Three men, a paint brush and a coronavirus.

Coronaviruses cause respiratory tract infection and a coryzal syndrome. Although described as a cause of gastroenteritis in HIV patients, with the exception of the severe acute respiratory syndrome (SARS), there is little in the literature about respiratory infection in HIV patients. We describe two patients with HIV, exacerbations of chronic obstructive pulmonary disease and proven coronavirus infection. A third patient presented with an upper respiratory tract infection but coronavirus was not isolated. All three men had spent a day decorating the first patient's flat four days prior to presentation. This is the first description of respiratory tract infection with coronavirus in HIV patients. Both patients with coronavirus required prolonged admission to hospital and extensive investigations because they were HIV infected. Coronavirus is often associated with less severe upper respiratory tract infection but can cause more severe disease and should be considered in patients with HIV and respiratory tract infection.

An outbreak of infantile gastroenteritis due to E. coli 0142.

Twelve cases of gastroenteritis caused by Escherichia coli 0142K86H6 are described. Ten of these cases were clearly involved in an outbreak of cross infection. The other two cases yielded interesting information on infection with E. coli. 0142. Five cases, two being fatal, required repeated intravenous infusion, and one further infant required parenteral replacement therapy on a single occasion only. Cross infection occurred at the primary site-a ward partitioned into cubicles-despite full barrier nursing techniques. Infection spread also to two other wards, and resulted from transfer of latently infected cases. Illness in several infants was protracted and debilitating because of the relapsing nature of the infection. The pathology of the two fatalities is reported briefly.

Efficacy and safety of combination therapy with delavirdine and zidovudine: a European/Australian phase II trial.

The objective of the study was to investigate the safety and antiviral effect of three delavirdine dose regimens or placebo in combination with zidovudine in patients who were already taking zidovudine. Eighty-nine symptomatic HIV-1 seropositive individuals with CD4 cell counts between 50 and 350 cells/microl were included in this trial The influence of combination therapy on viral susceptibility to both zidovudine and delavirdine was investigated. Death or the occurrence, or re-occurrence of an AIDS-defining illness was considered as a clinical endpoint. The addition of delavirdine to the antiretroviral treatment regimen resulted in a significant, but transient, reduction in virus load, as determined by quantitative RNA measurements. CD4+ cell count did not change significantly. Susceptibility to zidovudine remained unchanged after 12 weeks of combination therapy, while 70% of the patients demonstrated a substantial decrease (> 10-fold) in sensitivity to delavirdine. Two patients suffered from an AIDS-defining disease during the study. No deaths occurred. Generally, the drug appeared to be safe. Skin rash was the most frequently observed adverse event (52%). In most patients the rash either resolved spontaneously or was treated successfully with a short course of antihistamines. The definite place of the compound in the management of HIV disease, in particular when given in combination with other antiretroviral agents, remains to be further explored.

Domiciliary nebulized pentamidine for secondary prophylaxis against Pneumocystis carinii pneumonia.

The viability of a programme for delivering aerosolized pentamidine within the patient's home setting for the secondary prophylaxis of Pneumocystis carinii pneumonia (PCP) has been explored with seven homosexual AIDS patients, the major objectives being the assessment of the safety and acceptability of the treatment and the discovery of the most suitable care setting (home, ward, outpatient clinic) for the administration of therapy. It is concluded that a domiciliary prophylaxis programme is a viable alternative.

Clinical manifestations of HIV infections.

The wide clinical spectrum of HIV infection is reflected in the new CDC classification. Presentations range from acute infection, asymptomatic carriage and persistent lymphadenopathy through constitutional upset and neurological disease to the opportunistic infections and cancers of AIDS. AIDS is an enigmatic disease which presents special clinical diagnostic and management problems. Although any system may be affected the lungs and the brain are the most important target organs. Though the underlying disease is currently untreatable, many of the complications of AIDS are amenable to prompt therapy. Seropositive patients should be monitored to detect early signs of significant HIV disease. Skilled counselling about the avoidance of co-factors which may potentiate HIV infection, is important.

Fatal haemolytic anaemia complicating a case of common variable hypogammaglobulinaemia.

A fatal case of common variable hypogammaglobulinaemia (CVH) is described. The patient presented with fulminant haemolytic anaemia. Post mortem examination revealed evidence of chronic hypogammaglobulinaemia.

Should hyposplenic patients receive prophylaxis against bacterial infection?

The risk of overwhelming septicaemia, most commonly due to encapsulated organisms, is well recognised post-splenectomy. Although a similar risk is documented in hyposplenic patients, many physicians do not routinely give prophylaxis here. We report the case of a 41 year old woman with adult onset coeliac disease who developed pneumococcal meningitis resulting in severe residual disability and suggest that prophylaxis should be given to such individuals who have evidence of reduced splenic function.

A comparison of travel related ID admissions in Glasgow: (1985; 1998/99).

A comparative study was made of patients admitted over 12 months to the principal infectious diseases unit for Glasgow in 1985 and in 1998/99. During this interval UK travel statistics show a 135% growth in visits abroad and a 5% rise to 17% in destinations with a risk of malaria. Travel associated admissions rose by 96% to a total of 108. Patients of Asian/Oriental ethnicity declined from 55% to 18%, whilst Caucasians increased from 38% to 81%. Travellers aged 20-39 years formed the modal age groups (51% and 50%). Gastro-intestinal problems accounted for the largest single diagnostic category in both study periods, 38% and 40% respectively. In-patients diagnosed with malaria fell by 20%; these figures are cause for encouragement to those involved in the teaching and dissemination of advice on malaria prophylaxis. The findings re-enforce the need for the continuation and expansion of travel health education for both healthcare professionals and the public.

AIDS-related cholangitis: diagnostic features and course in four patients.

Radiological features of sclerosing cholangitis are an uncommon but well recognised complication of HIV infection in homosexual males. In this report we document the clinical features and course of the disease in four patients. Four homosexual males with established AIDS were referred in 1990-92. Three of the four had intractable upper abdominal pain which was poorly responsive to opiates. Three of the patients had diarrhoea and all had weight loss. The diagnosis of AIDS related cholangitis was confirmed by endoscopic retrograde cholangiography in three cases, but in only one patient was there no evidence of biliary disease on ultrasound scanning. In the two cases with cholangiographic features of papillary stenosis, endoscopic sphincterotomy was carried out and there was subsequently a dramatic improvement in the abdominal pain. Three of the patients had evidence of gastrointestinal infection with Microsporidia (1) or Cryptosporidia (2). All the patients died within 2-9 months of the diagnosis of cholangitis, but none of the deaths resulted from hepatobiliary disease.