RESUMEN
A 28-year-old woman who was undergoing treatment with eculizumab for paroxysmal nocturnal hemoglobinuria presented to the hospital with fevers, chills, headache, and a swollen left index finger. Blood cultures returned positive for Neisseria gonorrhoeae. We report the second case of disseminated gonococcal infection associated with the use of eculizumab.
Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Gonorrea/diagnóstico , Hemoglobinuria Paroxística/tratamiento farmacológico , Neisseria gonorrhoeae/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Anticuerpos Monoclonales Humanizados/efectos adversos , Azitromicina/uso terapéutico , Ceftriaxona/uso terapéutico , Consejo Dirigido , Femenino , Gonorrea/tratamiento farmacológico , Gonorrea/inmunología , Hemoglobinuria Paroxística/inmunología , Humanos , Conducta Sexual , Resultado del TratamientoRESUMEN
Neisseria bacilliformis has most often been associated with infections of the oral cavity and the respiratory tract. We report a case of N. bacilliformis mitral valve endocarditis in a previously healthy adult which required valve replacement, thus confirming the opportunistic nature and pathogenic potential of this novel organism.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Neisseria/clasificación , Neisseria/aislamiento & purificación , Infecciones por Neisseriaceae/diagnóstico , Antibacterianos/farmacología , ADN Bacteriano/química , ADN Bacteriano/genética , ADN Ribosómico/química , ADN Ribosómico/genética , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/cirugía , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Válvula Mitral/microbiología , Válvula Mitral/patología , Válvula Mitral/cirugía , Datos de Secuencia Molecular , Infecciones por Neisseriaceae/microbiología , Infecciones por Neisseriaceae/cirugía , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADNAsunto(s)
Complejo SIDA Demencia/patología , Enfermedades Cerebelosas/patología , Cerebelo/patología , Infecciones por VIH/complicaciones , Complejo SIDA Demencia/diagnóstico por imagen , Complejo SIDA Demencia/fisiopatología , Adulto , Antirretrovirales/uso terapéutico , Atrofia/diagnóstico por imagen , Atrofia/patología , Atrofia/virología , Ataxia Cerebelosa/patología , Ataxia Cerebelosa/fisiopatología , Ataxia Cerebelosa/virología , Enfermedades Cerebelosas/diagnóstico por imagen , Enfermedades Cerebelosas/virología , Cerebelo/diagnóstico por imagen , Cerebelo/virología , Femenino , Humanos , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Carga ViralRESUMEN
BACKGROUND: Regimens containing three nucleoside reverse-transcriptase inhibitors offer an alternative to regimens containing nonnucleoside reverse-transcriptase inhibitors or protease inhibitors for the initial treatment of human immunodeficiency virus type 1 (HIV-1) infection, but data from direct comparisons are limited. METHODS: This randomized, double-blind study involved three antiretroviral regimens for the initial treatment of subjects infected with HIV-1: zidovudine-lamivudine-abacavir, zidovudine-lamivudine plus efavirenz, and zidovudine-lamivudine-abacavir plus efavirenz. RESULTS: We enrolled a total of 1147 subjects with a mean baseline HIV-1 RNA level of 4.85 log10 (71,434) copies per milliliter and a mean CD4 cell count of 238 per cubic millimeter were enrolled. A scheduled review by the data and safety monitoring board with the use of prespecified stopping boundaries led to a recommendation to stop the triple-nucleoside group and to present the results in the triple-nucleoside group in comparison with pooled data from the efavirenz groups. After a median follow-up of 32 weeks, 82 of 382 subjects in the triple-nucleoside group (21 percent) and 85 of 765 of those in the combined efavirenz groups (11 percent) had virologic failure; the time to virologic failure was significantly shorter in the triple-nucleoside group (P<0.001). This difference was observed regardless of the pretreatment HIV-1 RNA stratum (at least 100,000 copies per milliliter or below this level; P< or =0.001 for both comparisons). Changes in the CD4 cell count and the incidence of grade 3 or grade 4 adverse events did not differ significantly between the groups. CONCLUSIONS: In this trial of the initial treatment of HIV-1 infection, the triple-nucleoside combination of abacavir, zidovudine, and lamivudine was virologically inferior to a regimen containing efavirenz and two or three nucleosides.