HIV合并结核分枝杆菌感染的探索研究

目的 了解该地区HIV合并结核分枝杆菌(TB)感染的发展状况.方法 随机选取2008年1月至2010年12月在该院检查并接受治疗的177例HIV感染者作为调查对象,统计这些病例中感染TB的例数,分析该地区HIV感染者合并TB感染的百分率,并进行TB药敏分析.结果 在177例HIV感染患者中有29例患者合并感染TB,占16.38%,其中男21例,占72.41%(21/29),女8例,占27.59%(8/29),差异有统计学意义(P<0.01).而在29例HIV合并TB感染患者中,TB对利福平、乙胺丁醇、链霉素、异烟肼的敏感性分别为100.00%、100.00%、89.65%、75.86%.结论 HIV合并TB感染是HIV患者死亡的最重要因素,在临床中应加强检测并合理使用抗菌药物和抗病毒药物,以减少HIV感染者的病死率.     

γ干扰素释放试验在HIV合并TB感染中的应用价值

目的探讨γ干扰素释放试验早期诊断HIV合并结核分支杆菌(tuberculosis,TB)感染的应用价值。方法收集2015年1月-2017年12月来我院就诊的40例确诊HIV合并TB感染患者为实验组,40例HIV未合并TB感染患者为对照,分别进行γ干扰素释放试验,痰涂片找抗酸杆菌,结核菌素PPD和血清结核抗体试验,并比较这四项检验结果对HIV合并TB潜伏感染诊断的敏感性、特异性。结果40例HIV合并TB感染患者,γ干扰素释放试验对诊断HIV患者合并TB感染的敏感性为65.0%(26/40)、特异性为97.5%(39/40),显著优于痰找抗酸杆菌17.0%(7/40),PPD 15%(6/40)和结核抗体40.0%(16/40)(P0.05)。且γ干扰素释放试验对免疫严重抑制(CD4100/mm3)的患者其敏感性也高达60.0%。40例HIV患者中未合并TB感染者,γ干扰素释放试验假阳性率仅2.5%(1/40),而结核抗体假阳性率却有32.5%(13/40)。结论γ干扰素释放试验较痰找抗酸杆菌,结核抗体等临床常规结核病诊断方法更敏感、特异,对判断HIV合并TB感染诊断的临床价值较大。     

可溶性白介素-2受体对艾滋病病毒感染者和(或)艾滋病患者的临床意义

目的观察国人艾滋病病毒感染者和(或)艾滋病 (HIV/AIDS)患者及其合并丙型肝炎时血清可溶性白介素-2受体(soluble interleukin-2 receptor,SIL-2R )水平,及HIV/AIDS患者血清SIL-2R与CD4 T淋巴细胞计数的关系,探讨血清SIL-2R对观察HIV/ AIDS患者病情进展、判断预后方面的临床意义及其合并丙型肝炎时机体的免疫激活情况.方法收集137例HIV/AIDS患者的血清和抗凝全血,用流式细胞术检测患者外周血CD4 T淋巴细胞计数,用酶联免疫吸附测定法(ELISA)检测血清SIL-2R.结果在正常人、丙型肝炎、HIV感染及HIV感染合并丙型肝炎4组不同人群中,SIL-2R值为正常人＜丙型肝炎患者＜HIV感染者＜HIV感染合并丙型肝炎者.HIV感染组较丙型肝炎组高,但组间差异无统计学意义,其余组间两两比较差异均有统计学意义.SIL-2R值为HIV感染者＜AIDS患者,CD4 T淋巴细胞计数正常人＞HIV感染者＞AIDS患者,SIL-2R与CD4 T淋巴细胞呈负相关(Pearson相关系数为r＝-0.656,P<0.001).结论 SIL-2R在HIV感染者外周血中异常增高,高于丙型肝炎与正常人,HIV感染合并丙型肝炎患者则进一步升高.SIL-2R随着HIV感染者的疾病进展而进行性增高,随着CD4 T淋巴细胞下降而明显升高,与疾病进展及CD4 T淋巴细胞计数有明显的相关性,因此,SIL-2R可以反映机体免疫激活程度,对判断疾病进展、估计预后等临床实践方面有重要的指导和实用价值.     

