肝硬化消化道出血院内感染的危险因素及其临床意义

目的探讨肝硬化消化道出血患者院内感染的危险因素及其临床意义。方法收集重庆医科大学附属第二医院2009年10月-2014年1月肝硬化并发消化道出血患者的临床资料,分析院内感染、再出血的高危因素,预防性使用抗生素对院内感染及再出血的影响。结果 (1)肝硬化消化道出血患者院内感染率20.9%,同期因肝硬化入院未并发消化道出血患者院内感染发生率5.5%(P0.01);(2)感染组与非感染组比较,两组患者在白细胞计数、Child-Pugh分级、出血方式、有无使用抗生素、院内再出血方面差异有统计学意义(P0.05);(3)再出血患者与无再出血患者相比,两组患者在年龄、白细胞计数、Child-Pugh分级、院内感染方面差异有统计学意义(P0.05);(4)预防性使用抗生素组与未预防性使用抗生素组院内感染率分别为11.3%、27.8%,差异有显著统计学意义(P0.01);再出血率分别为13.0%、12.0%,差异无统计学意义(P0.05);(5)预防性使用抗生素能够明显降低肝硬化呕血患者院内感染率,抗生素组与非抗生素组院内感染率分别为13.4%、37.0%,差异有统计学意义(P0.01);预防性使用抗生素对黑便患者院内感染率没有明显影响,抗生素组与非抗生素组院内感染率分别为12.1%、6.1%,差异无统计学意义(P0.05);(6)预防性使用抗生素对Child-Pugh A级肝硬化消化道出血患者院内感染发生率没有明显影响,抗生素组与非抗生素组院内感染率分别为7.9%、13.6%,差异无统计学意义(P0.05);预防性使用抗生素能够明显降低Child-Pugh B~C级肝硬化伴消化道出血患者院内感染率的发生,抗生素组与非抗生素组院内感染率分别为13.0%、38.0%,差异有统计学意义(P0.01);(7)多因素分析显示呕血、Child-Pugh分级高、白细胞计数高为院内感染危险因素。结论肝硬化消化道出血增加院内感染发生率,ChildPugh分级高、白细胞计数高、呕血为院内感染独立危险因素,高龄、Child-Pugh分级高是院内再出血的高危因素,Child-Pugh B~C级肝硬化呕血患者推荐入院时预防性使用抗生素。     

获得性免疫缺陷综合征合并肺结核临床特征与T细胞亚群的相关性分析

目的 探讨获得性免疫缺陷综合征合并肺结核(AIDS/PTB)双重感染的类型,影像特征及临床表现为PTB菌阴及菌阳时,患者T细胞亚群计数的差异及意义.方法 回顾性分析93例AIDS/PTB双重感染患者的类型,影像特征及临床表现分别为PTB菌阴及菌阳时,检测其T细胞亚群水平并进行统计学比较.结果 ①CD4+细胞计数与结核病的发病率成反比,当CD4+＜50×106/L时,结核的发病率明显上升(67.74%,63/93).②影像特征不典型的PTB病例CD4+T细胞计数为(47.79±32.17)×106/L,影像特征典型的PTB病例CD4+T细胞计数为(95.3456±64.89)×106/L.二者之间CD4+T细胞计数差异有统计学意义(P＜0.01).③不同临床表现患者CD4+T细胞计数差异有统计学意义,PTB菌阴组患者明显高于PTB菌阳组患者(P＜0.02),CD8+T细胞计数比较差异无统计学意义(P＞0.05).结论 AIDS/PTB感染患者临床特征与其T细胞亚群计数相关.     

