RESUMEN
Patients with coccidioidal meningitis require lifelong antifungal therapy. Cumulative toxicity and lack of antifungal efficacy require salvage therapy in the treatment of some patients. In a retrospective review of nine patients with coccidioidal meningitis treated with isavuconazole, successful therapy was seen in three patients and stable disease was confirmed in six patients. Isavuconazole may be a useful addition to the therapeutic choices currently available for coccidioidal meningitis.
Asunto(s)
Antifúngicos/uso terapéutico , Coccidioidomicosis/tratamiento farmacológico , Meningitis Fúngica/tratamiento farmacológico , Nitrilos/uso terapéutico , Piridinas/uso terapéutico , Triazoles/uso terapéutico , Adulto , Antifúngicos/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nitrilos/efectos adversos , Piridinas/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento , Triazoles/efectos adversosAsunto(s)
Parasitosis Intestinales/diagnóstico , Parasitosis Intestinales/parasitología , Strongyloides stercoralis , Estrongiloidiasis/diagnóstico , Animales , Antihelmínticos/uso terapéutico , California/epidemiología , Emigración e Inmigración , Humanos , Parasitosis Intestinales/epidemiología , Ivermectina/uso terapéutico , Laos/epidemiología , Masculino , Estrongiloidiasis/epidemiología , Estrongiloidiasis/parasitologíaRESUMEN
Coccidioidomycosis causes substantial morbidity and mortality in endemic areas, and dissemination is frequent in patients with impaired cellular immunity such as AIDS. Immune reconstitution inflammatory syndrome (IRIS) is paradoxical clinical worsening after initiation of antiretroviral therapy (ART) in a patient with HIV and a simultaneous opportunistic infection (OI). Immune reconstitution inflammatory syndrome has been well described for a host of mycobacterial, viral, and fungal OIs and malignancies such as Kaposi sarcoma. To date, only 3 cases of IRIS due to coccidioidomycosis have been reported in the literature. At our institution, we report 4 cases of IRIS in HIV-infected patients with disseminated coccidioidomycosis. Unfortunately, all 4 patients died of worsening coccidioidal infection after initiating ART. The optimal timing of ART in patients with AIDS and coccidioidomycosis remains to be elucidated.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Anfotericina B/uso terapéutico , Fármacos Anti-VIH/efectos adversos , Coccidioidomicosis/tratamiento farmacológico , Síndrome Inflamatorio de Reconstitución Inmune/inducido químicamente , Infecciones Oportunistas Relacionadas con el SIDA/etiología , Absceso/tratamiento farmacológico , Absceso/etiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Antifúngicos/uso terapéutico , Encéfalo/diagnóstico por imagen , Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico por imagen , Coccidioidomicosis/etiología , Resultado Fatal , Femenino , Fluconazol/uso terapéutico , Humanos , Hígado/patología , Imagen por Resonancia Magnética , MasculinoAsunto(s)
Adenoma Velloso/diagnóstico , Neoplasias Intestinales/diagnóstico , Schistosoma/patogenicidad , Esquistosomiasis mansoni/diagnóstico , Adenoma Velloso/parasitología , Adenoma Velloso/patología , Adenoma Velloso/cirugía , Animales , Antihelmínticos/uso terapéutico , Ciego/efectos de los fármacos , Ciego/parasitología , Ciego/patología , Ciego/cirugía , Colectomía/métodos , Femenino , Humanos , Neoplasias Intestinales/parasitología , Neoplasias Intestinales/patología , Neoplasias Intestinales/cirugía , Hígado/efectos de los fármacos , Hígado/parasitología , Hígado/patología , Hígado/cirugía , Persona de Mediana Edad , Praziquantel/uso terapéutico , Schistosoma/efectos de los fármacos , Schistosoma/crecimiento & desarrollo , Esquistosomiasis mansoni/parasitología , Esquistosomiasis mansoni/patología , Esquistosomiasis mansoni/cirugíaAsunto(s)
Coccidioidomicosis/diagnóstico , Coccidioidomicosis/tratamiento farmacológico , Disuria/etiología , Epididimitis/diagnóstico , Antifúngicos/uso terapéutico , Coccidioidomicosis/microbiología , Epidídimo/cirugía , Epidídimo/ultraestructura , Epididimitis/tratamiento farmacológico , Epididimitis/microbiología , Fluconazol/uso terapéutico , Hematuria/etiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: The incidence of Kaposi's sarcoma (KS) decreased dramatically after the introduction of highly active antiretroviral therapy (HAART). This study determined the ongoing incidence of and mortality from KS in HIV-infected adults from 1998-2012 in Fresno County, California. The role of virologic control and immune reconstitution was assessed. METHODS: Incident cases were identified from the state Electronic HIV/AIDS Reporting System (EHARS), the California Cancer Registry, and hospital records of the county HIV treatment center. RESULTS: From 1998-2012, the average incidence of KS was 0.51 cases per 100,000 person-years. Of the 66 cases of KS there were 20 deaths, with 85% of the mortality occurring in the first 12 months. Among patients on HAART achieving HIV RNA <400 copies/uL, but with a <50 cell/uL increase in CD4 count there was no improvement in mortality. CONCLUSIONS: The incidence of KS remains stable since 1998 with a 12-month mortality of 30%.
Asunto(s)
Infecciones por VIH/complicaciones , Sarcoma de Kaposi/epidemiología , Adulto , Terapia Antirretroviral Altamente Activa , California/epidemiología , Femenino , Infecciones por VIH/mortalidad , Humanos , Incidencia , Masculino , Estudios RetrospectivosRESUMEN
We describe an unusual presentation of disseminated Kaposi sarcoma in a 49-year-old African-American man with AIDS who was admitted to the hospital for constipation and back pain. Magnetic resonance imagings of the thoracic and lumbar spine were grossly abnormal, however, a biopsy of the iliac crest was interpreted as normal. The patient remained a diagnostic enigma until disseminated Kaposi sarcoma was suspected, based on vascular plaque-like lesions observed on his hard palate and right conjunctiva. Slides of the bone biopsy with were stained for human herpes virus-8 (HHV-8) antigen, and were positive. AIDS-related skeletal manifestations of Kaposi sarcoma have been reported in the literature but are infrequent.