Abscess resulting from Mycobacterium kansasii in the left thigh of AIDS patient

A case of abscess resulting from Mycobacterium kansasii, in theleft thigh of a 53-year-old woman infected with the Human Immunodeficiencyvirus, is reported. Curiously, there was no pulmonary or systemic involvement asis usual with these Mycobacterium infections. The patient had CD4 T lymphocytecount of 257 cells/µL and a viral load of 60,154 copies. Despite presenting arelatively preserved immunity, the patient also presented Criptococcicmeningoencephalitis and Esophageal candidiasis. The patient respondedsatisfactorily to treatment for infections and after 51 days was discharged.     

Cutaneous New World Leishmaniasis on a Port-wine stain birthmark

We present an interesting case report of two sarcoid-like lesions on a port-winestain (PWS) birthmark in a Brazilian patient which on investigation proved to becutaneous leishmaniasis.     

Lymphangiectatic Kaposi's sarcoma in a patient with AIDS

Kaposi''s sarcoma is a malignant disease that originates in the lymphatic endothelium. It has a broad spectrum of clinical manifestations. Its four distinct clinical forms are: classic, endemic, iatrogenic and epidemic Kaposi''s sarcoma. In non-HIV-associated Kaposi''s sarcoma, the disease is typically limited to the lower extremities, but in immunodeficient patients, it is a multifocal systemic disease. The clinical course of the disease differs among patients, ranging from a single or a few indolent lesions to an aggressive diffuse disease. Advanced Kaposi''s sarcoma lesions, typically those on the lower extremities, are often associated with lymphedema. In this paper, we report a case of a patient with a rare form of AIDS-associated Kaposi sarcoma called lymphangiectatic Kaposis''s sarcoma.     

HIV/AIDS患者口咽部念珠菌病与CD4+、CD8+T淋巴细胞分析

目的 研究HIV/AIDS患者的口咽部念珠菌病的发病特点,CD4⁺计数、CD8⁺计数、CD4⁺/CD8⁺比值的分布特点,以及抗真菌治疗的特点。方法 观察20例合并口咽部念珠菌病的HIV/AIDS患者和对照组口腔病损情况,病损部行真菌镜检和真菌培养,外周血流式细胞仪检测CD4⁺、CD8⁺计数。研究组和对照组伊曲康唑治疗第1周、第2周、疗程结束时、停药后两周真菌学疗效比较。结果 19例为白念珠菌感染,1例为近平滑念珠菌感染。20例艾滋病患者可见舌部感染6例,口腔侧壁感染14例。CD4⁺、CD8⁺计数和CD4⁺/CD8⁺比值分别在119.40±127.43、652.50±338.57和0.163±0.130范围。伊曲康唑治疗HIV/AIDS组第1周、第2周、疗程结束时、停药后两周真菌清除率分别为16.67%、50.00%、61.11%、66.67%。结论 HIV/AIDS患者口咽部念珠菌感染的最常见致病菌是白念珠菌,最常见靶部位是舌和口腔侧壁。HIV/AIDS患者的口咽部念珠菌病抗真菌疗效与免疫状态有关。     

Cutaneous histoplasmosis disclosing an HIV-infection

Histoplasmosis is a systemic mycosis endemic in extensive areas of the Americas. The authors report on an urban adult male patient with uncommon oral-cutaneous lesions proven to be histoplasmosis. Additional investigation revealed unnoticed HIV infection with CD4+ cell count of 7/mm³. The treatment was performed with amphotericin B, a 2065 mg total dose followed by itraconazole 200mg/daily plus antiretroviral therapy with apparent cure. Histoplasmosis is an AIDS-defining opportunistic disease process; therefore, its clinical diagnosis must drive full laboratory investigation looking for unnoted HIV-infection.     

