拉米夫定治疗无良好应答患者乙型肝炎病毒P区突变与基因型的关系

目的 观察拉米夫定治疗后无良好应答的慢性乙型肝炎患者HBV P区变异情况与基因型的关系.方法 对631例拉米夫定治疗后无良好应答的慢性乙型肝炎患者进行研究.通过荧光定量PCR或核酸测序确定HBV基因型,直接测序观察P区突变,实时荧光定量PCR方法检测患者病毒载量,比较不同基因型患者的HBV DNA水平及HBV P区变异情况.计量资料采用成组设计资料t检验,计数资料采用x~2检验或Fisher精确检验.结果 631例慢性乙型肝炎患者中,B基因型HBV感染者272例,C基因型感染者359例,C基因型感染者患者年龄为(39.1±11.4)岁,明显大于B基因型感染患者的(33.7±9.7)岁(t=-6.55,P<0.01).C基因患者病毒载量为(5.96±1.22)log_(10)拷贝/ml,高于B基因型患者的(5.58±1.21)log_(10)拷贝/ml,t=-2.01,P<0.05.A181V/T变异在C基因型的发生率高于B基因型(0.4%比5.3%,χ~2=12.23,P<0.01),M204I/V,L180M、T184A/G/I/S、S202G/I和V173L变异发生率在B、C基因型之间差异无统计学意义(P值均>0.05).M204I在B基因型的发生率为20.6%,高于C基因型的13.9%(χ~2=4.91,P<0.05);M204V和M201Ⅳ变异在B、C基因型中的发生率差异无统计学意义(χ~2值分别为1.70和2.21,P值均>0.05).拉米夫定耐药发生率在B、C基因型间差异无统计学意义(χ~2=0.00,P>0.05).结论 拉米夫定常见耐药位点在B、C基因型之间无明显差异,但是C基因HBV感染患者病毒载量高于B基因型HBV感染患者;M204I变异在B基因型中出现频率高于C基因型,拉米夫定加用或改用阿德福韦酯后可能会使A181V/T变异在C基因型出现的概率高于B基因型;年龄、免疫因素和非常见位点的变异或许是影响拉米夫定疗效的重要因素.     

云南省部分乙型肝炎病毒多基因型分布

目的 了解云南省HBV基因型分布情况和其特殊性.方法 对来自云南省7个地州市的55例HBV感染者,采集、分离其血清样本,核酸提取,套式PCR扩增前S1/前S2/部分S基因区段(877 bp),进行核酸序列测定与同源关系和重组位点分析.计量资料比较采用t检验,计数资料比较采用卡方检验.结果 建立更为准确的HBV基因分型方法,49份样本获得有效分型,13份(26.5％)为B2亚型;33份(67.3％)为C型,其中C1亚型7份,C2亚型19份,C5亚型3份,C7亚型4份;另有2份(4.1％)为Ⅰ基因型和1份为(2.0％)C/D重组型.B、C型感染者HBV DNA分别为(7.69±0.86)、(6.88±1.24) lg拷贝/mL,差异有统计学意义(t=1.621,P=0.016);B、C型感染者碱性磷酸酶分别为(78.6±28.8)、(124.0±46.8) U/L,差异有统计学意义(t=-1.534,P=0.028).结论 建立的HBV基因型/亚型分析方法可准确分型;云南地区HBV多基因型/亚型分布状况,可能为东南亚地区所流行HBV的传入所致,并可能影响中国HBV基因型的分布态势.     

