[Pulmonary cryptosporidiosis in AIDS patients]. / Criptosporidiosis broncopulmonar en pacientes infectados por el virus de la inmunodeficiencia humana.

Pulmonary cryptosporidiosis is a rare complication of intestinal cryptosporidiosis in AIDS patients. We report the epidemiological, clinical, radiological, microbiological and immunological findings in 5 AIDS patients with pulmonary cryptosporidiosis. Diagnosis was based on the detection of acid-fast oocysts in sputum or aspirated bronchial material using the Kinyoun technique. Microbiology laboratories should be alert to the possibility of Cryptosporidium spp oocysts presence in respiratory specimens from patients with advanced HIV/AIDS disease and pulmonary involvement.

Disseminated histoplasmosis and AIDS: clinical aspects and diagnostic methods for early detection.

Disseminated histoplasmosis in AIDS patients is the focus of this paper. Cutaneous lesions are reported as a frequent clinical sign. Bone marrow aspiration and biopsy, blood cultures (lysis-centrifugation technique), bronchoalveolar lavage, and skin lesion scrapings are the most effective diagnostic methods. The identification of a specific antigen in blood and urine may be a rapid means of evaluation and follow-up of patients with this disease.

[Cavum lymphoma in a hemophilic patient with AIDS]. / Linfoma de cavum en un paciente hemofílico con SIDA.

Intermediate and highly malignant non-Hodgkin and primary central nervous system lymphomas are marker diseases for AIDS. Cavum and oropharynx involvement by these tumors is uncommon. Although there are few cases reported in the literature, these may be primary localizations of the tumor. We present a hemophilic HIV+ patient with non-Hodgkin lymphoma of the cavum. The histologic diagnosis was high-grade, pleomorphic, centroblastic lymphoma. The patient was treated with chemotherapy plus intrathecal chemotherapy and highly active antiretroviral therapy (HAART). His evolution has been excellent. One year after diagnosis, the patient is asymptomatic with no evidence of residual tumor, and responding well to HAART.

[Cerebrospinal fluid viral load in HIV-1 positive hemophilic patients treated with HAART]. / Carga viral en líquido cefalorraquídeo de pacientes hemofilicos HIV-1 positivos bajo tratamiento con HAART.

As HIV seropositive patients with undetectable CSF viral load have a lower likelihood of developing neurologic disease, the determination of CSF viral load levels may be useful to evaluate the efficacy of HAART. We compared plasma viral load levels with HIV-1 RNA CSF levels in 18 hemophilic patients without neurocognitive involvement under HAART. We detected a significant correlation between plasma viral load levels and CSF viral load levels. Fourteen patients with undetectable plasma viral load had undetectable RNA HIV-1 CSF levels as well. Four patients with detectable plasma viral load had detectable HIV-RNA in CSF, but the latter were significantly lower. Viral load is usually lower in non-blood fluids and HAART decreases the viral load in CSF as well as in blood.

[Evaluation of 61 episodes of infective endocarditis in intravenous drug abusers and human immunodeficiency type-1 virus infection]. / Evaluación de 61 episodios de endocarditis infecciosa en pacientes adictos a drogas intravenosas e infección por el virus de la inmunodeficiencia humana tipo-1.