心理干预在HIV、HCV合并感染患者中的应用

目的:探讨心理干预在人类免疫缺陷病毒(HIV)和丙型肝炎病毒(HCV)合并感染患者中的应用及效果.方法:对 63例HIV、HCV合并感染患者给予个性化心理干预.结果:本组患者治疗依从性良好,均能遵医嘱服药、按时复查.结论:心理干预对提高HIV、HCV合并感染患者的治疗依从性有重要意义.     

神经系统疾病合并人类免疫缺陷病毒感染患者的护理

目的探讨神经系统疾病合并人类免疫缺陷病毒(HIV)感染患者的护理干预措施。方法对2010年12月-2012年7月收治的36例神经系统疾病合并HIV感染患者,在加强头痛、高热、颅内高压护理基础上,还针对HIV感染的病症特点,从日常生活、饮食、安全、心理及不良反应等方面予以护理干预。结果 36例患者中1例在住院期间并发脑疝死亡,2例患者转入感染科继续治疗,33例患者好转出院。医院内无交叉感染和医护人员职业暴露感染发生。结论对神经系统疾病合并HIV感染患者护理的关键是预见性的护理评估,HIV的筛查与医务人员的全面防护。     

艾滋病病毒单纯感染者与混合感染者的临床研究

HIV抗体阳性的有偿献血员中,HCV的感染率很高[1],徐州地处内陆,HIV的感染大都由输血引起,因此HIV合并HCV的感染明显高于HBV的感染以及HIV单独感染.现将40例HIV确诊患者各项检测指标作一回顾性研究.初步了解混合感染与单纯感染以及HIV携带者与AIDS患者间各检测指标的相互关系,有助于为此类患者提供及时有效的治疗.     

994例HIV感染者的临床分布及HIV和HCV合并感染的统计分析

目的了解该院2009~2012年检出人类免疫缺陷病毒（HIV）感染者及HIV和丙型肝炎病毒（HCV）合并感染的临床分布,为预防HIV及HCV提供理论依据。方法收集2009年1月至2012年12月该院收治的HIV感染者及及HIV和HCV合并感染者的临床资料,根据性别、年龄进行分组对HIV合并HCV感染的情况进行统计分析。结果统计时间内共收集到HIV感染者994例,男性685例,女性309例;其中合并HCV的感染率为18.01%（179/994）,30~〈40岁年龄组HIV合并HCV感染的发生率最高,且男性组合并感染的发生率高于女性组。结论 HIV和HCV合并感染的发生率较高,临床上应重视这种合并感染的诊断和治疗。     

2015-2019年云南地区HIV感染者/AIDS患者合并感 染病原微生物特征分析

目的 调查分析2015—2019年云南地区HIV感染者/ADIS患者合并感染病原微生物的分布特征.方法 对2015年1月至2019年12月昆明市第三人民医院感染一科收治的2824例HIV感染者/ADIS患者的电子病历资料回顾性分析,合并感染病原微生物细分为病毒、细菌、真菌、寄生虫、螺旋体等,统计分析其不同年份、性别等分...     

