RESUMO
BACKGROUND: The Mediterranean area is endemic for the zoonotic form of visceral leishmaniasis (VL) caused by Leishmania infantum, a species which has been recently associated with unexpected epidemiological and clinical features. METHOD: We report the result of a systematic review of the literature on VL unusually presenting with spleen focal lesions, including three previously unpublished cases. RESULTS: A total of 28 cases of VL with multiple spleen focal lesions were retrieved. Twenty-six (93%) were acquired in the Mediterranean area, where L. infantum is endemic. Thirteen cases were diagnosed in children, and the remaining 15 cases in middle-aged adults, of whom 9 were immunosuppressed. Four patients (14%) underwent diagnostic splenectomy, while the diagnosis was confirmed by less invasive techniques in the remaining patients. The most common radiological patterns were: multiple subcentimetric or centimetric spleen lesions (size ≤ 1 cm in 14 of 19 cases, 74%), hypoechoic at ultrasonography (25 of 26 cases, 99%) and hypodense at CT scan (9 of 10 cases, 90%). PET-CT (available for four patients) showed an intense FDG spleen uptake. MRI and contrast-enhanced ultrasonography, available for two and one cases each, showed complex patterns. CONCLUSIONS: VL must be added to the list of possible differential diagnosis of spleen focal lesions and health care provider awareness about this condition will avoid unnecessary invasive diagnostic procedures.
Assuntos
Leishmaniose Visceral/patologia , Doenças Negligenciadas/patologia , Baço/patologia , Esplenopatias/patologia , Adulto , Diagnóstico Diferencial , Humanos , Itália , Leishmaniose Visceral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Doenças Negligenciadas/diagnóstico por imagem , Baço/diagnóstico por imagem , Esplenopatias/diagnóstico por imagemRESUMO
Liver tissue alterations other than fibrosis may have an impact on liver stiffness measurement. In this study we evaluated 18 patients without a previous clinical history of liver disease, consecutively admitted for acute viral hepatitis. In each patient, aminotransferase determination and liver stiffness measurement were performed on the same study day, at 3 different points: (1) peak increase in aminotransferase; (2) aminotransferase 50% or less of the peak; (3) aminotransferase levels Assuntos
Técnicas de Imagem por Elasticidade/métodos
, Hepatite/diagnóstico
, Cirrose Hepática/diagnóstico
, Adulto
, Alanina Transaminase/sangue
, Aspartato Aminotransferases/sangue
, Feminino
, Hepatite/patologia
, Humanos
, Coeficiente Internacional Normatizado
, Cirrose Hepática/patologia
, Cirrose Hepática/virologia
, Masculino
, Pessoa de Meia-Idade
RESUMO
The introduction of highly active antiretroviral therapy in 1995 dramatically decreased AIDS-related events and deaths rates; however, the enthusiasm among the medical and social community was soon limited by the growing incidence of various side-effects that often greatly limited patients' quality of life. The second problem caused by such a complex treatment consisted of sub-optimal adherence, with a consequent higher risk of the development of drug resistance.
Assuntos
Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Adulto , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Contagem de Linfócito CD4 , Doença Crônica , Estudos de Coortes , Didanosina/administração & dosagem , Esquema de Medicação , Feminino , Inibidores da Protease de HIV/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , RNA Viral/análise , Inibidores da Transcriptase Reversa/administração & dosagem , Carga Viral , Zidovudina/administração & dosagemRESUMO
We examined the impact of a lamivudine-containing highly active antiretroviral therapy (HAART) regimen on 164 hepatitis B virus/HIV co-infected individuals starting their first HAART. Lamivudine-treated patients (accounting for 73% of the study population) showed a significantly lower level of alanine aminotransferase over follow-up [-81.1 mU/ml mean difference; 95% confidence intervals (95% CI): -30.3; -131.7, P=0.003] and a significantly reduced risk of liver-related morbidity/mortality [Relative hazard (RH)=0.07; 95% CI: 0.01-0.38, P=0.002] than those starting a lamivudine sparing-regimen.