗的疗效。     

马尔尼菲青霉病93例临床分析

目的:分析广西壮族自治区马尔尼菲青霉病(PSM)的发病情况、临床特征、诊治及预后.方法:回顾性分析93例PSM患者的临床资料.结果:93例患者中并发艾滋病(AIDS)84例,非AIDS 9例.主要临床表现为发热、皮损、消瘦、贫血、淋巴结增大、咳嗽等.并发AIDS患者全身中毒症状严重,皮损泛发,且有坏死.93例患者中CD4+细胞下降84例,临床标本马尔尼菲青霉菌培养阳性率由高到低依次为:血液、组织或脓液、骨髓.使用氟康唑、伊曲康唑及两性霉素B单独或联合治疗,以两性霉素B联合伊曲康唑口服疗效最佳.结论:广西壮族自治区PSM好发于AIDS患者,临床表现不典型,两性霉素B治疗效果肯定:合并AIDS的PSM患者与非AIDS患者在临床表现、治疗和预后有所不同.     

有银屑病表现的艾滋病1例

报告以银屑病为表现的艾滋病1例。患者，女，27岁。全身鳞屑性红色斑丘疹半年余。皮肤组织病理符合银屑病改变；人免疫缺陷病毒（HIV）初筛实验（ELISA）及确证实验（Western blot)阳性；CD4细胞计数下降；CD4／CD8＜1。患者于诊断为艾滋病半年后死亡。     

硝酸益康唑与曲安奈德霜治疗体股癣

我们自 1998年 5～ 10月用质量分数为 1％硝酸益康唑与 0.1％曲安奈德霜 (商品名为派瑞松 )治疗 30例体股癣患者，并以联苯苄唑霜作为对照。现将结果报道如下。 一、材料与方法 (一 )试验设计与方法：采用随机配对、开放对照的方法，按随机表分成试验组及对照组。试验用药为派瑞松，由西安杨森制药有限公司提供 (批号 7E0895)。对照用药为 1％联苯苄唑霜。取适量霜剂外用于患处每日 2次，疗程 2周。 (二 )病例选择：年龄在 18～ 75岁之间的男女体股癣患者，具有典型的临床症状，真菌镜检及培养阳性。 1个月内未系统应用抗真菌药，半个月…     

艾滋病合并中毒性表皮坏死松解症2例

例1男,27岁,全身大疱性皮损伴破溃及少许渗液,并出现颜面肿胀4 d,意识障碍5 h。患者10年前确诊HIV抗体阳性,未接受抗HIV治疗。1周前患者因“癫痫”控制不佳,开始“丙戊酸钠片”抗癫痫治疗。结合实验室检查诊断：中毒性表皮坏死松解症、艾滋病等。停用“丙戊酸钠”,同时静注人免疫球蛋白(pH4)22.5 g/d[0.4 g/(kg·d)]共5 d治疗,氢化泼尼松40 mg 2次/d[1.5 g/(kg·d)]抗炎,予五水头孢唑林钠抗细菌,更昔洛韦抗疱疹病毒及对症治疗。例2男,45岁,全身多发大疱样皮损,部分皮肤破溃,伴大量渗液,部分伴有少量脓性分泌物,少量渗血,咽痛、咳嗽、咳少量白色黏痰、吞咽困难,发热,最高40.2℃。患者入院前3个月确诊HIV抗体阳性,CD4细胞21个/μL,HIV-1 RNA 5.23×10^-5 CPs/mL,入院前1个月开始抗HIV治疗,方案：拉米夫定+富马酸替诺福韦+依非韦伦。血单纯疱疹病毒DNA、巨细胞病毒DNA阴性。床旁胸片：双下肺散在片状影,考虑感染可能。主要诊断：中毒性表皮坏死松解症、全身皮肤细菌感染、细菌性肺炎、艾滋病。停用全...     