性病就诊人群的HIV筛查的临床意义

对2010年3月~2013年2月来我院门诊就诊的性病或疑似性病的患者及其性伴侣进行研究,在争取患者同意的基础上实施HIV筛查,评价其临床意义。结果所有性病就诊患者共900例,确诊为性病这共523例,占就诊总人群的58.11%(523/900),确诊HIV感染者7例,占就诊总人口的7.78%(7/900),占性病患者的1.34%(7/523);分析可见,性病患者感染途径以性传播为主,其中通过异性性接触传播者共464例,占总检测人群的59.41%,通过同性性接触传播者共9例,占检测人群的40.91%。5例HIV阳性患者中。有4例为异性感染,2例为同性感染,1例为同性合并异性感染;根据检查结果,诊断各种性病感染者共523例,所有7例HIV阳性患者均合并其他疾病感染,其中合并尖锐湿疣感染者2例,合并梅毒感染者5例。性病就诊人群均存在感染HIV的风险,在门诊工作过程中针对性病就诊人群应广泛开展HIV筛查,降低人群中传播的概率。     

肺结核和肺结核合并人类免疫缺陷病毒感染患者总淋巴细胞的变化

为了解肺结核和肺结核合并人类免疫缺陷病毒（HIV）感染患者总淋巴细胞变化情况,探讨总淋巴细胞计数作为HIV感染患者免疫水平评价的指标及对机会性感染预防治疗的价值,我们采用回顾性诊断方法对单纯肺结核和肺结核合并HIV感染患者进行总结分析.     

Rheumatic disease and AIDS. An interesting but mysterious relationship.

Symptoms of rheumatic disease may be an indicator of HIV infection. In this article, Dr Golbus describes the spectrum of rheumatic syndromes in HIV-infected patients and how they differ from their idiopathic counterparts. His article brings a new perspective to the increasingly complex clinical picture of HIV infection and shows that very common complaints may be manifestations of HIV.     

Rheumatic fever in adult patients.

A study of rheumatic fever in adult patients (diagnosed according to the Jones revised criteria; Circulation 36: 664, 1965) was performed by examining 26 patients during the acute phase of the disease, and by re-examining 22 of them from 6 months to 64 months later (mean 33 months). Polyarthritis and carditis were the most common major manifestations. 23 patients had polyarthritis and 3 monoarthritis. 18 patients had signs of acute cardiac involvement. Carditis appeared to be rather benign: at the acute stage no patient developed congestive heart failure or any other serious complication. Five patients had erythema marginatum, but we saw no chorea or subcutaneous nodules. Of the 22 patients examined in the follow-up study, 4 had persistent signs of cardiac involvement and 15 showed chronic joint manifestations. Yersinia enterocolitica infection was by far the most difficult differential diagnostic problem, since polyarthritis and carditis associated with this enteric infection were very similar to those in patients with rheumatic fever. Current literature on rheumatic fever and the results of this series suggest that the diagnostic criteria of rheumatic fever (Jones) should be re-evaluated, at least in industrial countries.     

Rheumatologic diseases in the intensive care unit: epidemiology,clinical approach,management, and outcome

Patients with systemic rheumatic diseases may be admitted to the ICU because of worsening of or development of a new manifestation of the rheumatic disease, infections caused by immunosuppression, or adverse effects of drugs used to treat rheumatic diseases. Sometimes an unrelated, acute disorder may become life threatening because of the underlying rheumatic disorder. Rheumatoid arthritis is the most common rheumatic disease seen in ICU patients, followed by systemic lupus erythematosus and scleroderma. These three conditions together account for up to 75% of rheumatic cases admitted to the ICU. The respiratory system is the organ system most commonly affected in the acute process, followed by the renal, gastrointestinal, and nervous systems. More than 50% of admissions result from infections, and 25% to 35% result from exacerbation of the underlying rheumatic condition. In about 20% of patients, the rheumatic disorder may be diagnosed for the first time in the ICU. An aggressive approach should be pursued to establish the diagnosis of either disease exacerbation or infection. Delay in instituting appropriate immunosuppressive or antimicrobial therapy may result in multiple organ system failure and a poor outcome. The mortality rate in patients with rheumatic disease exceeds that predicted by the APACHE II or SAPS II scores and is higher than that in nonrheumatologic ICU admissions. The mortality may exceed 50% in patients admitted for infection; the prognosis is comparatively better for patients with exacerbations of disease activity. Renal failure, coma, and acute abdomen are predictors of poor outcome. Early recognition of abdominal complications requiring surgical intervention may help reduce mortality.     

