RESUMO
Nephrotic syndrome patients on long-term steroids face the risk of having heavy uncomplicated strongyloidiasis or death from its extreme form, the strongyloides hyperinfection. The risk can be minimized if we eradicate the parasite first. We compare a once daily and twice daily albendazole regimen in preventing this potentially fatal complication in 122 patients with nephrotic syndrome.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Síndrome Nefrótica/complicações , Strongyloides stercoralis/efeitos dos fármacos , Estrongiloidíase/prevenção & controle , Adolescente , Adulto , Albendazol/administração & dosagem , Animais , Anti-Helmínticos/administração & dosagem , Camboja , Quimioprevenção , Humanos , Pessoa de Meia-Idade , Síndrome Nefrótica/tratamento farmacológico , Prednisolona/administração & dosagem , Esteroides/administração & dosagem , Strongyloides stercoralis/patogenicidade , Estrongiloidíase/mortalidade , Resultado do TratamentoRESUMO
The incidence of nocardial infection in HIV-positive patients is increasing. In immune suppression the infection is often disseminated and can present as cardiac tamponade.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Tamponamento Cardíaco/etiologia , Infecções por HIV/complicações , Nocardiose/microbiologia , Nocardia asteroides/isolamento & purificação , Infecções Oportunistas Relacionadas com a AIDS/complicações , Adulto , Feminino , Humanos , Nocardiose/complicações , Derrame Pericárdico/microbiologiaRESUMO
Strongyloides stercoralis is present worldwide and can cause hyperinfection in patients on long-term immunosuppressive doses of steroids, as is sometimes the case for patients treated for leprosy reactions. Strongyloides hyperinfection can present with ileus, as is discussed in this case report. Physicians, including surgeons, should be aware of this entity in order to avoid an unnecessary laparotomy. Though patients may survive if diagnosed at an early stage, strongyloides hyperinfection syndrome has a mortality rate of 87% and prevention is therefore of utmost importance.
Assuntos
Íleus/tratamento farmacológico , Imunossupressores/efeitos adversos , Hanseníase/diagnóstico , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Superinfecção/diagnóstico , Adulto , Animais , Progressão da Doença , Evolução Fatal , Humanos , Íleus/microbiologia , Íleus/cirurgia , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Masculino , Medição de Risco , Estrongiloidíase/imunologia , Superinfecção/terapiaRESUMO
In a retrospective study of 648 persons with HIV infection in Cambodia, we determined the sensitivity, specificity, and accuracy of the 2003 World Health Organization (WHO) criteria to start antiretroviral treatment based on clinical criteria alone or based on a combination of clinical symptoms and the total lymphocyte count. As a reference test, we used the 2003 WHO criteria, including the CD4 count. The 2003 WHO clinical criteria had a sensitivity of 96%, a specificity of 57%, and an accuracy of 89% to identify patients who need highly active antiretroviral therapy (HAART). In our clinic, with a predominance of patients with advanced disease, the 2003 WHO clinical criteria alone was a good predictor of those needing HAART. A total lymphocyte count as an extra criterion did not improve the accuracy. Nine percent of patients were wrongly identified to be in need of HAART. Among them, almost 50% had a CD4 count of more than 500 cells/muL, and 73% had weight loss of more than 10% as a stage-defining condition. Our data suggest that, in settings with limited access to CD4 count testing, it might be useful to target this test to patients in WHO stage 3 whose staging is based on weight loss alone, to avoid unnecessary treatment.