RESUMO
OBJECTIVE: To report five new cases of Pneumocystis carinii pneumonia (PCP) and to review and analyze the existing reports on the subject. METHOD: Five new cases of PCP during pregnancy are described. The cases, case series, and related articles on the subject in the English language were identified through a comprehensive MEDLINE search and reviewed. RESULTS: More than 80% of women with AIDS are of reproductive age, and PCP is the most common cause of AIDS-related death in pregnant women in the United States. Among 22 reviewed cases, the mortality rate was 50% (11 of 22 patients), which is higher than that usually reported for HIV-infected individuals with PCP. Respiratory failure developed in 13 patients (59%), and mechanical ventilation was therefore required, and the survival rate in patients requiring mechanical ventilation was 31%. Maternal and fetal outcomes were better in cases of PCP during the third trimester of the pregnancy. A variety of treatment regimens were used, including sulfamethoxazole-trimethoprim (SXT) alone or in combination with pentamidine, steroids, and eflornithine. The survival rate in patients treated with SXT alone was 71% (5 of 7 patients) and for those treated with SXT and steroids was 60% (3 of 5 patients), with an overall survival rate in both groups of 66.6% (8 of 12 patients). CONCLUSION: PCP has a more aggressive course during pregnancy, with increased morbidity and mortality. Maternal and fetal outcomes remain dismal. Treatment with SXT, compared to other therapies, may result in an improved outcome. Withholding appropriate PCP prophylaxis may adversely affect maternal and fetal outcomes.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Pneumonia por Pneumocystis , Complicações Infecciosas na Gravidez , Adulto , Feminino , Humanos , Pneumonia por Pneumocystis/tratamento farmacológico , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológicoRESUMO
In a community hospital in Brooklyn, New York, over a 3-year period, 79 methicillin-resistant Staphylococcus aureus (MRSA) isolates from five different case clusters were subtyped by Southern blot hybridization with two previously characterized gene probes, mec and Tn554. Together, the genotyping enabled the hospital infection control team to differentiate simultaneous MRSA clusters in the surgical intensive care unit (type I:A) and the open heart unit (type II:J), document the spread of one strain (type I:A) between roommates, identify an endemic strain (type II:J) from cardiac monitors and medical personnel, and identify an unrelated outbreak strain (type II:NH) in the labor and delivery unit. On the basis of this investigation it is clear that the routine DNA fingerprinting of MRSA in health care facilities, to monitor their spread and identify cases of nosocomial infections, is an important infection control measure.
Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Genes Bacterianos/genética , Resistência a Meticilina/genética , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Southern Blotting , Infecção Hospitalar/transmissão , Impressões Digitais de DNA , Sondas de DNA , DNA Bacteriano , Humanos , Meticilina/farmacologia , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Cidade de Nova Iorque/epidemiologia , Penicilinas/farmacologia , Infecções Estafilocócicas/transmissãoAssuntos
Sarampo/complicações , Pneumonia Viral/microbiologia , Adulto , Feminino , Humanos , ImunocompetênciaRESUMO
A case of acute hepatitis induced by zidovudine in a 38-year-old patient with AIDS is presented. The mechanism whereby the hepatitis was induced is not known. However, the patient tolerated well an alternative reverse transcriptase inhibitor, 2'3' dideoxyinosine. Physicians caring for patients with AIDS should be aware of this hitherto rarely reported complication.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Infecções por HIV/tratamento farmacológico , Zidovudina/efeitos adversos , Adulto , Humanos , MasculinoRESUMO
Unremitting diarrhea is a common problem in patients with AIDS. We have reported the case of such a patient who was treated with the somatostatin analogue octreotide for chronic diarrhea and who had acute pancreatitis as a consequence of this therapy. We postulate that the possible mechanism for the pathogenesis of this pancreatic damage was octreotide-induced prevention of pancreatic exocrine secretion. We believe this acted as a "physiologic gallstone", inducing an attack of acute pancreatitis.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Octreotida/efeitos adversos , Pancreatite/induzido quimicamente , Doença Aguda , Diarreia/tratamento farmacológico , Diarreia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologiaRESUMO
Several forms of hepatic toxicity have been described with the antifungal agent ketoconazole. We report a case of massive liver enlargement with fatty infiltration presenting as gastric compression. This occurred in a young woman with AIDS taking ketoconazole as maintenance therapy for cryptococcal meningitis. This is the first reported case of ketoconazole causing fatty change in the liver.
Assuntos
Fígado Gorduroso/induzido quimicamente , Hepatomegalia/induzido quimicamente , Cetoconazol/efeitos adversos , Adulto , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Fígado Gorduroso/enzimologia , Feminino , Hepatomegalia/enzimologia , Humanos , L-Lactato Desidrogenase/sangueAssuntos
Alcaligenes , Infecções Bacterianas , Infecção Hospitalar , Meningite/etiologia , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Feminino , Humanos , Lactente , Meningite/diagnóstico , Meningite/tratamento farmacológicoRESUMO
A patient with acquired immune deficiency syndrome (AIDS) and cryptococcal arthritis occurring in the setting of disseminated cryptococcosis is described. The literature of cryptococcal arthritis is reviewed and the association of this unusual infection with AIDS is discussed. To our knowledge, this is the first reported association between AIDS and cryptococcal arthritis.