RESUMEN
A variety of dermatological lesions have been described in COVID-19, although the prevalence and pathogenic relationship remain unclear particularly for chilblain-like lesions. Dermatological examination was performed in a prospective cohort of consecutive patients seen at the service for SARS-CoV-2 infection. Out of 417 patients with confirmed SARS-CoV-2 infection [median age 29.5 years (range 15-65); 62.5% males], dermatological lesions were detected in 7 (1.7%). Three patients had acral lesions; their age (range) was 15-29 years; all had a negative nasopharyngeal swab and developed IgG and/or IgM-specific antibodies; all presented none or mild symptoms. A fourth patient remained negative at repeated testing; mother, father and sister had a documented mild COVID-19. Non-acral lesions were observed in four older patients, with severe COVID-19. Chilblain-like lesions may be the sole manifestation of SARS-CoV-2 infection; their presence in asymptomatic school children and adolescents should be considered a potential signal of familial or community spread of the virus.
Asunto(s)
COVID-19 , Eritema Pernio , Enfermedades de la Piel , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , SARS-CoV-2 , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the decay rate of cellular proviral HIV-DNA and viral replication in patients receiving highly active antiretroviral therapy (HAART) in the very early phase of infection. METHODS: Thirty-four patients treated with HAART and retrospectively selected for progressive decline of plasma viraemia up to undetectable levels (< 20 copies/ml), were stratified according to CD4+ cell count and plasma viraemia at base line: > 500 x 10(6) cells/l with < 5000 copies/ml (group 1) or with > 5000 copies/ml (group 2), > 5000 copies/ml with 300-500 x 10(6) cells/l (group 3) or with < 300 x 10(6) cells/l (group 4). Plasma HIV-RNA and proviral HIV-DNA were analysed at baseline and after 1, 2, 3, 6, 9 and 12 months of treatment. RESULTS: After 1 year of treatment, a significant decrease of proviral DNA titre was observed in all patients and a decrease > 1 log was achieved in 24 of 29 subjects of the first three groups. The more pronounced decay of HIV-DNA (half-life 28 weeks) up to < 50 HIV-DNA copies/10(6) CD4+ cells was detected in patients of group 1. At the year's endpoint, five patients (four in group 1 and one in group 2) had < 20 HIV-DNA copies. However, HIV strains sensitive to antiretroviral drugs were isolated from peripheral lymphocytes of 16 out of 34 patients. CONCLUSION: In patients with undetectable plasma viraemia after 1 year of HAART, the highest reduction of proviral DNA up to < 50 copies/10(6) CD4+ cells was obtained only in subjects in the early asymptomatic phase of infection. Nevertheless, a replication-competent virus can be detected in all phases of antiretroviral therapy.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , ADN Viral/sangre , Infecciones por VIH/tratamiento farmacológico , VIH-1/crecimiento & desarrollo , Provirus/crecimiento & desarrollo , ARN Viral/sangre , Viremia/tratamiento farmacológico , Adulto , Recuento de Linfocito CD4 , Didanosina/uso terapéutico , Quimioterapia Combinada , Femenino , Inhibidores de la Proteasa del VIH/uso terapéutico , VIH-1/metabolismo , Humanos , Indinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Provirus/metabolismo , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Estavudina/uso terapéuticoRESUMEN
We describe two cases of toxic epidermal necrolysis developed during an antiretroviral therapy regimen containing nevirapine. It seems likely that the poor adherence to the dose escalation regimen of nevirapine has caused this life-threatening disease. A complete and written information on the scheduled antiretroviral therapy is mandatory, above all for individuals coming from developing countries where language barriers have not yet been successfully overcome.