云南地区乙型肝炎病毒基因型分布与临床的相关性

目的: 了解云南地区乙型肝炎病毒基因型分布特征, 探讨其与慢性HBV感染者的性别和年龄、不同临床疾病谱、病毒复制水平的关系.方法:选择云南地区慢性HBV感染者117例, 其中慢性无症状乙型肝炎表面抗原携带者(ASC)26例、慢性乙型肝炎(CHB)55例(轻度21例、中度24例、重度10例)、慢性重型肝炎(CLF)18例、乙肝后肝硬化(LC)11例及原发性肝细胞肝癌(HCC)7例, 采用反向杂交技术(RDB)检测HBV基因型, 并对与其性别年龄、临床分型和病毒复制水平的关系进行分析.结果: 云南地区HBV基因型以B型和C型为主, 分别为41.0%(48/117)和54.7%(64/117) , 并以C型为最多(χ2 = 4.38, P = 0.036);D型1例(0.86%), B、C混合型2例(1.71%), A、C混合型2例(1.71%). B基因型在轻度慢乙肝组所占的比例显著高于中、重度慢乙肝组(χ2 = 8.27、11.98, P = 0.004、0.001)、ASC组(χ2 = 5.46, P = 0.02)、CLF组(χ2 = 4.13, P = 0.042)和LC/HCC组(χ2 = 11.3, P = 0.001). C基因型在LC/HCC组和重度慢乙肝组所占的比例均显著高于轻度慢乙肝组(χ2 = 11.3, P = 0.001;χ2 = 8.78, P = 0.003), 与其他各临床型组间的比较则无显著性差异(P>0.05). C基因型在HBV DNA( )组和HBeAg(-)组r所占的比例均分别显著高于HBV DNA(-)组(χ2 = 6.63, P = 0.01)和HBeAg( )组(χ2 = 7.12, P = 0.008). B基因型在HBV DNA低水平复制组中所占的比例显著高于高水平复制组(χ2 = 4.12, P = 0.042). C基因型在HBV DNA高水平复制组中所占的比例显著高于B基因型(χ2 = 3.89, P<0.05). C基因型在年龄≥30岁组中所占的比例(63.3%)高于年龄<30岁组(45.6%)(χ2 = 3.7, P = 0.05). HBV基因型在性别间的分布无统计学差异(P>0.05)结论:云南地区存在HBV的B、C、D、B C和A C基因型, 以B型和C型为主要基因型, 并以C型为最多. B基因型在轻度慢乙肝的比例显著高于其他各临床型HBV感染者, 并且与HBV的低水平复制和低年龄有关. C基因型主要分布于重度慢乙肝和LC/HCC、HBV DNA高水平复制、年龄≥30岁的患者中. 提示C基因型与慢乙肝重度、肝硬化、肝细胞肝癌及HBV DNA高水平复制关系密切.     

安康地区乙型肝炎病毒基因型分布及临床相关性研究

目的:探讨安康地区HBV基因型的分布状况及其与临床的相关性。方法:应用型特异性引物法检测陕西省安康地区1275例HBV感染者的HBV基因型,并分析了287例住院患者的基因型与临床的相关性。结果:1275例HBV感染者中B基因型902例(70.75%),C基因型370例(29.02%),B/C混合型3例(0.23%),未检测到其他基因型。287例住院患者基因型分布在性别上无明显差异(P=0.32),B型、C型患者在携带者、慢性肝炎、重型肝炎、肝硬化和肝癌中的分布无明显差异(P=0.45),在ALT水平及HBV DNA载量上无明显差异(分别为P=0.75,P=0.63);C基因型患者的HBeAg阳性率(70.37%)明显高于B基因型患者(44.17%),P0.001。结论:安康地区HBV感染者基因型以B型为主,C型次之,C基因型患者的HBeAg阳性率明显高于B基因型患者,B、C基因型在性别、疾病状态、肝脏炎症活动度及ALT水平上无显著性差异。     

徐州地区HBV感染者逆转录聚合酶区基因耐药变异特点及耐药影响因素分析

目的探讨江苏徐州地区HBV感染者逆转录聚合酶区(RT)基因耐药变异模式及与临床特征的关系,并分析影响耐药的相关因素。方法收集2014年5月-2019年4月于徐州医科大学附属医院感染科行HBV RT区检测的242例HBV感染者的临床资料,比较不同基因型、HBeAg状态患者的临床特征。既往有明确核苷(酸)类药物用药史的HBV感染者164例,其中发生已知耐药位点变异118例,未发生已知耐药位点变异46例,两组患者行影响HBV RT区耐药变异危险因素分析。计量资料采用独立样本t检验或Mann-Whitney U检验。计数资料组间比较采用χ~2检验。采用logistic回归分析筛选影响患者耐药的危险因素。结果江苏徐州地区HBV感染者RT区耐药突变模式以rtL180M+rtM204I/V/S(25例,21. 2%)、rtA181T/V(16例,13. 6%)、rtM204I/V/S(15例,12. 7%)多见。242例患者中B基因型13例(5. 4%),C基因型229例(94. 6%),未发现其他基因型。B基因型感染者ALT水平高于C基因型,差异有统计学意义(U=-2. 096,P=0. 036)。HBeAg阴性组(n=66)感染者年龄高于HBeAg阳性组(n=176),差异有统计学意义(t=4. 580,P 0. 001),而HBV DNA载量、HBsAg水平均显著低于阳性组(t值分别为2. 145、3. 526,P值分别为0. 033、0. 001)。HBeAg阴性组感染者病程较阳性组长,GGT水平高于阳性组,差异均有统计学意义(U值分别为-2. 561、-2. 016,P值分别为0. 010、0. 044)。HBeAg阴性组感染者CHB人数所占比例低于阳性患者组,LC、HCC人数所占比例高于阳性组,差异有统计学意义(χ~2=20. 609,P 0. 001)。多因素logistic回归分析发现,ADV(比值比=5. 493,95%可信区间:1. 377～21. 909)、不适当停药(比值比=5. 945,95%可信区间:1. 921～18. 403)是HBV感染者发生耐药的独立危险因素(P值均0. 05)。结论江苏徐州地区HBV感染者以C基因型为主,耐药突变模式复杂多变。HBeAg阳性患者的HBV DNA复制较为活跃,建议HBV感染者初始选用高效低耐药抗病毒药物,并加强抗病毒治疗的依从性。     