Disseminated histoplasmosis in a patient with AIDS: case report and review of the literature

Disseminated histoplasmosis was uncommon prior to the AIDS epidemic, and cutaneous eruption rarely was seen. Since the onset of the worldwide AIDS epidemic, histoplasmosis has become a more common opportunistic fungal infection and should be considered in the differential diagnosis of mucocutaneous lesions in patients with AIDS in endemic areas. We report a case of classic disseminated histoplasmosis in a patient with AIDS and discuss the epidemiology, clinical presentation, pathogenesis, laboratory and histopathologic findings, and treatment options for disseminated histoplasmosis.     

Disseminated ecthymatous herpes varicella-zoster virus infection in patients with acquired immunodeficiency syndrome

Herpesvirus infections are among the most common and debilitating opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS), and they may have atypical clinical features. We describe the cases of three patients with AIDS in whom atypical persistent ulcerative skin lesions developed as a result of varicella-zoster virus infection. Two patients had disseminated infection without a vesicular stage; one patient had underlying asteatotic eczema. All responded well to acyclovir. One patient was treated with azidothymidine, and typical dermatomal herpes zoster subsequently developed. The profound loss of helper T cell function in AIDS may lead to multiple abnormalities in local immune response to cutaneous herpesvirus infections and may be responsible for the atypical morphology and a prolonged course.     

Physicians'' perceived value of international AIDS conferences and attitudes towards patient attendance.

OBJECTIVE--To determine the perceived value of attendance at an International AIDS Conference and attitudes towards the effect of patient attendance on the conference. DESIGN--A confidential, self-administered questionnaire. PARTICIPANTS--102 physicians from the United Kingdom who attended the VIII International AIDS Conference in Amsterdam. RESULTS--There was an 84% response rate. 50% reported increased motivation for clinical work and 57% for research. Physicians with a lower HIV positive patient workload found the conference more valuable for finding out the latest information on HIV, compared with those with a higher workload (p = 0.04). Those with a higher patient workload found the conference more useful for increasing motivation for research than those with a lower HIV workload (p = 0.047). Conference attendance was felt to reduce burnout by 48% of respondents. The majority (55%) would prefer a more traditional meeting. Patient attendance was seen as improving the standard of discussion of ethical and political issues but not on medical or scientific issues. CONCLUSIONS--The International AIDS Conferences are perceived as useful by those UK physicians who attend, but most would prefer a more "traditional" scientific meeting. Whilst patient participation was not seen as useful for medical or scientific discussions, it was felt to improve discussion of ethical and political issues. A smaller more focused conference may be equally useful to UK physicians.     

Cutaneous manifestations of measles in AIDS

In immunocompetent patients, infection by the measles (rubeola) paramyxovirus produces fever, cough, coryza, Koplik's spots, and, on the skin, a macular erythema that can become confluent. The erythema has a striking cephalocaudal spread and clearing. The diagnosis of measles on a skin biopsy and the distinction from an erythema multiforme type of drug eruption can be difficult. We studied a skin biopsy from a patient with the acquired immunodeficiency syndrome (AIDS) who presented with measles. In contrast to erythema multiforme, the measles biopsy has necrosis of clusters of keratinocytes in the high spinous layer and granular layer of the epidermis, whereas erythema multiforme has necrosis of basal keratinocytes. Multinucleated keratinocytes may or may not be prominent in the measles biopsy. Cytoplasmic swelling of the keratinocytes in the granular layer may be present even when multinucleated cells are sparse. Immunoperoxidase reactivity for measles virus protein is present in intranuclear inclusions and in the cytoplasm of infected upper spinous keratinocytes. There were more cells with positive staining in the biopsy from the AIDS patient than in another biopsy from an immunocompetent patient with measles. The AIDS patient was seronegative for measles throughout the course of the illness. The examination of the skin biopsy can be very important in the diagnosis of measles in AIDS patients or immunocompromised patients who may not develop the usual diagnostic serology.     

