获得性免疫缺陷综合征误诊为肺结核

1　病例资料男 ,35岁。因反复发热、咳嗽 5个月 ,加重 10天 ,于1999年 6月 11日以发热待查入院。患者于同年 1月始发热伴阵发性干咳 ,体重渐减轻 ,无胸痛、咯血。 2月初住当地医院 ,摄 X线胸片示心肺正常 ,淋巴结活检未见异常 ,经抗感染治疗 7天热退 ,咳嗽减轻出院。出院后上述症状反复出现 ,近 10余天加重。患者既往曾在巴西工作 10年 ,因患慢性乙型肝炎 ,在巴西输过白蛋白 ,否认冶游和吸毒史。查体 :体温 39.5℃。头面部有白斑 ,躯干、四肢皮肤散在暗红色斑丘疹和色素沉着 ,颈、双侧腋下和腹股沟处可扪及 1～ 2枚蚕豆大小的淋巴结 ,质软…     

获得性免疫缺陷综合征误诊为肺炎

1 病例资料 男,43岁。主因咳嗽、咳痰、发热伴消瘦2个月入院。入院前曾在外院按“肺炎”应用多种抗生素治疗,症状无缓解,且出现胸闷、憋气,不能平卧,于1998年2月21日转入我院。患者于10年前到过坦桑尼亚,患曾“疟疾”,已治愈。无心脏病、慢性支气管炎、肺结核病史。无输血及应用血液制品史。否认冶游、吸毒及同性恋史。查体：体温38.6℃,脉搏120/min,呼吸40/min,血压98/58 mmHg。发育正常,营养中等,半卧位,急性热病容,意识清,皮肤、粘膜无黄染及出血点。浅表淋巴结未触及。巩膜无黄染,瞳孔等大等园,光反射灵敏。口唇轻度发绀,扁桃体Ⅱ度肿大,轻度充血,颈静脉充盈,颈软,无抵抗。气管居中,甲状腺不大,胸廓无畸形,呼吸动度相等,语颤对称,叩诊清音,肺肝界位于右锁骨中线第5肋间,左肺底闻及少许湿罗音。心界不大,心率120/min,律齐,各瓣膜区未闻及杂音,腹软无压痛,肝脾未触及,腹水征(-),双下肢水肿,浅感觉正常,病理反射未引出。实验室检查：血红蛋白115 g/L,白细胞1.4×109/L,中性粒细胞0.87,红细胞沉降率100 mm/h,乙型肝炎表面抗原(-),丙氨酸转氨酶(ALT)150 U/L,胆红素26 μmol/L,冷凝集试验(-),保罗试验(-);血气分析：pH 7.491,PaCO2 32.5 mmHg,PaO2 53.5 mmHg,HCO－3 24 mmol/L,BE 0.9 mmol/L;血纤维蛋白原9.5 g/L,C反应蛋白96 ng/L,免疫球蛋白IgG 1.73 g/L,IgA 5.73 g/L,IgM 2.03 g/L,C3 1.57 g/L,C4 1.01 g/L,血疟原虫(-),血培养(-),类风湿因子、抗核抗体、肥达反应及外裴反应均(-),痰结核菌(-),骨穿报告为感染性骨髓象。X线胸片示两肺纹理增强、紊乱,两下肺野可见片状模糊影,边界不清,密度不均。心电图示窦性心动过速。诊断：①肺炎;②急性左心功能不全;③急性呼吸窘迫综合征(ARDS)。给予面罩吸氧,先后予头孢他啶、环丙沙星、甲硝唑、阿米卡星抗感染,并予强心、利尿治疗,病情不见缓解。因不能排除结核,加用利福平、异烟肼抗结核治疗,仍无效。粗筛抗HIV(+),将血标本送外院经免疫印迹法检测,抗HIV(+),确诊为获得性免疫缺陷综合征(艾滋病)。     

