Subject(s)
Chagas Disease/diagnosis , Guideline Adherence/statistics & numerical data , Pregnancy Complications, Parasitic/diagnosis , Prenatal Diagnosis/statistics & numerical data , Chagas Disease/ethnology , Female , Humans , Latin America/ethnology , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Parasitic/ethnology , Prospective Studies , SpainABSTRACT
No disponible
Subject(s)
Humans , Adult , Female , Treatment Outcome , Whooping Cough , Diagnosis, Differential , Anti-Bacterial AgentsABSTRACT
Postinfectious proliferative glomerulonephritis may occur in HIV-infected patients, although it is not a common cause of severe acute renal failure in them. We report a woman with HIV infection, who developed hypocomplementemic acute nephritic syndrome 10 days after an upper respiratory infection. Systemic diseases were excluded. The serum creatinine level increased to 6.6 mg/dl. Renal biopsy showed diffuse endocapillary proliferative glomerulonephritis, with mesangial and capillary walls, granular deposits of IgG and C3 by immunofluorescence. She was given corticosteroids with progressive normalization of her renal function. No opportunistic infections have occurred during 1-year follow-up.
Subject(s)
Acute Kidney Injury/etiology , Glomerulonephritis/etiology , HIV Infections/complications , Respiratory Tract Infections/complications , Adult , Biopsy , Female , Glomerulonephritis/drug therapy , Glomerulonephritis/immunology , Glucocorticoids/therapeutic use , Humans , Kidney/pathology , Methylprednisolone/therapeutic use , Prednisone/therapeutic useABSTRACT
BASIS: To know the factors associated with the inadequate admissions in patients with human immunodeficiency virus (HIV) infection. PATIENTS AND METHODS: The adaptation of 710 hospital admissions of patients with HIV infection through the Appropriateness Evaluation Protocol criteria in two hospitals of the Comunidad Valenciana since 1995 to 1997 was analyzed. RESULTS: One hundred twenty-eight (18%) admissions were considered inadequate. The proportion of inadequate admissions was significantly higher in patients admitted because of constitutional syndrome (OR: 4.12; CI 95%: 2.11-8.05), or because of digestive symptoms (OR: 2.33; CI 95%: 1.46-3.88), and in patients admitted in facilities without day hospital (OR: 2.38; CI 95%: 1.39-3.89). Furthermore, other situations associated with the inappropriateness were the patients with a disease not related to AIDS (OR: 3.13; CI 95%: 1.93-5.08), the patients with oral or esophageal candidiasis (OR: 6.25; CI 95%: 3.08-12.7), the patients with a hospital stay less than 8 days (OR: 2.55; CI 95%: 1.57-4.01), or the patients who no died (OR: 3.61; IC 95%: 1.20-10.82). CONCLUSIONS: The reason for the admission and the availability of a day hospital unit had influence in the inadequate hospital admissions in this study.
Subject(s)
HIV Infections/complications , HIV-1 , Health Services Misuse/statistics & numerical data , Hospitalization/statistics & numerical data , Patient Admission/statistics & numerical data , Utilization Review , Adult , Female , Humans , Length of Stay/statistics & numerical data , Male , Retrospective Studies , SpainABSTRACT
BACKGROUND: To analyze the research output of Spanish authors on human immunodeficiency virus (HIV) infection/AIDS. METHODS: Papers published over 1991-1999 which were recorder in the MedLine database (CD-ROM) were selected by using the key words Spain or Espana in the address of author field and HIV, AIDS, VIH or sida in any field. Papers were analyzed according to publication journal specialty of authors, subjecte matter of the paper, institution, center of origin and geographical distribution. RESULTS: A total of 2,065 papers were studied. Their number doubled, from 148 in 1991 to 295 in 1999 (r = 0.917; p < 0.0001). The number of papers published in foreign journals trebled, from 51 to 182 (r = 0.933; p < 0.001). The journal with the highest number o papers published was Medicina Clínica: 241 (11.7%). Although the main topic was the clinical manifestations of HIV infection (64.6%), the proportion of papers on this subject decreased from 71.4% in 1991-93 to 58.3% in 1997-99 (p < 0.001). On the other hand, the percentage of articles on antiretroviral therapy increased from 3.6% in 1991-93 to 12.4% in 1997-99 (p < 0.001). The greatest number of contributions came from hospitals (79.8% of papers), followed by universities (9.5%). Centers with the highest output were the Hospital Clínic (Barcelona) (5.7%) and the Hospital Carlos III (Madrid) (5.5%). The Autonomous Communities of Madrid (33.1%) and Catalonia (25.3%) concentrated more than half of the total output, followed by Andalusia (11.5%) and the Valencian Community (8.1%). CONCLUSIONS: Spanish output on HIV infection/AIDS research grew during the 1991-1999 period. There was a remarkable increase in the papers published in foreign journals. Moreover, topics changed according to the epidemiological changes observed in HIV infection during the past decade.