Epidemiology of cryptosporidiosis among European AIDS patients.

OBJECTIVE: To study epidemiology and possible risk factors associated with the development of cryptosporidiosis among European patients with AIDS. METHODS: An inception cohort of 6548 patients with AIDS, consecutively diagnosed from 1979 to 1989, from 52 centres in 17 European countries was studied. Data on all AIDS defining events were collected retrospectively from patients' clinical records. Kaplan-Meier estimates, log rank tests and Cox proportional hazard models were used to examine for possible risk factors associated with cryptosporidiosis. RESULTS: Cryptosporidiosis was diagnosed in 432 (6.6%) patients, 216 at time of the AIDS diagnosis and 216 during follow-up. The probability of being diagnosed with cryptosporidiosis at AIDS diagnosis was significantly lower for intravenous drug users (1.3%) than for homosexual men (4.1%) and for patients belonging to other transmission categories (4.0%) (p < 0.001). The probability was also higher for patients from Central Europe compared with patients from South Europe (4.1% versus 2.5%, p = 0.005). The rate of developing cryptosporidiosis after the diagnosis of AIDS was 3 per 100 patient years of follow-up. The rate was significantly lower for intravenous drug users than for homosexual men (relative risk 0.34, 95% confidence limits 0.22-0.54) and for women compared with men (RR 0.43 (0.21-0.87)). The risk was higher in North Europe than in South and Central Europe. In a multivariate analysis only transmission category remained a significant predictor for the development of cryptosporidiosis. CONCLUSION: The development of cryptosporidiosis in AIDS patients may be associated with sexual risk behaviour.     

Cutaneous cryptococcosis resembling molluscum contagiosum in a patient with AIDS

A 29-year-old Haitian man with the acquired immune deficiency syndrome (AIDS) developed disseminated cryptococcosis with an unusual cutaneous presentation. He had numerous hypopigmented papules over his face that clinically resembled molluscum contagiosum. To our knowledge, cutaneous cryptococcosis resembling molluscum contagiosum has not been previously reported. The patient had a T-cell defect consistent with AIDS and belonged to a high-risk group. To our knowledge, this is the second report of cutaneous cryptococcosis in a patient with AIDS.     

Progressive disseminated histoplasmosis in acquired immune deficiency syndrome: presentation as a steroid-responsive dermatosis

We describe a patient with acquired immune deficiency syndrome (AIDS) and disseminated histoplasmosis. He presented with a mild inflammatory dermatitis that improved with topical steroid treatment but was proven to be cutaneous histoplasmosis. The clinical presentations, diagnosis, histopathologic basis, and treatment of disseminated Histoplasma capsulatum in patients with AIDS are discussed.     

艾滋病合并结核病98例临床分析

目的了解艾滋病(AIDS)合并结核病的流行病学特征,为艾滋病合并结核病的防治提供依据。方法回顾性分析98例艾滋病合并结核病者的临床资料。结果艾滋病合并结核病患者主要集中在20～39岁,20～29岁和30～39岁者分别占34.69%和33.67%;农民比例最大(88.78%);小学、初中、高中或中专、大专及以上分别占50.00%,33.67%,14.29%和2.04%;治疗后总存活70例(占71.43%)。结论加强农民工艾滋病的健康教育和行为干预,可减少艾滋病并发结核病的发生。     

Primary adenoid cystic carcinoma of the skin

Vitiligo and other autoimmune disorders are increasingly being reported in a background of immunosuppression. Viral-induced immune activation and molecular mimicry are the proposed mechanisms for the development of autoimmune diseases in individuals infected with human immunodeficiency virus (HIV). An association of vitiligo with Kaposi sarcoma (KS) rarely has been reported. The development of vitiligo preferentially around KS lesions in a patient with AIDS is unusual. We report a case of disseminated vitiligo that developed around KS nodules in a patient with AIDS.