Occurrence of two autochthonous cases of American cutaneous leishmaniasis in the neighborhood of Caju,city of Rio de Janeiro,Brazil

American cutaneous leishmaniasis is in full geographic expansion in Brazil and it isconsidered among the infectious and parasitic diseases of utmost importanceworldwide, not only by its frequency, but mainly by therapeutic difficulties,deformities and sequelae that may result. In the state of Rio de Janeiro, the firstautochthonous case of American cutaneous leishmaniasis was registered by Rabello in1913. The authors report two cases of the disease in the region around the CemeterySão Francisco Xavier, in the Caju neighborhood, Rio de Janeiro city, and emphasizethe need for actions that aim to early diagnosis and treatment of American cutaneousleishmaniasis cases.     

艾滋病患者HAART致高乳酸血症及乳酸酸中毒10例临床分析

目的分析艾滋病患者高效抗逆转录病毒治疗(HAART)过程中出现高乳酸血症或乳酸酸中毒的病例特点,进一步认识HAART的毒副作用,探究处理办法。方法对本院2008年以来收治的10例正在接受HAART治疗的艾滋病患者的临床表现、HAART方案、服用时间、乳酸水平、阴离子间隙(AG)、酸碱值(pH值)及治疗转归进行分析。结果 10例患者服用的HAART方案主要是司他夫定(d4T)、拉米夫定(3TC)、奈韦拉平(NVP),服用时间均在8个月以上。主要临床表现为:乏力3例,食欲不振2例,恶心呕吐1例,双下肢麻木及疼痛5例,体重明显下降2例,且临床表现有交叉。乳酸2.7～10.8mmol/L,AG均升高,pH值<7.35的1例,其余均在正常范围。死亡3例,死亡原因主要是呼吸衰竭1例,循环衰竭2例;好转5例;自动出院2例。结论以d4T为主的HAART方案容易发生线粒体毒性,表现为高乳酸血症或乳酸酸中毒,一旦发生乳酸酸中毒,死亡率较高,因此应该重视HAART线粒体毒性的副作用,早发现,早治疗,以便改善患者预后。     

艾滋病合并马尔尼菲青霉病11例临床分析

目的 探讨11例艾滋病合并马尔尼菲青霉病患者的临床特征.方法 对2002-2004年来我院住院和门诊就诊的11例艾滋病合并马尔尼菲青霉病患者的一般资料、临床表现、体征、实验室检查进行分析.结果 11例患者中男9例,女2例,临床症状除非特征性的表现如发热、消瘦、贫血、肝脾淋巴结肿大外,8例合并有皮疹;3例有消化道症状,其中2例腹痛,1例腹泻、排红色湖状便:1例吞咽困难,进食梗阻感;5例有呼吸系统症状;1例关节痛;2例合并口腔念珠菌感染、4例骨髓、1例痰、1例血涂片、8例皮疹刮片或分泌物涂片、2例淋巴结和皮肤病理活检切片中可见成堆的PAS染色阳性的圆形或腊肠形分隔孢子.11株分离株经形态学、培养皆证实为马尔尼菲青霉,其中4株分离株经DNA分析证实为马尔尼菲青霉.结论 艾滋病患者机会性感染中马尔尼菲青霉病的临床表现多样,且多伴有皮疹.     

Soft-tissue masses as presentation of non-Hodgkin's lymphoma in AIDS patients

Primary soft tissue Non-Hodgkin lymphomas are very rare and account only for 0.1 % of the cases. Generally, Non-Hodgkin lymphomas of the soft tissue present as large subcutaneous masses without evidence of nodal or skin involvement. We describe four cases of primary Non-Hodgkin lymphomas of the soft tissue in patients infected with the human immunodeficiency virus. The most common site of involvement was the chest wall in all the patients; histopathological and immunophenotypic examination of the biopsy smears revealed two cases of plasmablastic lymphomas, one Burkitt and one diffuse large B-cell lymphoma. Non-Hodgkin lymphomas should be included in the differential diagnosis of soft tissue masses in human immunodeficiency virus - seropositive patients.     