CNS toxoplasmosis as the initial presentation of the acquired immunodeficiency syndrome

Neurological manifestations are present in 30% to 60% of patients with acquired immunodeficiency syndrome (AIDS) and may be the initial presentation in 10% to 20% of cases. Central nervous system toxoplasmosis now represents the most common focal brain lesion in patients with AIDS and possibly the most common opportunistic infection. A case of fulminant central nervous system toxoplasmosis as the initial presentation of AIDS is presented. Emergency physicians will be confronted with neurological complications of AIDS with increasing frequency in the future and should maintain a high index of suspicion for human immunodeficiency virus infection in young patients with neurological dysfunction.     

FURTHER OBSERVATIONS ON PATHOLOGIC SIMILARITIES BETWEEN EXPERIMENTAL SCURVY COMBINED WITH INFECTION,AND RHEUMATIC FEVER

In the guinea pig, chronic scurvy with superimposed infection (beta streptococcus) and to a lesser extent chronic scurvy alone, produces an arthropathy with striking pathologic similarities to that of rheumatic fever and the closely allied condition of rheumatoid arthritis. Considerable significance is attached to the widespread occurrence in the experimental animal subjected to scurvy and infection, and to a lesser extent in scurvy alone, of lesions similar to if not identical with the fibrinoid degeneration which has been considered the fundamental lesion of rheumatic fever. A subcutaneous nodule essentially similar to the subcutaneous nodules of rheumatic fever was observed in one experimental animal. Attention is called to a group of general pathologic changes frequently observed in rheumatic fever which were also found in the experimental animals subjected to scurvy and infection. These include degenerative changes in skeletal muscle, focal necrosis in the liver, fibrosis of the Malpighian bodies in the spleen, erythrophagocytosis in the lymph nodes, and focal lymphocytic accumulations in the kidneys. The problem of hemorrhage is considered. It is suggested that a scorbutic state may be the basis of the hemorrhagic manifestations common to the acute phases of rheumatic fever. The unsatisfactory nature of previous experimental attempts to reproduce the pathology of rheumatic fever is noted. The lesions produced by subjecting the guinea pig to the combined influence of scurvy and infection are considered to be fundamentally similar in character and distribution to those of rheumatic fever. The pathologic observations recorded in this and a previous publication (2) are believed to offer evidence that the disease known as rheumatic fever may be the result of the combined influence of scurvy and infection. It is suggested that a subclinical degree of scurvy may constitute the rheumatic tendency in which the added factor of infection causes the development of rheumatic fever or possibly the closely allied condition of rheumatoid arthritis. Epidemiological and clinical considerations appear to afford supportive evidence to this concept.     

Practical issues in the management of hypersensitivity reactions: sulfonamides

Approximately 3% of the general population and 60% of patients with human immunodeficiency virus (HIV) infection have adverse reactions when treated with sulfonamide antimicrobials. The most common clinical manifestations of sulfonamide hypersensitivity are fever and a maculopapular rash 7 to 14 days after initiating therapy, though a variety of more severe manifestations may occur. The sulfonamide chemical moiety is present in many medications that are not antimicrobials, and fortunately hypersensitivity reactions to these medications are less common. The immunogenicity of sulfonamide antimicrobials may be due to the presence of an arylamine group at the N4 position of the sulfonamide molecule. No diagnostic tests are available to confirm sulfonamide hypersensitivity, and while avoidance of the drug is generally appropriate when a previous hypersensitivity reaction is suspected, desensitization protocols are available for use in HIV patients in whom Pneumocystis carinii pneumonia prophylaxis or treatment is indicated.     