We conducted a retrospective evaluation to determine the clinical and microbiological characteristics of 61 episodes of infective endocarditis (IE) in intravenous drug abusers (IDA), HIV seropositive patients. Forty-nine males and 6 females between 15 and 42 years of age were included in the study. All the included patients presented 61 episodes of IE. Fever and cardiac murmur were present in all episodes; 43 (70.4%) had hepatomegaly; 29 (47.5%) had splenomegaly. Thirty-eight (62.3%) presented cough (9 with hemoptysis); 25 (41%) had dyspnea, and 5 (8.2%) had jugular ingurgitation. Fundoscopy showed alterations in 3 patients (4.9%). Bacteriological confirmation was obtained in 41 episodes (67.2%); blood cultures revealed Staphylococcus aureus in 30 cases (73.1%), Streptococcus viridans in 8 (19.5%) patients, Staphylococcus epidermidis in 1 (2.4%), Staphylococcus hominis in 1 (2.4%) and Streptococcus pneumoniae in one case (2.4%). The tricuspid valve was involved in 51 episodes (83.6%), the aorta in 6 (9.8%), the mitral valve in 3 (4.9%) and the pulmonary valve in one (1.6%). There was evidence of right bivalvular involvement in 2 patients (3.2%) and tricuspid and mitral involvement in another (1.6%). Pericardial effusion was detected in 19 episodes (31.1%). Six patients (10.9%) died during the acute episode of IE.

[Disseminated cryptococcosis in patients with AIDS. Clinical, microbiological, and immunological analysis of 51 patients]. / Criptococosis diseminada en pacientes con SIDA. Análisis clínico, microbiológico e inmunológico de 51 pacientes.

In the context of HIV infection, cryptococcal meningitis is the most common mycosis threatening the patient's life. We conducted a retrospective evaluation to determine the epidemiological, microbiological, immunological and clinical characteristics of disseminated cryptococcosis in 51 hospitalised HIV seropositive patients. All the individuals (n = 51) presented reactive serology for HIV (ELISA and/or Western blot) and none fulfilled strict HAART treatment, previous to the opportunistic infection. CD4+ lymphocyte T counts showed levels between 361 and 0 cells/microliter (mean = 45). All patients but one had counts lower than 100 cells/microliter. Cryptococcosis presented as unique episode in 35 patients (68.6%) and in 16 as relapse (31.3%). In all of them we detected central nervous system involvement. The induction treatment was carried out with amphotericin B (AMB), continued with maintenance therapy with fluconazole. Lethality rate was 36.7%, slightly superior among patients in relapse (40%) compared to those who presented a first episode of the mycosis (35.2%). In those individuals for whom data were available, 65.2% of blood cultures, 94.1% of CSF cultures and 79.06% of microscopic CSF examination with India ink were positive. Titers of Cryptococcus neoformans capsular antigen in CSF > or = 1/1000 were found in 36.1% and > or = 1/1000 in 73.6% of serum samples. In conclusion, manifestations and severity of disseminated cryptococcosis continue maintaining the characteristics of half a decade behind, in those patients who are not treated with HAART. Neurological involvement existed in all patients of this cohort. Treatment is not able to modify the parameters of mortality seen in previous communications. Diagnostic methods applied in this study are in accordance with those in the bibliography.

[The compromise of esophagus in HIV/AIDS diseases]. / El compromiso del esófago en la enfermedad HIV/SIDA.

Esophageal disease is a common complication in patients infected with human immunodeficiency virus type-1 (HIV-1). Dysphagia, odynophagia and retrosternal pain are the most common symptons associated with the esophageal compromise. Esophageal candidiasis, the most frequent opportunistic infection, may occur in patients with long-standing infection or may be a manifestation of the seroconversion. Cytomegalovirus and Herpes simplex virus are more likely to produce esophageal ulcers or erosions. HIV itself may be responsible for ulcerative esophagitis. Neoplasms as Kaposi's sarcoma, are an infrequent cause of symptomatic disease. Barium esophagography and specially upper endoscopy are the most commonly employed diagnostic modalities for the evaluation of symptomatic patients. Endoscopy may be warranted to make a rapid diagnosis such that specific therapy will not be delayed. The use of a combination of histologic, cytologic, mycologic and virologic studies is necessary to provide an etiologic diagnosis of these lesions.

[Primary esophageal lymphoma in a patient with AIDS]. / Linfoma primario de esófago en una paciente con SIDA.