大连市HIV感染者/AIDS病人行为习惯的调查分析

目的:了解大连市HIV感染者/AIDS病人的现状及其行为习惯。方法:对参加大连市艾滋病自愿咨询与检测门诊的HIV感染者/AIDS病人进行问卷调查,进行相关的统计描述与分析。结果:发出问卷200份,有效问卷151份。其中男性136人(90.1%),女性15人(9.9%)。近期(7d以内)调查中92.2%的患者并未存在漏服,但在既往史调查中发现有多半数患者曾经存在漏服。感染后有性生活的为67.4%,58.3%与配偶每次都会使用安全套,与其他性伴使用安全套的频率为87.0%。被调查人群感染后至今有性接触的在不同性别上有统计学意义(χ2=7.06,P0.05),感染后再有性接触者男性多于女性;在不同文化程度上有统计学意义(χ2=4.49,P0.05),感染后再有性接触者学历高中以上者多于初中以下者。认为与配偶发生性行为有必要使用安全套的占77.3%。临时性伴中92.9%的人群并不知晓患者的病情。同性性行为(MSM)人群中,有固定同性性伴的占50.5%;群交行为发生率19.6%。男性性工作者(MB)人群中目前每天的性伴数目,1个以上者占62.5%。有群交行为62.5%。结论:应有计划地在普通人群中进行宣传教育,制定有效的措施,降低社会对艾滋病的恐慌、歧视,减少由艾滋病病毒感染者引发的社会问题。为艾滋病患者提供社会关怀和感情支持,为今后有针对性的开展艾滋病防治工作提供依据。     

American tegumentary leishmaniasis: an uncommon clinical and histopathological presentation

We report a case of an unusual presentation of American Tegumentary Leishmaniasis involving a male patient with a solitary lesion on the ear lobe, persisting with minimal increase for at least six months without ulceration or related symptoms. The histological sections showed epithelial atrophy and a large number of structures consistent with Leishmania sp. amastigotes within macrophages. Treatment commenced with meglumine antimoniate resulting in regression of the condition. This report is of importance given the unusual clinical manifestation and histopathological findings in this case and the fact that there was low correlation with the extended duration of the disease.     

Histopathological and immunohistochemical aspects of American cutaneous leishmaniasis before and after different treatments

BACKGROUND

The histopathology and immune responses of the healing process of leishmaniasis are still poorly studied.

OBJECTIVES

This study aimed to examine the histopathological and immunological aspects of lesions of patients with cutaneous leishmaniasis before and after different therapeutic methods.

METHODS

We studied 23 individuals grouped according to the treatments: Glucantime, Glucantime + Leishvacin and Glucantime + Leishvacin associated with Bacillus Calmette-Guerin. For analysis of the histopathological changes present in the dermis and epidermis, histological sections were stained with hematoxylin and eosin. The samples were immunostained before and after treatment to analyze the expression of interferon (IFN)-γ, interleukin (IL) 12, IL-10 and IL-4.

RESULTS

Before treatment the presence of intense infiltrates of mononuclear cells was noticed and after treatment, even with a diagnosis of clinical cure, the subjects still showed a moderate inflammatory process. In the immunohistochemical analyses, we noticed a difference between the cytokines, with increased expression of cytokines IFN-γ and IL-12 compared to IL 10 and IL-4, both before and after treatment and, comparatively, the difference in this expression was more intense before treatment. However, the cytokine expression analyzed by treatment group showed no statistically significant difference.

CONCLUSION

We conclude that a clinical cure does not always coincide with the histopathological one, and that before treatment there is a predominance of Th1 cytokines. In terms of treatment type, there was no difference in the progression of healing for all the three types of treatment, indicating their clinical equivalence.     

