RESUMO
This article reports the case of a 45-year-old male immunocompetent patient who presented with acute epigastric pain and vomiting. Diagnostic tests confirmed a recent cytomegalovirus (CMV) infection as a contributory cause of a florid gastric ulcer. Primary CMV infections affecting the upper gastrointestinal tract are rare in immunocompetent adults. In this case treatment with a proton pump inhibitor and eradication of concomitant Helicobacter pylori colonization led to a full recovery. Anti-CMV treatment was not necessary.
Assuntos
Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/imunologia , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/imunologia , Hospedeiro Imunocomprometido/imunologia , Úlcera Gástrica/imunologia , Úlcera Gástrica/prevenção & controle , Dor Abdominal/diagnóstico , Dor Abdominal/imunologia , Dor Abdominal/prevenção & controle , Dor Aguda/diagnóstico , Dor Aguda/imunologia , Dor Aguda/prevenção & controle , Antibacterianos/administração & dosagem , Antivirais/administração & dosagem , Infecções por Citomegalovirus/diagnóstico , Diagnóstico Diferencial , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Gastrite/imunologia , Infecções por Helicobacter/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico , Úlcera Gástrica/diagnóstico , Vômito/diagnóstico , Vômito/imunologia , Vômito/prevenção & controleAssuntos
Infecções por Alphavirus/diagnóstico , Artrite/virologia , Ross River virus , Adulto , Infecções por Alphavirus/tratamento farmacológico , Infecções por Alphavirus/patologia , Analgésicos de Curta Duração/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Austrália , Culicidae/virologia , Feminino , Humanos , ViagemRESUMO
OBJECTIVES: There is only little data on immune reconstitution in antiretroviral naive AIDS-patients with toxoplasmosis. The observation of several cases with reduced increase of CD4-cells upon start of antiretroviral treatment (ART) prompted us to investigate the topic using the ClinSurv cohort. METHODS: 17 German HIV treatment centers contribute to ClinSurv, a multicentre observational cohort under the auspices of the Robert Koch Institute. We retrospectively selected all antiretroviral-naive patients with toxoplasmic encephalitis (TE) and - as comparator group - with pneumocystosis (PCP) between January 1999 and December 2005. RESULTS: A total of 257 patients were included in the analysis, 61 with TE and 196 with PCP. Demographic baseline data showed differences with regard to gender, transmission group, and baseline CD4 superset+ counts (60.9 vs. 44.7/microl, p = 0.022). After ART-initiation the increase in CD4 superset+ lymphocytes was lower in the TE- versus the PCP-group in the first, second and fourth three-month-period (74.4 vs. 120.3/microl, p = 0.006; 96.6 vs. 136.2/microl, p = 0.021; 156.5 vs. 211.5/microl, p = 0.013). Viral load (VL) was higher in the PCP-group at baseline (4.46 log subset10cop/ml vs. 5.00 log subset10cop/ml, p = 0.008), while virological success of ART was equal. CONCLUSIONS: Our data show for the first time that the average CD4 superset+ T-cell increase of patients with toxoplasmosis is impaired compared to PCP-patients. Most clinicians would not be prepared to discontinue follow-up TE-therapy unless CD4 superset+ counts of 200/microl are reached. Explanation for our finding might be the myelosuppressive side effect of pyrimethamine, possible interactions of toxoplasmosis therapy with ART, or an unknown direct biological influence of toxoplasmosis on immune restoration.