Primary esophageal lymphomas are extremely rare. We report a primary esophageal T cell lymphoma of a diffuse large cell phenotype B in a patient with AIDS. Also we reviewed other published cases. The diagnosis of this complication should be considered in HIV seropositive patients with progressive displagia and endoscopic findings of masses, polyps or ulcerations and, specially in those unresponsive to antifungal or antiviral therapy. Biopsy and histopathologic studies are needed to confirm the diagnosis.

Síndrome de Sweet asociado a infección por el Virus de la Inmunodeficiencia Humana / Sweet's syndrome associated to human immunodeficiency virus infection

El síndrome de Sweet es una dermatosis neutrofílica aguda y febril que puede ser desencadenada por diferentes noxas. El diagnóstico es clínico a partir de una dermatosis aguda, con fiebre, leucocitosis y lesiones cutáneas localizadas en cara, cuello y extremidades. La histopatología muestra un denso infiltrado inflamatorio de la dermis a predominio neutrofílico, sin signos de vasculitis. Se presenta un paciente con síndrome de Sweet asociado a infección por el virus de la inmunodeficiencia humana

Sweet's syndrome associated with human immunodeficiency virus infection Sweet's syndrome is a neutrophilic and acute febrile dermatosis that can be triggered by different noxas. Diagnosis should be suspected in a patient with fever, leukocytosis and cutaneous lesions located on the face, the neck and the extremities. Cutaneous biopsy confirms the diagnosis of Sweet syndrome, with typical features of a neutrophilic dermatosis in the absence of vasculitis. Here we present a case of Sweet syndrome associated with human immunodeficiency virus infection

Sífilis secundaria con lesiones de la cavidad bucal como única manifestación clínica Presentación de 20 casos y revisión de la literatura / SECONDARY SYPHILIS WITH BUCAL CAVITY LESIONS AS SINGLE CLINICAL MANIFESTATION

La sífilis es una enfermedad infectocontagiosa causada por una espiroqueta: el Treponema pallidum. Se transmite por contacto directo (generalmente sexual) con las lesiones cutáneo-mucosas durante el estadio primario y secundario, por vía transplacentaria durante el embarazo o a través del pasaje por el canal uterino y por sangre. Se trata de una enfermedad sistémica con una gran variedad de manifestaciones clínicas. La sífilis secundaria cursa con manifestaciones generales de un síndrome infeccioso inespecífico y lesiones mucocutáneas características. La presentación clínica de los 20 pacientes que se describen en este trabajo es singular ya que solo poseían lesiones en la cavidad oral. Es importante considerar esta patología en el diagnóstico diferencial de lesiones mucosas orales, para realizar un diagnóstico temprano, tratamiento precoz y evitar el contagio, así como siempre descartar la asociación con infección por el retrovirus VIH

Syphilis is a sexually transmitted disease caused by the spirochete bacterium named as Treponema pallidum. Syphilis is transmitted by direct contact (generally non-protect sexual contact) with cutaneous and mucosal lesions during the primary and secondary periods, by trans-placental transmission if the mother develop the infection during pregnancy and by blood. Syphilis is a systemic disease with a wide variety of clinical manifestations. Secondary syphilis is characterized by a nonspecific infectious syndrome and mucocutaneous lesions. Here we describe a serie of 20 patients with secondary syphilis as the unique clinical manifestation. Secondary syphilis should be included in the differential diagnosis of oral cavity mucosal lesions to achieve an early diagnosis and avoid the contagion. Human immunodeficiency virus infection should be always considered

Oral cavity and extra-oral plasmablastic lymphomas in AIDS patients: report of five cases and review of the literature.