Asunto(s)
Fármacos Anti-VIH/efectos adversos , Nevirapina/efectos adversos , Inhibidores de la Transcriptasa Inversa/efectos adversos , Síndrome de Stevens-Johnson/etiología , Adulto , Fármacos Anti-VIH/administración & dosificación , Barreras de Comunicación , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Nevirapina/administración & dosificación , Cooperación del Paciente , Inhibidores de la Transcriptasa Inversa/administración & dosificación , Índice de Severidad de la Enfermedad , Síndrome de Stevens-Johnson/diagnósticoRESUMEN
Castleman's disease is a heterogeneous group of lymphoproliferative disorders of unknown aetiology. Recently, human herpesvirus type 8 (HHV-8) has been associated with various diseases in individuals with HIV infection, including Kaposi's sarcoma, B cell non Hodgkin's lymphomas, and Castleman's disease. In Castleman's disease it has been hypothesized that HHV-8, encoding a number of various virokines, can be responsible for clinical manifestations of the disease.Previously, two reports have described a clinical recovery from HIV-associated Castleman's disease: by administration of a monoclonal antibody neutralizing human IL-6 in one case, and in another case by treatment with highly antiretroviral therapy and anti-herpesvirus therapy, following splenectomy. We report two cases where HAART alone led to clinical recovery from Castleman's disease. In both the cases reported here, although follow-up biopsy was not performed, it is likely that the inhibition of HHV-8 replication and of virokine release, through the restoration of immunity by HAART, was the basis for the disappearance of the clinical symptoms.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Enfermedad de Castleman/tratamiento farmacológico , Infecciones por VIH/complicaciones , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Adulto , Quimioterapia Combinada , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Resultado del TratamientoRESUMEN
OBJECTIVES: Highly active antiretroviral therapy (HAART) produces a rapid decline in plasma HIV-1 RNA levels with concomitant immune reconstitution. Probably due to the enhanced immune function, shortly after starting HAART, some latent opportunistic infections precipitated. The aim of this study was to illustrate the results of a survey on Cryptococcus associated mediastinitis occurring after HAART introduction, carried out at a referral centre of Infectious Diseases in the north-east of Italy, between October 1999 and October 2000. METHODS: All consecutive HIV-positive patients, naive to HIV-protease inhibitor therapy, and diagnosed with culture-proven cryptococcal infection were included in the study. Clinical and immuno-virological parameters before HAART and subsequently for 12 months were evaluated. RESULTS: Three of five patients were diagnosed with cryptococcal mediastinitis within a median time of 90 days (range, 60-150) after commencing HAART and fluconazole prophylaxis. Diagnosis was established by lymph node biopsy alone. Clinical improvement was documented when systemic anti-fungal therapy was combined with surgical drainage of the suppurative lesions. The role of immune restoration was confirmed by the significant increase in CD4 cell count, the reduction of HIV-RNA to undetectable levels and the prominent inflammatory reactions of lymph nodes. CONCLUSIONS: Our report suggests that HIV-positive patients with prior cryptococcal systemic infection may present a re-exacerbation of atypical cryptococcosis as a manifestation of immune restoration, even when fluconazole prophylaxis is ongoing.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Terapia Antirretroviral Altamente Activa , Criptococosis/complicaciones , Infecciones por VIH/complicaciones , Mediastinitis/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Adulto , Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4 , Líquido Cefalorraquídeo/microbiología , Criptococosis/diagnóstico , Criptococosis/inmunología , Cryptococcus/inmunología , Cryptococcus/aislamiento & purificación , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , Humanos , MasculinoRESUMEN
OBJECTIVES: To see whether in severely immunosuppressed AIDS patients (with prior Cytomegalovirus retinal disease) who have significant increases in CD4+ lymphocytes following the initiation of highly active antiretroviral therapy (HAART) anti-Cytomegalovirus (CMV) maintenance therapy can be withdrawn with no subsequent progression of CMV retinitis. METHODS: Eight patients with AIDS and one or more previous episodes of CMV retinitis interrupted anti-CMV maintenance therapy following the successful beginning of HAART. CD4 cell counts and HIV-RNA were monitored monthly while measurement of CMV antigenemia and ophthalmoscopy were carried every 2 weeks thereafter. RESULTS: The HAART recipients in whom anti-CMV maintenance therapy had been interrupted had measureable increases of CD4+ T lymphocytes, substantial control of both HIV-RNA and CMV viraemia and did not show recurrence of retinitis during a mean follow-up of 98.4 weeks (range 78-120, SD 15.2). CONCLUSIONS: Anti-CMV maintenance therapy can be interrupted with no subsequent progression of retinal damage over a long time in patients with AIDS who successfully respond to HAART with a significant increase in CD4 cell count.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Antivirales/uso terapéutico , Retinitis por Citomegalovirus/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/inmunología , Adulto , Antígenos Virales/sangre , Recuento de Linfocito CD4 , Femenino , Humanos , Masculino , Persona de Mediana Edad , ARN Viral/sangreAsunto(s)
Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Hipertensión/inducido químicamente , Indinavir/efectos adversos , Adulto , Anciano , Recuento de Linfocito CD4 , Estudios de Cohortes , Inhibidores de la Proteasa del VIH/uso terapéutico , Humanos , Indinavir/uso terapéutico , Persona de Mediana Edad , Estudios Retrospectivos , Estadísticas no Paramétricas , Carga ViralRESUMEN
Encephalitis can represent a complication of both Mycoplasma and Human Herpesvirus type 6 infections and, although uncommon, is associated with significant morbidity and mortality. We describe a 13-year-old girl with fever, headache and mental changes with a pattern of concomitant Mycoplasma and Human Herpesvirus-6 infection. The hypothetical relationship between this dual infection and the central nervous system disease is discussed.