核糖核酸注射液联合胸腺五肽对晚期非小细胞肺癌化疗患者免疫功能的影响

目的 探讨核糖核酸注射液联合胸腺五肽对晚期非小细胞肺癌化疗患者免疫功能的影响.方法 将72例晚期非小细胞肺癌患者分为对照组和研究组,每组36例.对照组采用常规TC(紫杉醇与卡铂)化疗方案;研究组在对照组治疗基础上给予核糖核酸注射液联合胸腺五肽治疗.对比2组近期疗效及不良反应发生情况;于治疗前、后检测2组患者免疫功能指标的变化.结果 研究组有效率显著高于对照组(66.67％ vs41.67％,x2=4.532,P＜0.05).2组治疗后CD3、CD4、CD4/CD8均低于治疗前(P值均＜0.05);对照组治疗后CD8高于治疗前(P＜0.05);治疗后研究组CD3、CD4、CD4/CD8均高于对照组,CD8低于对照组,差异有统计学意义(P值均＜0.01).对照组治疗后IgA、IgG、IgM水平均低于治疗前(P值均＜0.01);研究组治疗前、后IgA、IgG、IgM水平比较差异无统计学意义;治疗后研究组IgA、IgG、IgM水平均高于对照组(P值均＜0.01).研究组的生存质量显著优于对照组(Z =2.753,P＜0.05).研究组恶心呕吐、白细胞减少、感染的发生率均低于对照组(x2值分别为4.576、4.079、4.345,P值均＜0.05).结论 核糖核酸注射液联合胸腺五肽能显著提高晚期非小细胞肺癌化疗患者免疫功能,降低不良反应的发生.     

双重膜滤过式血浆置换治疗系统性红斑狼疮近期疗效观察

目的 评价双重膜滤过式血浆置换(DFPP)对系统性红斑狼疮(SLE)的临床疗效.方法 选取1998-04-30-2006-04-20于中国医科大学附属第一医院肾内科住院的50例SLE患者,随机分为DFPP组(治疗组25例)与非DFPP组(对照组25例).治疗组全部应用DFPP治疗,同时予激素和(或)免疫抑制剂治疗.对照组予激素和(或)免疫抑制剂治疗.治疗时间为2～3周.结果 治疗组治疗后补体CA、白蛋白升高,IgG、IgA、IgM、γ-球蛋白、红细胞沉降率下降,与治疗前比较差异均有统计学意义(P＜0.05).对照组仅IgG、红细胞沉降率治疗前后差异有统计学意义(P＜0.05).治疗后治疗组与对照组相比,ANA抗体及ds-DNA抗体差异有统计学意义(P＜0.05).治疗组好转率显著高于对照组(P＜0.05).结论 DFPP联合激素和(或)免疫抑制剂治疗SLE可改善血生化指标,降低自身抗体,提高临床疗效.     

人类免疫缺陷病毒和丙型肝炎病毒重叠感染者的临床及免疫特征

目的 观察人类免疫缺陷病毒(HIV)和HCV重叠感染者与慢性丙型肝炎患者临床特征及HCV特异性细胞毒性T淋巴细胞(CTL)的数量及功能,探讨两组患者免疫功能的差异及其可能的影响因素.方法 以HIV和HCV重叠感染患者59例、慢性丙型肝炎患者36例为研究对象,取治疗前外周血检测肝脏生物化学指标、血常规、外周血T淋巴细胞亚群(CD4+T、CD8+T淋巴细胞计数)及HIV、HCV病毒载量,以酶联免疫斑点法检测HCV特异性CTL的数量和功能,统计学分析两组问免疫功能的差异及与上述检测指标的相关性. 结果 中国河南省有偿献血、单采血浆人群HIV感染者中HIV和HCV重叠感染率达60.8%.ALT、AST值在重叠感染组与HCV组间差异无统计学意义;球蛋白在重叠感染组为(40.3±5.8)g/L,HCV组为(32.8±6.3)g/L,差异有统计学意义(P＜0.01).重叠感染组外周血CD4+T淋巴细胞数明显低于HCV组(P＜0.01),而CD8+T淋巴细胞数高于HCV组(P＜0.01).重叠感染组HCV RNA定量高于HCV组(P＜0.01).重叠感染组对HCV-NS3区肽段的反应强度(每106个外周血单个核淋巴细胞中斑点形成细胞的个数)较HCV组弱,649.34±685.90对比1233.70±1085.16,差异有统计学意义(P＜0.05).重叠感染组白蛋白与HCV病毒载量呈现负相关(r=0.540);重叠感染组对HCV-NS3区肽段反应强度与HIV病毒载量负相关(r=0.356);重叠感染患者CD4+T淋巴细胞数与血小板正相关(P＜0.05).但未见重叠感染组HCV RNA与CD4+T淋巴细胞数量及HIVRNA水平有相关关系.结论 重叠HIV感染有利于HCV的复制,而HIV载量可影响针对HCV的特异性免疫反应,HIV载量高则不利于HCV的清除.慢性丙型肝炎患者重叠HIV感染时,病情易慢性化,预后更差.     