Subject(s)
HIV Infections , Publishing , Research , MEDLINE , SpainABSTRACT
BACKGROUND: To determine the etiology of community-acquired pneumonia (CAP) in ambulatory patients and to assess the efficiency of a diagnostic protocol by using tests to detect bacterial antigens in urine samples. PATIENTS AND METHOD: One-year prospective study that included blood and sputum cultures, serologic studies, and detection of Legionella pneumophila and Streptococcus pneumoniae urinary antigens. RESULTS: 49 patients were recruited and an etiological diagnosis was attained in 34 (69%). Microorganisms most frequently isolated were S. pneumoniae (12 cases), Mycoplasma pneumoniae (7), Haemophilus influenzae (4), respiratory viruses (4) and Coxiella burnetii (3 cases). CONCLUSIONS: By means of a non-invasive protocol with urinary antigen tests, a microbial etiology can be established in two thirds of patients with mild CAP. S. pneumoniae is the main cause of mild CAP.
Subject(s)
Antigens, Bacterial/urine , Legionnaires' Disease/diagnosis , Pneumonia, Bacterial/diagnosis , Pneumonia, Pneumococcal/diagnosis , Adolescent , Adult , Community-Acquired Infections/diagnosis , Community-Acquired Infections/urine , Female , Humans , Legionella pneumophila/immunology , Legionnaires' Disease/urine , Male , Middle Aged , Pneumonia, Bacterial/urine , Pneumonia, Pneumococcal/urine , Prospective Studies , Streptococcus pneumoniae/immunologyABSTRACT
No disponible
Subject(s)
Humans , Immunocompromised Host , Vaccination , HIV Infections , Influenza Vaccines , Influenza VaccinesABSTRACT
No disponible
Subject(s)
Middle Aged , Male , Humans , Spain , Radiography, Thoracic , Utilization Review , Gemfibrozil , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Rhabdomyolysis , Preoperative Care , Pyridines , Hypolipidemic Agents , Drug Interactions , Hospitals, PublicABSTRACT
A point prevalence study to document oral yeast carriage was undertaken. Risk factors for the development of oropharyngeal colonization or infection by fluconazole-resistant Candida strains in HIV-infected patients were investigated with a case-control design. Cases included all patients with fluconazole-resistant strains (MIC> or =64 microg/ml), and controls were those with susceptible (MIC< or =8 microg/ml) or susceptible-dependent-upon-dose (MIC 16-32 microg/ml) strains. One hundred sixty-eight Candida strains were isolated from 153 (88%) patients, 28 (16%) of whom had oropharyngeal candidiasis. Overall, 19 (12%) of the patients harbored at least one resistant organism (MIC > or = 64 microg/ml). Among patients with resistant strains, tuberculosis (P<0.001), esophageal candidiasis (P = 0.001), clinical thrush (P<0.001), and a CD4 + cell count < 200/mm3 (P = 0.03) were more frequent. These patients had also been treated more commonly with antituberculous drugs (adjusted odds ratio [OR] 6.13; 95% confidence interval [CI] 2.11-17.80), ciprofloxacin (OR 6.0; 95% CI 1.23-29.26), fluconazole (OR 4.59; 95% CI 1.55-13.52), and steroids (OR 4.13; 95% CI 1.11-15.39). Multivariate analysis showed that the determinants for fluconazole resistance were therapy with antituberculous drugs (OR 3.61; 95% CI 1.08-12.07; P=0.03) and one of the following: previous tuberculosis (OR 3.53; 95% CI 1.08-14.57; P=0.03) or fluconazole exposure (OR 3.41; 95% CI 1.10-10.54). Findings from this study indicate that treatment with antituberculous drugs, previous tuberculosis, and fluconazole exposure are the strongest determinants for development of oropharyngeal colonization or infection by fluconazole-resistant Candida strains in HIV-infected patients.
Subject(s)
AIDS-Related Opportunistic Infections/microbiology , Antifungal Agents/pharmacology , Candida/drug effects , Candidiasis, Oral/microbiology , Fluconazole/pharmacology , Oropharynx/microbiology , Adult , Candida/growth & development , Candida/isolation & purification , Carrier State/microbiology , Case-Control Studies , Drug Resistance, Microbial , Female , Humans , Male , Microbial Sensitivity Tests , Prospective Studies , Risk FactorsSubject(s)
Abscess/drug therapy , Abscess/microbiology , Bacteremia/drug therapy , Cloxacillin/therapeutic use , Penicillins/therapeutic use , Prostatic Diseases/drug therapy , Prostatic Diseases/microbiology , Staphylococcal Infections/drug therapy , Bacteremia/complications , Humans , Male , Middle Aged , Remission Induction , Staphylococcal Infections/complicationsSubject(s)
Exchange Transfusion, Whole Blood , Malaria, Cerebral/therapy , Adult , Animals , Antimalarials/pharmacology , Antimalarials/therapeutic use , Chloroquine/pharmacology , Chloroquine/therapeutic use , Drug Resistance , Humans , Malaria, Cerebral/drug therapy , Male , Plasmodium falciparum/drug effects , Treatment FailureABSTRACT
No disponible
Subject(s)
Middle Aged , Male , Humans , Staphylococcal Infections , Bacteremia , Penicillins , Prostatic Diseases , Remission Induction , Cloxacillin , AbscessABSTRACT
Paecilomyces lilacinus is an emerging fungal pathogen that is highly resistant to many antifungal drugs. Skin and subcutaneous soft tissue infections caused by this organism are very unusual. Most cases occur in patients with impaired host defenses or following surgical procedures. There has been only one previous report of a histologically confirmed cutaneous infection due to Paecilomyces lilacinus in a patient without predisposing factors. Described here is the second histopathologically proven case of Paecilomyces lilacinus cutaneous infection in a healthy patient without any apparent portal of entry. Prolonged antifungal chemotherapy with itraconazole led to resolution of the skin lesion. This case of sporadic cutaneous infection due to Paecilomyces lilacinus is believed to be the first reported in Europe and the first histopathologically proven case successfully treated with itraconazole.