获得性免疫缺陷综合征及人免疫缺陷病毒感染43例误诊

我院 1998年 9月～ 2 0 0 1年 10月在住院病人中发现人免疫缺陷病毒 (ＨＩＶ)感染者及获得性免疫缺陷综合征 (ＡＩＤＳ ,又称艾滋病 )共 4 3例。现将有关资料进行总结分析 ,以进一步提高对ＡＩＤＳ的认识。1　临床资料1 1　一般资料　本组男 38例 ,女 5例 ;年龄 2 1～30岁 2 7例 ,31～ 4 0岁 12例 ,4 1～ 4 8岁 3例 ,6 8岁1例 ,平均 2 8 9岁。职业 :农民 14例 ,无业人员10例 ,个体经营者 8例 ,干部 6例 ,一般职员 5例。文化程度 :大专 2例 ,中学 30例 ,小学 8例 ,文盲3例。本组均经 2次抗 ＨＩＶ粗筛 (酶联免疫法 )阳性 ,再经省防疫部门蛋…     

获得性免疫缺陷综合征一例误诊

【病例】　女 ,3 1岁。因久治不愈的瘙痒性皮疹 ,在数家医院多次治疗 ,效果不佳入我院。患者自觉一般情况好 ,无发热、咳嗽及腹泻等全身症状。系统检查未见异常。专科检查 :双颌下、颈部及躯干部见数 10个圆锥形丘疹 ,直径约 5ｍｍ ,尖顶 ,中央脐凹状损害不明显 ,可挤出软疣小体。咽红 ,舌背见白色膜状鹅口疮 ,取样镜检 ,见有大量孢子 ,培养有白色念珠菌生长 ,双侧耳后淋巴结及颈淋巴结均未触及。胸部Ｘ线摄片无异常。实验室检查 :血、尿及粪常规未见异常 ,肝功能正常 ;酶联免疫吸附试验(ＥＬＩＳＡ)检测人类免疫缺陷病毒 (ＨＩＶ) /1抗体 (…     

获得性免疫缺陷综合征误诊4例分析

1　病例资料例 1,男 ,38岁。因发热、剧烈头痛半个月入院。病初曾在院外行脑脊液检查 ,诊断为“病毒性脑炎”,经治疗病情无好转。入院后再行脑脊液检查 ,涂片墨汁染色检出隐球菌 ,即查人类免疫缺陷病毒 (HIV )抗体 (抗 - HIV) ,结果阳性。遂诊断获得性免疫缺陷综合征 (AIDS)即艾滋病。 1周后自动出院 ,出院后 2 0余天死于家中。例 2 ,男 ,4 8岁。因咳嗽、咳痰、发热伴右侧胸痛 4天入院。查 :双肺底可闻及湿 口罗音 ,血白细胞 1.8× 10 9/ L ,中性粒细胞0 .89,淋巴细胞 0 .11,X线胸片示双下肺大片状模糊影。初诊肺部感染。先后给予氧哌…     

获得性免疫缺陷综合征误诊为慢性结肠炎

【病例】　男 ,38岁。近 1个月来无规律发热 ,反复出现脐周及中上腹胀痛 ,阵发性加剧 ,每排稀糊状大便后腹痛可稍缓解 ,大便无脓血。既往无吸毒史 ,无手术及输血史 ,有冶游史。查体 :体温 37.5℃ ,脉搏 92 /ｍｉｎ ,呼吸 2 3/ｍｉｎ ,血压 10 5 /70ｍｍＨｇ。营养中等 ,皮肤无皮疹 ,浅表淋巴结不大。咽充血 ,扁桃体不大。腹平软 ,无肌紧张 ,脐周及中上腹压痛 ,肝脾不大 ,肠鸣音正常。粪常规正常。初诊为慢性结肠炎 ,入院后给予多种抗生素治疗无效。粪培养示无细菌生长 ;纤维结肠镜检查示大肠粘膜未见异常。入院后 2 1天做获得性免疫缺陷综合…     