散发性成人急性乙型肝炎病原学随访研究

目的 观察分析成人急性乙型肝炎(AHB)病原学特点,探讨急性HBV感染肝损伤及病毒清除的机制.方法 以120例成人AHB患者为研究对象.采取病区及门诊随访方法,收集患者流行病学资料和住院期间及出院后历次复诊时的系列血清标本,ELISA法检测血清HBV标志物,实时荧光定量PCR法检测HBV DNA和HBV基因型,动态观察AHB病原学变化规律.计数资料采用非参数秩和检验,组间均数比较采用t检验,两个样本率的比较采用Pearsonχ2检验.结果 就诊时48.33%的患者HBV DNA阳性,平均为9.84×104拷贝/mL,平均12.5 d降到检测限以下.HBVDNA阳性组血ALT中位数为1600 U/L,阴性组为1490 U/L(z=0.678,P=0.498);HBV DNA≤1×104拷贝/mL组血ALT为(2058±123)U/L,>1×104拷贝/mL组为(1393±139)U/L,差异有统计学意义(t=2.17,P-0.049).40份HBV DNA阳性标本中,HBV B基因型占52.5%,C基因型占42.5%,B、C混合型占5.0%.初诊时血清HBV标志物呈现8种模式,以HBsAg、HBeAg、抗-HBc、抗-HBc IgM阳性和HBsAg、抗-HBe、抗-HBc、抗-HBe IgM阳性2种模式最多见,分别占38.3%和30.0%.前瞻性动态监测28例AHB患者HBV标志物,HBsAg阴转率为100.0%,平均阴转时间中位数为3周;观察52周抗-HBs累计阳转率为85.7%;HBeAg阴转率为100.0%,其中53.6%的患者就诊时血清HBeAg已转阴,其余患者于发病4周内阴转,在52周的观察期内抗-HBe阳转率为82.1%;血清抗-HBc(总抗体)始终为阳性,39.3%患者抗-HBc IgM在观测期阴转.结论 快速HBV的清除和病毒标志物的血清转换,构成了AHB与慢性乙型肝炎的显著差异.     

湖北地区乙型肝炎病毒基因型分布与临床的相关性

目的 了解湖北地区乙型肝炎病毒(HBV)基因型的分布及其与临床的相关性。 方法 选择湖北地区HBV DNA阳性的慢性HBV感染者190例,其中乙型肝炎表面抗原(HBsAg)携带者52例、慢性乙型肝炎56例、重型肝炎32例、肝硬化22例、原发性肝癌28例,应用多对型特异性引物-聚合酶链反应检测HBV的基因型。 结果 多对HBV型特异性引物法可快速准确鉴定HBV的基因型。190份HBV DNA阳性血清标本中,B基因型140例(73.7％),C基因型42例(22.1％),BC混合型8例(4.2％),未发现A、D和E基因型;B基因型在重型肝炎和肝癌患者中占绝对优势,分别为87.5％和89.3％,显著高于HBsAg携带者的67.3％;B基因型患者血清丙氨酸氨基转移酶水平(253.1±306.7)U／L高于C基因型患者的(154.1±192.9)U／L,差异有统计学意义(P<0.05);除HBsAg携带者外的慢性HBV感染者中,B基因型患者血清抗-HBe阳性率50.5％(53／105)显著高于C基因型的18.5％(5／27),P<0.01。 结论 多对型特异性引物同时进行聚合酶链反应的基因分型方法可用于HBV基因型的流行病学调查;湖北地区存在HBV的B、C和BC混合基因型,B型为本地区的优势基因型并在严重肝病和肝癌中的比例较高,基因型的分布可能有较大的地区差异。     

