Chorioretinitis secondary to mycobacterium tuberculosis in acquired immune deficiency syndrome.

BACKGROUND: Several opportunistic intraocular infections have been described in patients with the human immunodeficiency virus, among them infections caused by Mycobacterium tuberculosis. In most cases, the diagnosis is based on clinical findings. Recent reports have described the usefulness of polymerase chain reaction techniques in the diagnosis of bacterial infections. METHODS: The authors observed a 29-year-old woman with acquired immune deficiency syndrome in whom unilateral chorioretinitis developed. The chorioretinitis appeared after cessation of treatment for pulmonary tuberculosis. We obtained aqueous humor by paracentesis and tested it by polymerase chain reaction to detect M. tuberculosis DNA. RESULTS: The polymerase chain reaction of the aqueous humor was positive for M. tuberculosis DNA. CONCLUSION: Polymerase chain reaction was useful in identifying M. tuberculosis in aqueous from a patient with chorioretinitis, pulmonary tuberculosis, and acquired immune deficiency syndrome.

[Tuberculosis associated with HIV infection]. / Tuberculosis asociada a infección por el virus VIH.

Tuberculosis and human immunodeficiency virus (HIV) infection are two important linked public health problems in the world of today. Tuberculosis in HIV infected patients is frequently atypical in its clinical and radiological findings and commonly has an extrapulmonary dissemination. Atypical mycobacteriosis have also been reported in patients with HIV infection. We review here all the patients admitted from 1986 to 1991 with definitive diagnosis of tuberculosis and HIV infection at the National Institute of Respiratory Diseases in Mexico City. Out of 220 patients with HIV infection and pulmonary complications, 19 had proven tuberculosis. Their mean age was 34 +/- 8 years and seven were homosexual males. In 16 patients (84%), respiratory symptoms (cough with sputum) and fever were the first manifestations of the HIV infection. Only two patients had the typical cavitary lesions but also coexisting with miliary tuberculosis. The rest had several types of non cavitated pulmonary opacities or other thoracic or pleural alterations. Eleven patients (58%) had, in addition, extrapulmonary tuberculosis. Mycobacterium tuberculosis was cultured in 11 of 12 patients but no atypical mycobacteria were isolated. Only seven of the 19 patients completed at least six months of treatment and two of them relapsed. Three patients died in their first admission; the rest were lost in the follow up. Our results show that the clinical features of tuberculosis associated to HIV infection are similar to those described in other countries.

[Pneumonia caused by measles: description of a clinical case of giant cell pneumonia in a non-immunosuppressed adolescent patient]. / Neumonía por sarampión: descripción de un caso clínico de neumonía de células gigantes en una paciente adolescente no inmunosuprimida.

Measles pneumonia is the most frequent complications associated with mortality in this infection. There are two types, one corresponds to the giant-cells pneumonia and the other one to lung superinfection after measles infection. The first one has been occurred in immunosuppressed patients, without rash. We reported a measles pneumonia case in a previously healthy adolescent girl who had a fatal pneumonia by giant cells demonstrated by open lung biopsy. The review of the literature showed that this is very unusual in normal population.

Manifestaciones extrapulmonares y curso rapidamente fatal en tres pacientes con neumonitis descamativa. / Extrapulmonary symptoms and rapidly fatal course in three patients with desquamative interstitial pneumonitis

Se presentan los casos clinicos de tres mujeres en la sexta decada de la vida que acudieron a nuestro hospital por presentar un padecimiento multisistemico, semejante a lupus eritematoso generalizado, y caracterizado por una evolucion rapidamente progresiva que las llevo a la muerte por insuficiencia respiratoria. En vida fueron sometidas a biopsia pulmonar, la que demostro mediante tinciones especiales fibrosis intersticial y neumonitis descamativa, que ante la falta de antecedentes y/ o examenes de laboratorio se catalogo como idiopatica. Las tres pacientes recibieron esteroides como tratamiento, sin respuesta adecuada. Es posible que dentro del grupo de pacientes con fibrosis pulmonar idiopatica haya un subgrupo de curso acelerado, refractario al tratamiento, com manifestaciones extrapulmonares preponderantes y pronostico sombrio

[Polymicrobial endocarditis. Report of a case and review of the literature]. / Endocarditis polimicrobiana. Informe de un caso y revisión de la literatura.

We describe a case of polimicrobial endocarditis in a patient with congenital aortic stenosis and end-stage renal failure in treatment with steroids and chronic haemodialisis. The blood culture grew e.coli, enterobacter sp, and s.epidermidis. Only a few papers in the literature have been devoted to this entity. Its frequency seems to be progressively higher. The present case is a good example to talk about the predisponent factors. The review of literature has shown that the occurrence of this entity is specially high among addicts, the most frequent bacteria are s.aureus, streptococci and pseudomonas and the mortality can be as high as 80%.

Artritis septica. Salmonella como causa frecuente en enfermos inmunocomprometidos en zonas endemicas. / Septic arthritis. Salmonella as common cause in immunosuppressed patients in endemic zones

Se revisa la experiencia de 4 anos en artritis septica en el Instituto Nacional de la Nutricion y se presentan 24 pacientes, 80% de ellos inmunosuprimidos. En 42% de los casos la causa fue estafilicoco, y en el mismo porcentaje bacterias Gram negativas. Dentro de este grupo el germen mas frecuente fue salmonella, la cual se aislo en seis de nueve pacientes. El retraso en el inicio de antibioticos y puncion articular hizo necesaria la cirugia y se acompano de un pobre pronostico. El presente trabajo demuestra la alta incidencia de artritis septica por salmonella en pacientes inmunosuprimidos, y confirma la necesidad de un tratamiento medico temprano en pacientes con artritis septica

Mucormicosis. Informe de 14 casos. / Mucormycosis. Report of 14 cases

Se reviso la experiencia del Instituto Nacional de la Nutricion Salvador Zubiran en mucormicosis acumulada en los ultimos 20 anos. Se analizan fundamentalmente las caracteristicas clinicas y se hace hincapie en el tratamiento oportuno con el uso de anfotericina B y cirugia radical en base a un diagnostico temprano, el cual requiere un alto indice de sospecha