小儿获得性免疫缺陷综合征2例误诊分析

例1 患儿，男，3．5岁，因急剧消瘦1月，咳嗽10余天，发热4d，于2002年11月6日入院。患儿来自农村，母乳喂养至1岁。1岁起因反复肺部感染、发热、腹泻，曾先后住院3次。1月前出现进食后上腹疼痛，不思饮食，体重由12．5k迅速下降，10余天前出现咳嗽，近4d发热，无寒战。入院查：慢性病容，消瘦，Ⅲ度营养不良，体重9k，T38℃，浅表淋     

获得性免疫缺陷综合征与梅毒

2 0 0 0年卫生部发出的《临床输血技术规范》通知中列出了输血者在输血前应作经血传播疾病的检查 ,其中包括献血员筛查中的 4项检验 :乙型肝炎表面抗原 (HBsAg)、抗丙型肝炎病毒抗体 (抗 HCV)、抗人类免疫缺陷病毒抗体 (抗 HIV)和梅毒检验。由于当前科技水平的限制 ,输血时仍可能发生某些不能预测或不能防止的输血传染病 ,因此输血前有必要进行以上各项检查 ,以了解受血者的有关情况。为了使读者对这 4项检查的临床意义和技术要点有进一步的了解 ,本期刊登了这一专辑。HBsAg和抗HCV是检验科经常检查的项目 ,在《乙型肝炎病毒感染和丙型肝炎病毒感染的实验室检查》一文中叙述了检测方法的要点和进展。艾滋病和梅毒这两种性传播性疾病的流行病学和检测方法的进展颇受同道们关注 ,在《获得性免疫缺陷综合征与梅毒》一文中作了较全面的介绍。另外刊登的几篇有关文章 ,颇有参考价值。在输血前进行这 4项检查时试剂的选用极为重要。献血员筛查时必须应用卫生部批批检的试剂 ,这一原则也适用于输血前检查。为保证检验质量 ,实验室还须注意有关的规定和技术操作的正确性。希望读者对这一专辑提出宝贵意见。     

获得性免疫缺陷综合征致脑脓肿

【病例】　男 ,3 3岁。因发热、头痛、恶心、呕吐、左侧肌力降低 4余月 ,于 2 0 0 0年 5月 15日入我院。患者于 3个月前无明显诱因发热 ,体温 3 7～ 3 9℃ ,自觉疲软、乏力、多汗、食欲缺乏。对症处理及口服、静脉滴注多种抗生素均无明显效果。 1个月后病人出现右侧肌力进行性降低 ,伴头痛、恶心、喷射状呕吐 ,颈部不能前曲。头部ＣＴ检查诊断为左侧脑脓肿。住院对症治疗1月余 ,未见明显效果 ,故来我院要求手术治疗。自 1999年起有吸食海洛因史 1年。 2 0 0 0年元月已戒。否认输血液制品史。查体 :体温 3 9℃ ,呼吸 2 1/ｍｉｎ ,血压 12 0 /…     

HIV infection and AIDS during adolescence

It is clear from the evidence that a growing number of adolescents are acquiring HIV infection and developing AIDS. The impact this epidemic will have on all teenagers is overwhelming. Given the high prevalence of risk-related sexual behaviors, many adolescents are likely to become HIV infected, thus requiring extensive medical and psychosocial services. Other adolescents will lose a parent, relative, or friend to AIDS, and these adolescents will similarly require special services and psychological counseling. Thus, there is an immediate need for the development of methods for (1) providing all adolescents with age-appropriate and culturally relevant interventions for prevention and risk reduction, (2) identifying high-risk adolescents and triaging them to different levels of care and risk reduction counseling, and (3) providing ongoing medical and psychosocial treatments. Accessing adolescents at risk for HIV infection will require networking between the health care system and youth-serving and community-based agencies, particularly agencies servicing high-risk adolescents. We must begin addressing these needs now, in order to prevent further infection and to provide appropriate care for those adolescents who are or will become infected with HIV.     

