TB/HIV co infection in Georgia.

HIV and TB co-infection is a considerable problem worldwide. HIV significantly increases the morbidity and mortality from TB and often makes the diagnosis more challenging. In this study we attempted to evaluate the prevalence of TB among newly diagnosed HIV infected persons and determine the rate of HIV infection among active TB patients in Georgia. The prospective observational study has been conducted in Georgia since January 01, 2006. All newly diagnosed HIV positive persons were screened for active and latent TB infection and the prevalence of TB was identified. During the same time period HIV screening was performed in all identified active TB cases. Up to 22% (16.7 to 22%) of HIV positive individuals were found to have active TB, and 22.4 to 32.6% had LTBI. The prevalence of HIV among TB patents ranged from 1.7 to 2.2%. The study showed significant prevalence of TB (both active and latent TB) among HIV patients. Because of problems with TB diagnosis in HIV patients, the real prevalence may be underestimated. The alarming statistical data should force us towards meticulous and scrupulous screening for tuberculosis among HIV positive individuals. The prevalence of HIV among TB patents was not very high, ranging from 1.7 to 2.2%, but we recommend routine screening for HIV in all active TB patients.

Important aspects of nosocomial bacterial resistance and its management.

The article reviews management of nosocomial bacterial resistance aspects. Nosocomial infections are associated with substantial morbidity, mortality and cost. During the last several decades multi-drug resistant organisms increased in number considerably. Methicillin-resistant staphylococcus aureus, Vancomycin-intermediately resistant staphylococcus aureus and fully vancomycin-resistant staphylococcus aureus evolved as a consequence of methicillin and vancomycin use. The introduction of third generation cephalosporins were followed by emergence of extended spectrum and AMP-C -lactamases among gram negative bacteria, and carbapenems were targeted by carbapenemases. The poor diagnostic yield of current microbiologic methods in identifying certain resistant organisms, combined with decreasing numbers of newly developed antibiotics pose a significant challenge to physicians. We reviewed some of the approaches which can be followed to maximize the positive clinical outcome in patients with resistant nosocomial infections, using currently available antibiotics. More sensitive microbiological methods and new types of antibiotics are needed to adequately address the problem in the future.

Oral lesions in HIV-positive patients in Georgia.

To study the prevalence of oral lesions in HIV infected patients and its relationship with CD4+ cell count in Georgia 732 HIV positive adult patients who were admitted to the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC) since January, 2006 till October, 2008 were evaluated. Each patient underwent full clinical and standard laboratory examination. CD4+ cell count was determined by the Becton-Dickinson FACSCalibur flow cytometer (MultiTEST CD3 FITC/CD8 PE/CD45 PerCP/CD4 APC Reagent). Socio-demographic data was obtained using a standard questionnaire at the epidemiology department of IDACIRC. Oral manifestations were diagnosed according to EEC clearinghouse classification (1993). Oral lesions were revealed in 546 patients (75%). 186 patients (25%) did not exhibit any oral complications. The prevalence of two or more simultaneously exhibited types of lesions was as follows: three types of lesions were detected in 45 patients (6%) and two types of lesions were detected in 245 patients (33%). The investigation revealed oral candidiasis constituted the most common form of oral lesions, representing a 64% (467 patients), followed by HIV associated periodontal diseases in 216 patients (30%), recurrent aphthous like ulcerations in 118 patients (16%), oral hairy leukoplakia in 58 patients (8%), orolabial herpes simplex infection in 50 patients (7%), human papillomavirus (wart like lesions) in 37 patients (5%) and Kaposi's sarcoma in 3 patients (0.4%). Most of oral lesions cases were found in patients with low CD4+ cell count. Results of this study provide evidence that mucous membrane disorders with HIV infection might serve as an indicator for advanced HIV infection, immunosuppression and decreased CD4 cell counts. The physicians who are taking care of HIV patients have to be familiar with HIV-associated mucocutaneous diseases, their diagnoses, and management.