ABSTRACT
The paper presents changes in the picture of CMV disease (CMV-D) in the era of combination antiretroviral treatment. A significant reduction in the incidence of CMV-D and deaths due to CMV-D as well as the increase of survival after the diagnosis of CMV-D was observed. Although, CMV infection remains the problem among HIV infected persons. Clinical presentation of CMV end-organ disease and immune reconstitution inflammatory syndrome were presented. Methods of diagnosis and recommended forms of therapies were described. The risk of HIV-disease progression and death in CMV-viremic patients and the data on efficacy and safety of preemptive therapy were discussed.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/therapy , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/therapy , AIDS-Related Opportunistic Infections/epidemiology , Antiretroviral Therapy, Highly Active , Comorbidity , Cytomegalovirus/isolation & purification , Cytomegalovirus Infections/epidemiology , Humans , Risk Factors , Secondary Prevention , Treatment OutcomeABSTRACT
The prevalence of hepatitis C virus (HCV) infection in dialyzed patients (pts) with end stage renal disease (ESRD) is higher than that of the general population. Generally it is thought that the course of hepatitis C is milder then in pts with normal renal function, but there is no agreement about natural history of HCV infection in dialyzed. Immunosuppressive therapy after renal transplantation (RTx) worsens the prognosis for pts with HCV infection. Additionally, actually available anti-HCV treatment is contraindicated after RTx due to the high risk of the graft rejection. That is the reason why antiviral therapy should be given before RTx and indications for treatment should be wider (treatment of HCV infection not only of hepatitis). The biggest number of papers addressed to anti-HCV treatment in dialyzed pts considers monotherapy with standard interferon. One out of two pegylated interferons was approved for dialyzed pts--but up to date there is no data about efficacy and safety of this compound in this group of pts. The use of ribavirin in ESRD pts is contraindicated due to the high risk of anemia.
Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C/drug therapy , Hepatitis C/etiology , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Antiviral Agents/adverse effects , Hepatitis C/complications , Hepatitis C/epidemiology , Humans , Interferon alpha-2 , Interferon-alpha/adverse effects , Interferon-alpha/therapeutic use , Kidney Failure, Chronic/drug therapy , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/surgery , Kidney Failure, Chronic/virology , Kidney Transplantation/adverse effects , Polyethylene Glycols , Recombinant Proteins , Renal Dialysis/adverse effects , Ribavirin/adverse effects , Ribavirin/therapeutic use , Risk FactorsABSTRACT
BACKGROUND: Toxigenic strains of Corynebacterium diphtheriae are well known agent of diphtheria. Nontoxigenic strains can cause atypical course of the disease. Invasive diseases caused by C. diphtheriae occur very rare. CASE PRESENTATION: We have described the first case of septicemia and endocarditis due to nontoxigenic C. diphtheriae biotype gravis in Poland. The patient has not belonged to any group of risk such infection. CONCLUSION: The case presented in this article shows unusual case of infection connected with nontoxigenic C. diphtheriae that took place in the area where have been no cases of diphtheria and other C. diphtheriae infections for near ten years. It shows the importance of identifying Corynebacterium isolates at the species level especially when the strain has been isolated from normally sterile sites.