Diagnosis of visceral leishmaniasis in HIV-infected individuals using peripheral blood smears.

OBJECTIVE: To compare the clinical and laboratory features of visceral leishmaniasis (kala-azar) in HIV-infected and non-infected subjects, and to determine the presence of Leishmania amastigotes in circulating leukocytes using peripheral blood smears. PATIENTS: Twenty-eight HIV-infected and six HIV-negative adult patients diagnosed as having kala-azar presenting at one institution over a 7-year period. METHODS: Retrospective review of clinical charts and re-examination of peripheral blood smears. RESULTS: There were no significant differences in the clinical presentation and laboratory features of HIV-positive and HIV-negative patients. However, Leishmania amastigotes were observed in circulating leukocytes in eight out of the 17 available peripheral blood smears (15 from HIV-infected patients). All eight individuals presenting with Leishmania in peripheral blood leukocytes were HIV-positive. CONCLUSIONS: Direct visualization of Leishmania amastigotes in leukocytes on peripheral blood smears enabled the diagnosis of kala-azar in a high proportion [eight out of 15 (53%)] of our HIV-infected patients.

AIDS and tuberculosis in Spain. A report of 140 cases.

From January 1984 to October 1990, 140 of 392 (35.7%) patients with the acquired immunodeficiency syndrome (AIDS) were found to have had tuberculosis. One hundred and sixteen were intravenous drug abusers and 16 were homosexual men. Fever, cough, weight loss and generalised lymphadenopathy were common features of their illness. Tuberculin skin tests were negative in 74% and 55% had intraabdominal lymphadenopathy. The chest radiographs showed hilar lymphadenopathy and lower lobe interstitial or alveolar infiltrates, but rarely cavitation. Forty-one of our patients had pulmonary tuberculosis, 38 had extra pulmonary and in 61 it was disseminated. In 80 cases tuberculosis was the presenting feature of AIDS. Tuberculosis usually responded well to chemotherapy.

[Visceral leishmaniasis: a study of 15 cases]. / Leishmaniasis visceral: estudio de 15 casos.

We report 15 cases of visceral leishmaniasis in adults, diagnosed by visualization of the parasite in 14 of them and in one case, based on clinic, serology and good response to treatment. Thirteen patients developed an acute clinical state and two patients, a subacute-chronic state. All of them had fever, half of them, a constitutional syndrome and 12, visceromegaly. Fifteen had anemia, 13, leukopenia and 10, thrombopenia. Serology was positive in 75% of cases. All patients were treated with meglumine antimoniate. No adverse effects were observed and in 14 patients, the treatment was successful. There were no recurrences. A patient died due to septic shock by Pneumococcus with DCI.

[Diagnostic imaging in Lemierre's+ syndrome]. / Diagnóstico por imagen en el síndrome de Lemierre.

BACKGROUND: The Lemierre syndrome is a septic picture with jugular thrombophlebitis and secondary septic embolisms usually produced by Fusobacterium necrophorum. In previous reports published in the literature, imaging techniques are seldom referred to report the presence of jugular thrombophlebitis. A case of the Lemierre syndrome is presented with the aim of calling attention to this process and its current diagnostic possibilities. METHODS: The case of a patient who was diagnosed of having a Lemierre syndrome with sepsis by Fusobacterium is presented, with radiologic pulmonary embolisms. The echo-Doppler exam showed the presence of internal jugular involvement in absence of signs and symptoms leading to suspicion. A review of 6 cases is also made with special attention being given to the data on jugular vein involvement. RESULTS: Only in 2 of the 6 patients reviewed were imaging techniques used on the internal jugular view (in one 2D echography and in the other computerized axial tomography) with the diagnosis being performed on the base of symptomatic and physical exam data in the remaining 4 cases. CONCLUSIONS: The Lemierre syndrome should be suspect in all patients with bacteremia by Fusobacterium and radiologic imaging of pulmonary embolism, even in the absence of signs and symptoms of oropharyngeal and jugular involvement. Modern imaging techniques, particularly echo-Doppler, may play an important diagnostic role.

[Description and survival analysis of 401 cases of AIDS in Madrid]. / Descripción y análisis de supervivencia de 401 casos de SIDA en Madrid.

A descriptive trial and an analysis of global survival, in relation to the different risk's groups and the type of clinical onset, was carried out in 401 patient diagnosed of AIDS in our hospital form 1984 to 1990. The males with addiction to parenteral drugs account for the most numerous group. Extrapulmonary tuberculosis was the most frequent presentation. During the period mentioned before, the survival distribution using the Kaplan-Meyer method was 52% for 12 months (SE = 0.0347). The survival rate was significantly higher (p less than 0.01) in those patients who presented an extrapulmonary tuberculosis as an onset of his disease.

[Bacteremia caused by Salmonella non-typhi in patients infected with HIV]. / Bacteriemia por Salmonella no-typhi en pacientes infectados por VIH.

All the cases of HIV infected patients diagnosed in our department during 1987 of Salmonella bacteremia are included in this report. Out of a total of 10 patients with both conditions, six were diagnosed of AIDS, three of AIDS related complex, and one presented an asymptomatic HIV infection. The mean age was 32.9 years (range 22 to 56). Eight of them were males, seven were intravenous drug addicts, and three were homosexual. Fever was observed in all cases and diarrhea in four of them. Salmonella enteritidis was isolated from the blood culture of nine patients and salmonella typhimurium from one. Salmonella enteritidis was isolated from the stool culture of 5 patients and Salmonella typhimurium and Campylobacter from the stool culture of one patient. Of the 10 patients 6 have died, 4 of them within the three weeks after the diagnosis of Salmonella non-typhi bacteremia, 2 have not relapsed and two patients were lost during follow up.

[Cryptococcosis in AIDS patients: a study of 19 cases]. / Criptococosis en pacientes con SIDA: estudio de 19 casos.

We discuss 19 cases of infection due to Cryptococcus neoformans diagnosed in 438 AIDS patients admitted to our center (4%). Fourteen of them showed meningitis confirmed by culture of C. neoformans in CSF. Clinical features were rather unspecific and disorders in CSF parameters were non striking. The diagnostic techniques performed with best results were culture of C. neoformans and antigen determination, especially in serum. Survival probability at one year was 75%. Treatment response was good. Treatment with fluocytosine did not seem to provide additional benefits versus amphotericin alone, neither in respect to clinical evolution nor regarding survival probability at one year. Fluconazole has shown effectiveness in maintenance therapy, being not be possible to evaluate it as an acute phase therapy because the low number of cases in which it was studied. It is advisable to follow a suppressive treatment, having found a 10% relapse rate in patients following therapy and a 50% in those who interrupted it.

[Tuberculosis and HIV infection: study of 50 cases]. / Tuberculosis e infección por HIV: estudio de 50 casos.

The clinical, microbiological, radiological and sonographical finding of 50 patients with tuberculosis and HIV infection are herewith described. 44 of the patients were men and 46 were intravenous drug addicts. Severe respiratory symptoms and peripheral pathological adenopathies were the most encountered manifestations. Those patients with tuberculosis and negative HIV titers (p less than 0.005) commonly showed lung miliary signs and mediastinal adenopathies when compared to others. Abdominal adenopathies evidenced by sonography were seen in 64.3% of the patients, of which only 2 out of the 27 HIV-positive-markers were of no tuberculous origin (p less than 0.0001). Sputum, urine and ganglia cultures were positive in more than 82%. 24 patients had pulmonary tuberculosis, 11 extra-pulmonary and 17 mixed. The response to treatment was good.