乙型肝炎病毒基因分型与拉米夫定临床应用反应

目的了解常州地区乙型肝炎病毒(HBV)基因型分布特征,探讨基因型与肝功能损害、病毒复制水平及其与拉米夫定疗效关系.方法 76例慢性乙型病毒性肝炎患者每天口服拉米夫定100mg治疗,并于治疗4～6周时测定不同基因型患者的丙氨酸转氨酶(ALT)和HBV DNA,治疗48周后测定HBV DNA反跳和YMDD变异.采用巢式聚合酶链反应(nest PCR)法扩增HBV S基因区,以4色荧光标记PCR产物末端,在以毛细管高压电泳为核心技术的核酸序列分析仪上自动测序,将测序结果与基因库中登录的标准基因型序列相比较.结果 76例慢性乙型肝炎患者血清HBV DNA基因分型示B型株感染26例(34.2%),C型株感染50例(65.8%).B和C基因型患者ALT值分别为(246.3±138.8)U和(283.7±125.6)U,(t=0.335,P>0.05),HBV DNA含量分别为107.124±101.49和107.189±101.56拷贝/ml(t=0.138, P>0.05),HBeAg阳性数分别为20例和41例(χ2=0.159,P>0.05).拉米夫定治疗4～6周后,B基因型和C基因型患者ALT、HBV-DNA(阴转)、HBV DNA(拷贝/ml)均呈良好恢复状态,两组间差异无显著性.治疗48周后,HBV DNA反跳者B基因型20例,C基因型16例(χ2=13.49,P<0.001).结论常州地区HBV DNA基因型以单一B或C型为主;不同基因型患者ALT水平、病毒复制水平以及HBeAg表达水平差异均无显著性,拉米夫定对C基因型患者的疗效优于B基因型.     

慢性乙型肝炎患者HBV基因型和亚型分布调查

目的研究慢性乙型肝炎患者HBV基因型和亚型流行情况。方法应用HBV基因型和亚型特异性引物PCR法对北京、长春、大连、西安、石家庄、郑州和合肥7个城市660份HBVDNA阳性慢性乙型肝炎患者血清进行基因型和亚型分析。结果在660份HBVDNA阳性血清中,B基因型、C基因型和B/C混合感染分别为16.67%(110/660)、74.54%(492/660)和8.79%(58/660);在C基因型中,C1亚型6例(1.22%)、C2亚型473例(96.14%)、C1/C2混合基因亚型13例(2.64%);B基因型均为Ba亚型,B基因型和C基因型混合感染者均为Ba与C2亚型混合感染,未发现其他基因型和基因亚型;不同基因型感染患者HBeAg阳性率差异无统计学意义(P=0.153);B基因型和C基因型患者之间血清HBVDNA水平差异无统计学意义(6.37±1.62lgcopies/ml对6.29±1.76lgcopies/ml),但均高于B和C基因型混合感染患者(5.25±1.65lgcopies/ml)。结论这7个城市慢性乙型肝炎患者以B基因型和C基因型感染为主,有部分B/C基因型混合感染。HBV亚型以Ba和C2亚型占优势。     

HBV基因型（B/C）是影响HBeAg阳性慢性乙型肝炎患者血清HBsAg水平的重要因素

目的了解HBV基因型（HBV/B和HBV/C）对血清HBsAg水平的影响。方法对492例慢乙型肝炎患者应用亚培12000进行血清HBsAg定量检测,基因分型采用PCR联合限制性片段长度多态性方法。将不同基因型HBV复制质粒转染Huh7细胞,比较HBsAg分泌效率。结果HBV/B患者（n=260）血清HBsAg水平高于HBV/C（n=197）患者（P〈0.001）。以全部患者为研究对象的多变量回归分析发现,HBV DNA水平（B=0.098,P=0.002）、HBeAg状态（B=0.594,P〈0.001）和HBV基因型（B=-0.420,P〈0.001）决定血清HBsAg水平;在HBeAg（＋）患者中（n=337）,HBV DNA水平（B=0.136,P=0.001）、性别（B=0.441,P=0.011）和HBV基因型（B=-0.278,P=0.049）决定血清HBsAg水平;而在HBeAg（-）患者中（n=155）,仅HBV DNA水平（B=0.195,P=0.018）是影响血清HBsAg水平的因素。转染试验表明HBV/C的HBsAg的分泌效率仅有HBV/B的1/3（P=0.010）。结论HBV基因型因为不同的HBsAg分泌效率影响HBeAg阳性患者HBsAg水平。     

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.