Presentation of non-Hodgkin's lymphoma as a sole cutaneous lesion in a patient with human acquired immunodeficiency syndrome

Background High-grade non-Hodgkin's lymphoma is a clinical criterion for the diagnosis of AIDS. Extranodal involvement is not infrequent, but the observation of skin as the only site affected is rare. Patient A 29-year-old female, CDC stage 4A: history of drug use. AIDS diagnosed clinically and historically on the observation of a non-Hodgkin's lymphoma of B-cell origin from a single cutaneous lesion. Treatment and results There was no evidence of lymphoma in other locations apart from skin. Therapy with local radiation alone resulted in clearance at I year follow-up.     

获得性免疫缺陷综合征合并红皮病1例

患者男,48岁。以获得性免疫缺陷综合征合并红皮病收治入院,糖尿病史10余年。治疗过程中出现右下肢坏死性筋膜炎,后死于败血症。     

昆明市中、小学生艾滋病知识知晓率调查分析

目的了解昆明市中、小学生艾滋病知识知晓率水平，为制订和完善学校艾滋病宣传教育工作提供决策依据。方法采用分层系统抽样的方法对全市小学、中学、职高在校学生共781人进行统一的问卷调查。结果艾滋病传播和预防知识知晓率为84．7％，民办学校小学生低于公办学校小学生15．7％：对艾滋病基本知识和艾滋病非传播途径认识不清。结论艾滋病宣传教育工作取得了一定的成效，但对一些非传播途径的认识有待提高。建议加强民办学校小学生的艾滋病宣传教育工作。     

北京市HIV/AIDS患者生存质量现状及影响因素分析

目的 分析艾滋病病毒(HIV)感染者及艾滋病(AIDS)患者(简称HIV/AIDS患者)的生存质量现状,探讨相关影响因素,为提高随访管理和改善患者的生存质量提供参考.方法 使用世界卫生组织(WHO)艾滋病生存质量简表(WHOQOL-HIV BREF)和中文版艾滋病压力量表(CSS-HIV)对北京市220例HIV/AID...     

黑热病合并HIV感染3例误诊分析

目的探讨黑热病合并HIV感染误诊的原因及防范策略。方法回顾性分析3例黑热病合并HIV感染患者的临床资料。结果该3例主要表现为长期反复出现不规则发热、全血细胞减少、肝脾淋巴结肿大和皮肤损害等症状,骨髓或淋巴结穿刺物涂片中均检出利什曼原虫无鞭毛体,血清免疫学检查为强阳性。结论黑热病合并HIV感染的临床表现虽无特异性,但实验室检查灵敏度和特异性较高,提高非疫源性地区医务人员的诊断意识和能力、及时完善实验室的各项检查,可避免或减少其误诊。     

艾滋病合并念珠菌食管炎的放射学诊断

目的：本文描述了AIDS并发念珠菌食管炎的X线表现，旨在能对早期诊断提供帮助。方法：对11例AIDS并发念珠菌食管炎患者，行常规和双重对比食管造影。结果：念珠菌食管炎表现为在正常食管粘膜上散在并相互分离的斑块样病变；暴发型食管炎则呈现粗糙、不规则的食管外观，似“杂草丛生”状。暴发型念珠菌食管炎多并发于AIDS患者，且可能是其首发症状。当发现此种X线表现时，应高度怀疑病人为AIDS患者。结论：联合应用常规和双重对比食管造影，可提高对念殊菌食管炎诊断的敏感度和精确度，是一种可广泛应用的非侵入性检查方法。     

Cutaneous Manifestations of HIV/AIDS in the Era of Highly Active Antiretroviral Therapy: Evidence from Bangladesh

Objective: Skin diseases are common and striking features of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and may vary considerably by ethnic and geographic regions and by the influence of highly active antiretroviral therapy (HAART). However, little information exists regarding the cutaneous manifestations of patients with HIV/AIDS in Bangladesh. This study was performed to elucidate the spectrum of cutaneous disorders in patients with HIV/AIDS in the...