Primary acute rheumatic fever in juveniles from an organized community

A closed population of juveniles was studied to follow-up manifestations of primary rheumatic fever. In line with other unfavourable factors, the onset of the disease within the first 6 months of the observation was due to cross streptococcal infection (foci of chronic nasopharyngeal infection were detected in 68.6% examinees, rheumatism debut after acute nasopharyngeal infection was in 91.0% patients). Persistence of streptococci was established in many blood counts in immunofluorescence reaction in 88.2% patients in acute disease, in more patients with lingering rheumatic process. Clinical manifestations include, aside from arthritis and rheumocarditis, frequent thyroid and gastrointestinal lesions. It is thought valid to raise the dose and duration of administration of penicillin in patients with primary rheumatic fever as it eradicates chronic infection foci, prevents recurrences, reduces the number of patients with a lingering course of the disease, with recurrences and valvular defects of the heart.     

感染性心内膜炎194例的临床和病原学特点

目的 分析血培养阳性的感染性心内膜炎(infective endocantitis,IE)患者的临床及病原学特点,为合理使用抗菌药物提供依据.方法 回顾性分析武汉亚洲心脏病医院2014年1月-2018年12月收治的194例血培养阳性的IE患者病历资料,包括年龄、性别、临床表现及病原学检查结果 等.结果 194例血培养阳...     

STUDIES ON THE IMMUNE RESPONSE OF THE RHEUMATIC SUBJECT AND ITS RELATIONSHIP TO ACTIVITY OF THE RHEUMATIC PROCESS : III. OBSERVATIONS ON THE REACTIONS OF A RHEUMATIC GROUP TO AN EPIDEMIC INFECTION WITH HEMOLYTIC STREPTOCOCCUS OF A SINGLE TYPE

This study of an isolated colony showed that of seven children who escaped the epidemic streptococcus infection none developed rheumatic symptoms; and that of seventeen children who contracted the epidemic streptococcus infection, fourteen developed acute rheumatism and three showed no recognizable rheumatic manifestations. The seven children who failed to contract infection with Streptococcus hemolyticus showed clearly that susceptible individuals may live in dose association with an epidemic of acute rheumatism, develop no rise in antistreptolysin titer and maintain excellent health. The patient with congenital heart disease demonstrated that a non-rheumatic subject may be infected with a highly effective strain of hemolytic streptococcus, and develop a typical antibody response, yet escape all rheumatic manifestations. The two patients who, although infected with the epidemic strain, failed to show any antibody response, also failed to develop rheumatic recrudescences. Environmental, dietary, age and the other factors investigated did not appear to be significant in this outbreak of acute rheumatism. Three factors appeared to determine the development of the fourteen recrudescences: (1) infection with a highly effective agent; (2) the disease pattern, peculiar to each rheumatic subject; (3) the intensity of the immune response of the patient as indicated by the rise in antistreptolysin titer.     

Association of class II human histocompatibility leukocyte antigens with rheumatic fever.

The association of class I and II HLA antigens with rheumatic fever and its manifestations was examined in 72 patients, including 48 blacks and 24 Caucasians. No significant association was found between class I antigens and rheumatic fever. In contrast, HLA-DR2 and HLA-DR4 phenotypes were encountered in a significantly higher frequency in black and Caucasian patients with rheumatic fever, respectively, compared with the control populations (P less than 0.005). The most significant association (P less than 0.005) of these DR antigens with a major manifestation of rheumatic fever was found for mitral insufficiency. In addition, a significant association was encountered between persistent elevation of antibody to the group A streptococcal carbohydrate and HLA-DR4 in Caucasian patients (P less than 0.04) or HLA-DR2 in the black patients (P less than 0.001). The frequency of HLA-DR2/4 heterozygotes among patients with rheumatic fever did not differ significantly from controls. These findings support the concept of a genetically determined susceptibility to rheumatic fever and, particularly, to rheumatic heart disease. The association of the clinical manifestations of rheumatic fever and the immune hyperresponsiveness to a streptococcal antigen could be ascribed to a disease-associated immune-response gene which is in linkage disequilibrium with the DR2 and DR4 alleles of HLA-DR locus on chromosome six.