Asunto(s)
Meningoencefalitis/microbiología , Meningoencefalitis/virología , Infecciones por Mycoplasma/complicaciones , Infecciones por Roseolovirus/complicaciones , Aciclovir/uso terapéutico , Adolescente , Antibacterianos/uso terapéutico , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/líquido cefalorraquídeo , Anticuerpos Antivirales/sangre , Antivirales/uso terapéutico , Ceftriaxona/uso terapéutico , Electroencefalografía , Femenino , Herpesvirus Humano 6/genética , Herpesvirus Humano 6/inmunología , Humanos , Inmunocompetencia , Imagen por Resonancia Magnética , Meningoencefalitis/diagnóstico , Meningoencefalitis/tratamiento farmacológico , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/tratamiento farmacológico , Reacción en Cadena de la Polimerasa , Infecciones por Roseolovirus/diagnóstico , Infecciones por Roseolovirus/tratamiento farmacológicoRESUMEN
The DRESS (drug rash with eosinophilia and systemic symptoms) syndrome is a serious condition that has been reported in association with various drugs, such as allopurinol, sulfonamides and aromatic anticonvulsants. Recently the condition has been described in HIV-infected patients taking antiretroviral agents. We report the first case, to our knowledge, of DRESS syndrome complicated by meningoencephalitis associated with nevirapine therapy.
Asunto(s)
Fármacos Anti-VIH/efectos adversos , Hipersensibilidad a las Drogas/etiología , Infecciones por VIH/tratamiento farmacológico , Meningoencefalitis/inducido químicamente , Nevirapina/efectos adversos , Adulto , Fármacos Anti-VIH/uso terapéutico , Erupciones por Medicamentos/complicaciones , Erupciones por Medicamentos/etiología , Hipersensibilidad a las Drogas/complicaciones , Eosinofilia/inducido químicamente , Eosinofilia/complicaciones , Exantema/inducido químicamente , Exantema/complicaciones , Humanos , Masculino , Meningoencefalitis/complicaciones , Nevirapina/uso terapéutico , SíndromeRESUMEN
We present a case of splenic infarct during infectious mononucleosis in a 17-y-old boy. The patient's condition improved without the need for surgery.
Asunto(s)
Mononucleosis Infecciosa/complicaciones , Infarto del Bazo/diagnóstico , Infarto del Bazo/etiología , Adolescente , Diagnóstico Diferencial , Humanos , Masculino , Infarto del Bazo/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Sarcoidosis occurring in patients with AIDS is rare. This infrequent association has been attributed to the impairment of the immune system that may interfere with the granuloma formation in HIV infected patients. However, the introduction of highly active antiretroviral therapy (HAART) has brought about a substantial and sustained increase in CD4+ T lymphocyte cells, and has consequently led to the development of the so called "immune restoration disease". The case of an HIV infected man who developed sarcoidosis after the initiation of HAART is described. Skin nodule images and histological specimens are reported. The association between sarcoidosis and HIV infection is also reviewed.
Asunto(s)
Infecciones por VIH/complicaciones , Sarcoidosis/virología , Enfermedades de la Piel/virología , Corticoesteroides/uso terapéutico , Adulto , Terapia Antirretroviral Altamente Activa/efectos adversos , Recuento de Linfocito CD4 , Humanos , Masculino , Sarcoidosis/inducido químicamente , Sarcoidosis/tratamiento farmacológico , Enfermedades de la Piel/inducido químicamente , Enfermedades de la Piel/tratamiento farmacológicoRESUMEN
Drug interactions are an important and emerging problem in the treatment of HIV-infected patients. Protease inhibitors, like nonnucleoside reverse transcriptase inhibitors, are metabolized by the cytochrome P-450 enzyme system and each of these antiretroviral agents may interact with other drugs metabolized by this system. Some protease inhibitors may also interact with glucuronosyl transferase activity affecting plasma concentrations of drugs metabolized through this pathway. We describe a case of an HIV-infected patient, taking levothyroxine for hypothyroidism and clinically stable, who, after the introduction of an antiretroviral regimen containing indinavir, developed a pharmacological hyperthyroidism.