血清降钙素原在慢性阻塞性肺疾病急性加重期抗菌治疗中的指导作用

目的 探讨降钙素原(PCT)在慢性阻塞性肺疾病急性加重期(AECOPD)抗生素治疗中的指导作用. 方法 入选72例AECOPD患者.随机分成PCT组(40例)和常规治疗组(32例).PCT组患者根据血清PCT水平决定抗生素的使用和停用,如PCT＜0.25μg/L停用抗生素;常规治疗组患者由主治医师根据临床症状决定抗生素的使用.主要观察指标为抗生素的使用率、抗生素使用时间、住院天数、临床有效率、二重感染、加重以及死亡例数等. 结果 PCT组患者临床治疗有效率82.5％,与常规治疗组75.8％比较,差异无统计学意义(x2=0.217,P=0.641),但是PCT组患者抗生素使用率47.5％,较常规治疗组71.9％明显降低(x2=4.346,P=0.037),抗生素平均使用天数也更短[(6.8±3.3)d与(10.2±3.7)d,t=3.116,P=0.003],PCT组患者住院天数(11.7±5.2)d较常规治疗组患者(20.3±8.7)d更短(t=5.202,P=0.000).两组的二重感染的发生率(2.5％与18.8％,x2=3.657,P=0.056)、加重例数(3例与4例,x2=0.097,P=0.756)、死亡率(2.5％与6.3％,x2 =0.039,P=0.843)差异无统计学意义. 结论 PCT可能是指导AECOPD抗生素使用的一项较合适的指标,能有效降低抗生素的不合理使用,降低二重感染,减少住院时间.     

脂阿拉伯甘露糖抗体检测对AIDS合并肺结核患者的诊断价值

目的 探讨脂阿拉伯甘露糖(lipoarabinomanna,LAM)抗体检测在获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)合并肺结核患者中的诊断价值.方法 收集我院2013年3月至2016年3月就诊的AIDS感染肺结核患者38例(研究组)及无肺结核的AIDS患者38例(对照组),对两组患者均进行LAM抗体检测及PPD试验,比较两组患者LAM抗体阳性率及PPD阳性率.同时对所有患者行CD4+T淋巴细胞计数.根据CD4+T淋巴细胞计数,将研究组患者进一步分为CD4+T淋巴细胞≥200/μl组和CD4+T淋巴细胞＜200/μl组,比较两组患者LAM抗体阳性率及PPD阳性率.比较LAM抗体检测及PPD试验对AIDS合并肺结核的诊断价值.结果 研究组患者LAM抗体检测阳性率为84.2％,对照组LAM抗体检测阳性率为l0.5％,两组患者比较差异有统计学意义(P＜0.05).研究组患者PPD阳性率为42.1％较对照组(23.7％)高,但差异无统计学意义(P＞0.05).CD4+T淋巴细胞≥200/μl组患者LAM抗体阳性率92.9％,较CD4+T淋巴细胞＜200/μl组(79.2％)高,但差异无统计学意义(P＞0.05).CD4+T淋巴细胞≥200/μl组患者PPD阳性率为92.9％,较CD4+T淋巴细胞＜200/μl组(12.5％)高,且差异有统计学意义(P＜0.05).LAM抗体检测诊断AIDS合并肺结核的敏感度为84.2％,特异度为89.5％,阳性预测值为94.1％、阴性预测值为85.7％、阳性似然比为15.9、阴性似然比为0.17.LAM抗体诊断AIDS合并肺结核阳性似然比＞10,即表示LAM抗体诊断AIDS合并肺结核的可能性显著增加.结论 LAM抗体检测在AIDS患者合并肺结核的诊断中特异度及敏感度高,有利于AIDS合并肺结核患者的诊断.值得临床进一步地推广应用.     