HIV infection and AIDS in Austria

AIDS is a notifiable disease in Austria. Until August 31, 1989, a total of 324 cases were recorded, with 145 deaths. Since 1988, the annual doubling of cases that was initially found is no longer observed. Centralization of confirmatory testing of samples that are positive in the ELISA permits us to follow up the incidence and prevalence of HIV infections. By September 15, 1989, a total of 3,071 persons were found to be infected. The highest rates of AIDS patients and seropositive individuals were recorded in Vienna (151/1,712), followed by Upper Austria (63/606) and the Tyrol (29/367). Among those found to be positive since October 1987, 28% are homo- or bisexual and 42% are i.v. drug addicts. About 4% of men and women report heterosexual contacts as the likely mode of infection. Since 1986 the yearly incidence of HIV infection appears to be decreasing. This development corresponds with a decline in other sexually transmitted diseases (gonorrhoea, hepatitis B) and indicates a change in the sexual behaviour of the population.     

Stroke in HIV infection and AIDS

HIV/AIDS appears to increase the risk of both ischemic and hemorrhagic stroke. This increased risk is most apparent in the young HIV-infected population in which other risk factors for stroke are seldom evident. Mechanisms underlying the increased risk include opportunistic infectious meningitides and vasculitides, primary HIV vasculopathy, altered coagulation and cardioembolic events, although the cause may be multifactorial or remain cryptic. With better control of HIV via effective, highly active antiretroviral therapy, the role of many of these risks has been mitigated, only to be supplanted by an aging population with more conventional atherosclerotic risk factors magnified by the hyperlipidemia attending the use of protease inhibitors. Selecting the appropriate therapy for treating stroke in the HIV-infected patient is dependent on diagnostic rigor in identifying its underlying etiology.     

The work of clinical nurse specialists (HIV/AIDS) in areas with a low prevalence of HIV infection

The role of the clinical nurse specialists (HIV/AIDS) who work in areas with a low known prevalence of HIV is considered and their contribution to patient care, either directly or indirectly through the education and support of other health care workers, is discussed. Attention is given to the implications for nursing practice and the role of the clinical nurse specialist associated with the relative infrequency of contact with patients who have HIV disease; and some of the issues for people living with HIV/AIDS in rural areas are alluded to. Finally, some of the limitations of the clinical nurse specialist role are delineated and some consideration is given to the future role of clinical nurse specialists for HIV and AIDS.     

Simplified regimens for treating HIV infection and AIDS

PURPOSE: To review the variables that greatly affect adherence to the complex treatment regimens used in HIV disease and to examine available options that could improve patient outcomes. DATA SOURCES: Comprehensive review of current medical and scientific literature, drug-prescribing literature, and randomized clinical trials of drug treatments. CONCLUSIONS: Effective treatment of HIV infection is dependent on consistent adherence to prescribed antiretroviral medications. A large pill burden, multiple daily doses, and adverse events are some of the complexities that negatively impact patient adherence. For example, lipodystrophy and hyperlipidemia are two serious side effects associated with some agents. Once-daily antiretroviral agents offer many advantages over historical treatment options but are associated with possible drawbacks. IMPLICATIONS FOR PRACTICE: Currently, four single agents are available for once-daily administration, and a few others are under investigation. In addition, combination therapy with either dual or boosted protease inhibitor regimens is becoming a popular way of overcoming the poor pharmacokinetic characteristics of individual protease inhibitors.     

Darunavir (Prezista) for HIV infection

Darunavir (Prezista--Tibotec), a new protease inhibitor, has received accelerated approval from the FDA for use in combination therapy of human-immunodeficiency-virus (HIV) infection in previously treated adults. It is coadministered with low-dose ritonavir (Norvir), which increases its bioavailability.     

HIV infection and AIDS 2: transmission and diagnosis

This is a two-part unit on HIV infection and Aids. Part 1 reviewed the evolving global and national epidemiology of HIV infection and Aids. This second part examines routes of transmission, diagnosis and antiretroviral treatment.