Neurologic disorders in HIV-positive orphans: 10 years of follow up.

OBJECTIVE: Neuropsychic manifestations of AIDS are still noticeable especially in developing countries. The aim of this short communication is to describe psychological, behavioral and neurologic disorders caused by either HIV-related disorders, or drug related toxicities in HIV-infected children from Cambodia (Phnom Penh, Sihanoukville) treated during 10 years with highly active antiretroviral therapy (HAART). METHODS: One hundred and thirty seven (137) HIV-positive children (age 2-19 years) treated with HAART since 2003 (6-10 years follow up) have been analyzed concerning opportunistic infections, other co-infections, renal parameters, hematologic parameters, chest X-ray, antiretroviral treatment, anti-tuberculotics and antibiotics treatment. We recorded prospectively all data since the start of HAART from 2003-2005 up to December 2012. RESULTS: Occurrence of drug related neuritis due to stavudine (HAART) was less than 1% and was associated with anti-tuberculous agents accompanying HAART in HIV- and tuberculosis co-infected patients. Co-infections with neurotropic viruses were more frequent: 1 case of CMV retinitis, 18 cases of herpes zoster neuritis and 37 cases of generalized HZV infections (varicella), after onset HAART in children were recorded. All children responded well to anti-viral therapy with ganciclovir (CMV), vanciclovir or acyclovir (HZV) in combination with first line HAART. CONCLUSION: Neurologic disorders in children with HAART are less frequent than in adults. Anti-retrovirals and anti-tuberculosis drugs seem to be safe and less toxic in children then in adults. Co-infections with neurotropic viruses were more frequent, however, were successfully treated with anti-virals.

Bacteremias caused by Escherichia coli in cancer patients - analysis of 65 episodes.

OBJECTIVES: The aims of this study were to evaluate risk factors, clinical presentation, outcome and antimicrobial susceptibility in patients with Escherichia coli bacteremia occurring over seven years in a single cancer hospital. METHODS: Sixty five episodes of bacteremia from E. coli appearing over seven years from 12,301 admissions in a single cancer institution were retrospectively analyzed. RESULTS: The proportion of bacteremia caused by E. coli among Gram-negative bacteremia was 20.8% (the second most common organism after Pseudomonas aeruginosa), and infection-associated mortality was 17%. The incidence in 1989-1995 varied from 14.3 to 24.7%. The most common risk factors were: solid tumors as the underlying disease (70.7%); central venous catheter insertion (32.3%); prior surgery (46.2%), and prior chemotherapy within 48 h (44.4%). Neutropenia and urinary catheters did not place patients at high risk in any of the subgroups. When we compared the two subgroups of 61 cases of bacteremia - monomicrobial and polymicrobial (when E. coli was isolated from blood culture with another microorganism) - we found that acute leukemia and breakthrough (recurrence while receiving antibiotics) bacteremia were more frequently associated with polymicrobial E. coli bacteremia. There was also a difference in infection-associated mortality: monomicrobial bacteremia due to E. coli only had a significantly lower mortality in comparison with polymicrobial E. coli bacteremia (8.9 vs 35.0%, respectively; P<0.03). CONCLUSION: The susceptibility of 115 E. coli strains isolated from 65 episodes of bacteremia was stable. Only two episodes caused by quinolone-resistant strains occurred, both in 1995, after six years of using ofloxacin for prophylaxis in neutropenic patients in our hospital. We found that 85.2-91.3% of all strains were susceptible to aminoglycosides, 97.8% to quinolones, and 90-100% to third generation cephalosporins and imipenems. The patients most commonly infected had solid tumors and the mortality was only 17%.