Plasmablastic lymphoma (PBL) is a distinct disease entity of the diffuse large B-cell lymphoma, which often occurs in HIV-positive patients. The immunophenotype of this lymphoid neoplasm is characterized by the presence of plasma cell-associated markers VS38c and CD138 antigens and the absence of B-cell markers such as CD20 and CD45. The most frequent site of involvement is the oral cavity and the jaw, while several reports describe the development of PBL in extra-oral sites including the lymph nodes, the anal canal, the soft tissue, the skin and the gastrointestinal tract as less frequent. Epstein-Barr virus is often associated with PBL pathogenesis and the neoplastic cells contain this virus genome. Here we review the epidemiological, clinical, immunological, histopathological and virological characteristics and their prognosis and outcome in a series of five patients with diagnoses of HIV/AIDS and PBL.

Disseminated paracoccidioidomycosis with a single brainstem lesion. A case report and literature review.

Paracoccidioidomycosis is a systemic disease endemic to subtropical areas in Central and South America caused by a dimorphic fungus known as Paracoccidioides brasiliensis. Central nervous system involvement is a severe complication of the systemic disease, and has been found in approximately 13% of patients. This paper describes the case of a patient whose computed tomography scan and magnetic resonance imaging showed a single tumor-like lesion in the brainstem. Histopathological and mycological examinations of stereotactic biopsy smears showed the characteristic yeast cells that confirmed the diagnosis of neuroparacoccidioidomycosis.

Criptosporidiosis broncopulmonar en pacientes infectados por el virus de la inmunodeficiencia humana / Pulmonary cryptosporidiosis in AIDS patients

La criptosporidiosis pulmonar es una rara complicación de la enfermedad intestinal causada por este agente en pacientes con SIDA. En este trabajo se describen las características epidemiológicas, clínicas, radiológicas, microbiológicas e inmunológicas de 5 pacientes con SIDA y criptosporidiosis pulmonar. El diagnóstico de la localización pulmonar se basó en el hallazgo de ooquistes de Cryptosporidium spp. en muestras de esputo o lavado broncoalveolar utilizando la coloración de Kinyoun. Los laboratorios de microbiología deben estar alerta ante la posibilidad de identificar ooquistes de Cryptosporidium spp. en secreciones broncopulmonares de pacientes con enfermedad VIH/SIDA avanzada.

Pulmonary cryptosporidiosis is a rare complication of intestinal cryptosporidiosis in AIDS patients. We report the epidemiological, clinical, radiological, microbiological and immunological findings in 5 AIDS patients with pulmonary cryptosporidiosis. Diagnosis was based on the detection of acid-fast oocysts in sputum or aspirated bronchial material using the Kinyoun technique. Microbiology laboratories should be alert to the possibility of Cryptosporidium spp oocysts presence in respiratory specimens from patients with advanced HIV/AIDS disease and pulmonary involvement.

Necrosis avascular de cabeza y cuello de fémur en un paciente con sida / Avascular osteonecrosis of femoral head and neck in an AIDS patient

Avascular osteonecrosis (AON) has increased in the last few years in patients infected with the human immunodeficiency virus type-1 (HIV-1). The most commonly affected bone is the femoral head and neck. Frequently these bilateral and clinical findings include moderate to severe pain and functional impotence of the affected joints. The etiology is multifactorial and highly active antiretroviral therapy (HAART) with protease inhibitors (PI) is probably related to its development. In the evolution, a total hip replacement may be needed. We present an hemophilic patient with AIDS, who developed a bilateral AON of the femoral head and neck during HAART.

La osteonecrosis avascular (ONA) es una complicación que se describe con frecuencia creciente en pacientes infectados por el virus de la inmunodeficiencia humana tipo-1 (HIV-1). En su localización más común compromete la cabeza y cuello del fémur con dolor e impotencia funcional, en una o ambas caderas. Su etiología es multifactorial y la terapia antirretroviral de alta eficacia (HAART) con inhibidoresde proteasa (IP) puede estar relacionada con la patogenia. En su evolución puede requerir el reemplazo total de la cadera con la colocación de una prótesis. Se presenta un paciente hemofílico, HIV-1 seropositivo, quedesarrolló una ONA bilateral de cabeza y cuello de fémur mientras se encontraba bajo HAART.