乙型肝炎病毒感染者不同疾病阶段外周血T淋巴细胞表面程序性死亡受体-1及血清细胞因子的表达

目的 探讨HBV感染后不同疾病阶段(免疫耐受期、免疫清除期、非活动携带状态)患者T淋巴细胞表面程序性死亡受体-1(PD-1)和血清细胞因子的表达差异.方法 2011年4月至2011年9月无锡市第五人民医院住院或门诊的HBV感染者105例,HBV感染后免疫耐受期、免疫清除期、非活动携带状态患者各35例,另选20名健康人作为对照组.收集研究对象的外周血,流式细胞术检测CD4+T淋巴细胞、CD8+T淋巴细胞表面PD-1的表达水平,ELISA检测血清IL-10、IFN-γ的表达水平.数据处理采用t检验,相关性分析采用Pearson相关分析.结果 HBV感染组CD8+T淋巴细胞表面PD-1表达水平为(12.35±3.48)％,高于健康对照组的(4.65±1.21)％(t=9.76,P＜0.01);HBV感染组CD4+T淋巴细胞表面PD-1表达水平为(4.95±2.87)％,健康对照组为(4.08±2.14)％,两组比较差异无统计学意义(t=1.29,P＞0.05).免疫耐受组、免疫清除组、非活动携带组CD8+T淋巴细胞表面PD-1表达水平分别为(15.87±3.18)％、(7.69±3.64)％和(10.12±2.84)％,均高于健康对照组(t值分别为15.12、3.61和8.17,均P＜0.01),免疫耐受组CD8+T淋巴细胞表面PD-1表达水平高于免疫清除组(t=10.01,P＜0.01).慢性乙型肝炎患者外周血CD8+T淋巴细胞表面PD-1表达水平与IL-10呈正相关(r=0.377,P＜0.05),与IFN-γ呈负相关(r=-0.620,P＜0.05).结论 慢性乙型肝炎患者外周血CD8+T淋巴细胞表面PD-1表达上调,PD-1水平与血清Th1细胞因子IFN-γ呈负相关,与血清Th2细胞因子IL-10呈正相关;HBV感染慢性化可能与PD-1高表达有关.     

辅助性T细胞17在人类免疫缺陷病毒合并结核感染致病中的作用

目的 观察HIV合并结核感染患者IL-17的表达情况,探讨Thl7细胞在HIV合并结核感染致病中的作用.方法 将54例确诊的HIV感染患者,分为单纯HIV感染组、HIV合并潜伏结核感染组和HIV合并结核感染组,采用全血胞内细胞因子染色方法,使用BD FACSCanto流式细胞仪检测各项指标,FACSDiva软件分析CD4+ IL-17+T淋巴细胞及CD4+ IFNΥ+T淋巴细胞表达情况,组间比较采用独立样本配对t检验.结果 3组患者CD4+T淋巴细胞计数及病毒载量无明显区别;CD4+ IL-17+T淋巴细胞表达百分比单纯HIV感染组为(1.40±1.01)％,HIV合并结核潜伏感染组为(1.29±0.86)％,两组比较差异无统计学意义(t=0.336,P＞0.05),但均显著高于合并结核感染组的(0.58±0.43)％(t=3.680,t=2.516,P＜0.05);3组患者之间CD4+IFNγ+T淋巴细胞表达百分比分别为(32.8±24.0)％、(40.3±21.9)％和(46.1±31.2)％,3组比较,差异无统计学意义(t=-0.939,t=-1.602,t=-0.646,均P＞0.05).结论 HIV合并结核感染患者出现明显的Th17应答下调,Th17细胞可能在HIV合并结核感染中起着重要的抗结核免疫保护作用.     

HBV感染对人T细胞免疫及细胞因子TNF-α、GF-β2的影响

目的:检测HBV感染后外周血及感染肝组织内CD4+T和CD8+T细胞的数量及功能,以及肝组织内TNF-α及TGF-β2表达,探讨HBV对人体T细胞免疫的影响及其可能机制.方法:用流式细胞仪检测HBV感染者36例和正常人20例外周血中T细胞亚群的数量.用免疫组化法HBV感染肝组织50例中CD4,CD8,CD25和TNF-α,TGF-β2的表达,并作相应比较.结果:HBV感染组外周血,CD4+和CD4+/CD8+比值明显低于对照组(P＜0.05);CD8+细胞升高,明显高于对照组(P＜0.05).肝组织内浸润的淋巴细胞主要聚集在汇管区和小叶坏死区,免疫组化结果显示HBV感染组肝组织内的CD8+和CD4+细胞数量多于非HBV感染组(P＜0.01).HBV感染组肝组织内CD25+细胞数量减少,但统计学上无显著意义.HBV感染组肝组织TNF-α表达明显增强,与非HBV感染组相比有显著差异(P＜0.05);而TGF-β2在HBV感染组肝组织的表达与非HBV感染组相比无显著差异.TGF-β2及TNF-α在肝硬化、癌旁肝硬化、肝细胞癌中均较强表达,且与慢性乙肝组和正常对照组比较有非常显著差异(P＜0.01).结论:HBV感染者外周血和肝内的T细胞亚群紊乱,活性下降,功能受损.TNF-α表达与HBV感染和免疫损伤密切相关,而HBV对TGF-β2的影响微弱.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.