Osteomyelitis caused by Mycobacterium haemophilum: successful therapy in two patients with AIDS.

OBJECTIVE: Difficulties involved in diagnosis and response to antimicrobial therapy are described in detail for two cases of biopsy-proven osteomyelitis caused by Mycobacterium haemophilum in AIDS patients. SETTING: Two large, private teaching hospitals in New York City, New York, USA. PATIENTS, PARTICIPANTS: A 31-year-old woman with previous diagnoses of candida esophagitis and peripheral neuropathy (patient 1), and a 37-year-old man with Kaposi's sarcoma (patient 2). INTERVENTIONS: One patient was treated with a combination of rifampin, ethambutol, clofazimine, and ciprofloxacin, while the other received rifampin, ciprofloxacin and doxycycline. Both patients also received a short course of intravenous amikacin. MAIN OUTCOME MEASURES: Disease activity was monitored clinically by observing resolution of skin ulcers, lymphadenopathy, and pain and swelling in areas affected by osteomyelitis. RESULTS: Both patients experienced complete resolution of signs and symptoms of M. haemophilum infection. Patient 1 was treated for 17 months and remains well after 10 months without therapy. Patient 2 shows no evidence of infection after 14 months of therapy. CONCLUSIONS: M. haemophilum infection must be considered in the differential diagnosis of osteomyelitis in AIDS patients, although specialized culture techniques are required to isolate and identify this pathogen. Excellent clinical response can be achieved with oral antimicrobial therapy.

A comparison of zidovudine, didanosine, zalcitabine and no antiretroviral therapy in patients with advanced HIV disease.

Three nucleoside analogues, zidovudine (AZT), didanosine (ddI), and zalcitabine (ddC), are approved for use in the treatment of patients with HIV infection. This retrospective study compares the 3 drugs and examines the overall utility of antiretroviral therapy by way of comparisons to a no treatment (No Rx) group in patients with advanced HIV disease. Patients with advanced HIV disease were enrolled in didanosine (August 1989-December 1990) or zalcitabine (October 1990-February 1992) expanded access programmes; continued on zidovudine treatment despite fulfilling criteria for zidovudine failure or intolerance; or maintained on no antiretroviral treatment. Statistical analysis revealed that patients on nucleoside analogue therapy had fewer opportunistic infections (P = 0.001) than those who received no antiretroviral treatment. The Kaplan-Meier 12-month estimate of survival was significantly longer among patients who switched from zidovudine to zalcitabine but not among patients who switched to didanosine, when compared to the other 2 groups (P = 0.05).

Event history calendars and question list surveys: a direct comparison of interviewing methods.

The research reported in this article provides the first direct experimental comparison between Event History Calendar (EHC; N=309; 84.4 percent response rate) and standardized state-of-the-art question list (Q-list; N=307; 84.1 percent response rate) interviewing methodologies. Respondents and 20 interviewers were randomly assigned to EHC and Q-list interviews that were conducted via telephone in the spring of 1998. All interviews asked for retrospective reports on social and economic behaviors that occurred during the calendar years of 1996 and 1997. Using data from the same respondents collected 1 year earlier on events reported during 1996 as a standard of comparison, the quality of retrospective reports on 1996 events from the 1998 administration of EHC and Q-list interviews was assessed. In comparison to the Q-list, the EHC condition led to better-quality retrospective reports on moves, income, weeks unemployed, and weeks missing work resulting from self illness, the illness of another, or missing work for these reasons in combination with other ones. For reports of household members entering the residence, and number of jobs, the EHC led to significantly more overreporting than the Q-list. Contingent on additional research that examines a wider range of reference periods and different modes of interviewing, the EHC may become a viable and potentially superior method to the Q-list in the collection of self-reported retrospective information.