Subject(s)
Antifungal Agents/therapeutic use , Dermatomycoses/drug therapy , Dermatomycoses/microbiology , Itraconazole/therapeutic use , Paecilomyces/isolation & purification , Adult , Dermatomycoses/pathology , Humans , Male , Treatment OutcomeSubject(s)
Abdomen , HIV Infections/complications , Lipodystrophy/diagnosis , Magnetic Resonance Imaging , Adult , Female , HIV Infections/drug therapy , HIV Protease Inhibitors/administration & dosage , HIV Protease Inhibitors/adverse effects , HIV Protease Inhibitors/therapeutic use , Humans , Indinavir/administration & dosage , Indinavir/adverse effects , Indinavir/therapeutic use , Lipodystrophy/chemically induced , Syndrome , Time FactorsABSTRACT
BACKGROUND: An increasing frequency of opportunistic fungal infections in immunosuppressed patients in recent years. Concurrent with this finding, it has been noted an increasing use of fluconazole. In addition, non-Candida albicans species (NCAS), most of which are fluconazole-resistant have been increasing isolated. The aim of this study was to investigate the epidemiology of colonization and infection due to NCAS in HIV-infected patients. PATIENTS AND METHODS: A cross sectional study was conducted with HIV-infected patients in different stages, who were attended at two hospitals in Alicante, Spain. We assessed the prevalence and microbiology of oropharyngeal colonization and infection due to Candida spp., and its fluconazole susceptibility patterns. To determine the clinical risk factors for the development of fluconazole resistance, we carried out a case-control study with prevalent cases. RESULTS: We studied 168 strains from 153 patients. NCAS were isolated in 32 (21%) of them, 25 (77%) were colonized, and 5 (26%) had infection due to NCAS. The most common isolate was Candida glabrata (n = 15). MICs were significantly higher for NCAS than for Candida albicans species, with a MIC50 of 16 and 0.25 microgram/ml, respectively, and a MIC90 of 128 micrograms/ml and 8 micrograms/ml (p = 0.0001). The median CD4 cell count in patients with NCAS was 0.06 x 10(9)/l, and 0.19 x 10(9)/l patients with Candida albicans (p = 0.009). Overall, 56% of the patients with NCAS and 41% of the patients with Candida albicans had been treated with fluconazole (p = 0.1). CONCLUSIONS: NCAS are isolated in a high proportion of HIV infected patients. Most of the NCAS have a decreased susceptibility to fluconazole. The only risk factor associated with the acquisition of NCAS in HIV-infected patients is an advanced immunosuppression.
Subject(s)
HIV Infections/microbiology , Mycoses/microbiology , Oropharynx/microbiology , Pharyngeal Diseases/microbiology , Yeasts/isolation & purification , Adult , Aged , Candida/drug effects , Candida/isolation & purification , Candidiasis/microbiology , Female , Fluconazole/pharmacology , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Yeasts/drug effectsABSTRACT
Despite being a well-known respiratory pathogen for immunocompromised patients, Corynebacterium pseudodiphtheriticum has uncommonly been reported to occur in persons with infection attributable to HIV virus. We report three cases of respiratory tract infection attributable to C. pseudodiphtheriticum in HIV-infected patients and review the four previous cases from the medical literature. All of them were male with a median CD4 lymphocyte count of 110 cells/mm3 (range, 18-198/mm3); five of the seven cases occurred in persons for whom AIDS was diagnosed previously. The onset of symptomatology was usually acute and the most common radiographic appearance was alveolar infiltrate (six patients) with cavitation (two patients) and pleural effusion (two patients). In five of the seven cases, C. pseudodiphtheriticum was isolated from bronchoscopic samples and in the remaining two cases was recovered from lung biopsy (one patient) and sputum (one patient). In the three patients reported herein and in one previous case from the medical literature, quantitative culturing of bronchoscopic samples obtained through either bronchoalveolar lavage or protected brush catheter procedures yielded more than 10(3) CFU/mL. All the strains tested were susceptible to penicillin and vancomycin. Resistance to macrolides was common. Recovery was observed in six of the seven patients. C. pseudodiphtheriticum should be regarded as a potential respiratory pathogen in HIV-infected patients. This infection presents late in the course of HIV disease and it seems to respond well to appropriate antibiotic treatment in most of the cases. This easily overlooked pathogen should be added to the list of organisms implicated in respiratory tract infections in this population.