HIV-1 Langerhans' cell tropism associated with heterosexual transmission of HIV.

Heterosexual transmission by vaginal intercourse accounts for most transmission of human immunodeficiency virus-type 1 (HIV-1) in Africa and Asia but is less important in the HIV-1 epidemics of the United States and Western Europe. Epithelial Langerhans' cells (LCs) represent a possible source of initial cell contact for vaginal infection. Fifteen primary isolates of HIV-1 from U.S. homosexuals and 18 HIV-1 isolates from Thailand heterosexuals were evaluated for growth in LCs of U.S. origin. All the viruses from the Thai heterosexuals, which were subtype E, grew more efficiently in the LCs than any of the viruses from the U.S. homosexuals, which are subtype B. These results suggest that LC tropism is associated with the efficiency of heterosexual transmission of HIV.

Clinical manifestations of 174 AIDS cases in Maharaj Nakorn Chiang Mai Hospital.

PIP: The human immunodeficiency virus (HIV) has, since it was first reported in 1981, become a worldwide epidemic. The immunosuppressive nature of HIV results in opportunistic infections, neoplasms, and other pathological conditions. Clinical manifestations of these conditions are often the first indication that an individual is infected with HIV. This article reports and describes the clinical findings for 174 HIV-positive patients and is intended to educate Thai physicians concerning the rising HIV infection rate in Thailand. The opportunistic infectious agents included fungal, parasitic, viral, and bacterial organisms. Cryptococcosis, penicillosis, candidiasis, and histoplasmosis are fungal diseases which are discussed. Protozoal organisms and diseases covered are Pneumocystis carinii, toxoplasmosis, cryptosporidiosis, isosporiosis, and Demodex folliculorum. Bacterial infections addressed are tuberculosis, syphilis, and salmonellosis. The parasite causing nocardiosis is also discussed. Viral infections addressed are cytomegalovirus infection, herpes simplex, and hairy leukoplakia. Neoplasms or tumors discussed are Kaposi's sarcoma and non-Hodgkins lymphoma. Other pathological conditions described are brain atrophy, HIV retinopathy, and HIV wasting syndrome. In most cases, a suggested therapy regime is given for the condition discussed.^ieng

AIDS--associated Kaposi's sarcoma: a rare entity at Maharaj Nakorn Chiang Mai Hospital.

Kaposi's sarcoma [KS] is rare in Asian countries. Since the AIDS epidemic, KS has become the most common AIDS-related cancer reported in the international literature. Up to March 1996, 4 cases of AIDS-associated KS were histologically documented at the registry at the Maharaj Nakorn Chiang Mai University Hospital, comprising 2 adult and 2 pediatric male patients. Routes of HIV exposure included intravenous injection and heterosexual contact in adult cases, and perinatal transmission and blood transfusion in the pediatric ones. KS was present as an AIDS diagnostic condition in one of the adults and in both children. In our institution, KS was second in frequency to malignant lymphoma among AIDS patients. Predomination of non-homosexual transmission of HIV infection in this region was probably a factor associated with the rarity of AIDS-associated KS.

Pregnancy outcome in Thai patients with systemic lupus erythematosus.

The outcome of 48 pregnancies from 42 patients with systemic lupus erythematosus was studied. Their mean age and the duration of the disease were 28.47 and 4.42 years, respectively. The conception occurred when the disease was inactive or quiescent in 45 and active in 3. Four pregnancies were terminated by criminal abortion. Flares occurred in 16 pregnancies. The kidney and mucocutaneous system were the 2 organs that flared most commonly. The fetal outcomes were term delivery in 18 (40.90%), prematurity in 17 (38.64%), spontaneous abortion in 6 (13.64%) and still birth in 3 (6.82%). There was no statistical difference in pregnancy loss and successful delivery between pregnant patients with and without flares. Concerning 35 successful live births, those pregnancies without flares had significantly more full term deliveries (p < 0.02), higher gestational age (p < 0.002) and more birth weight (p < 0.001) than those with flares. Small for gestational age was seen in 20%. Pregnancy with active renal disease had a poor fetal outcome. There were no cases of congenital anomalies or neonatal lupus. Maternal complications were more common in patients with flares.

Histopathologic spectrum of AIDS-associated lesions in Maharaj Nakorn Chiang Mai Hospital.

The histopathological alterations in various organs and the presence of AIDS-associated lesions were studied in 86 biopsy and 29 necropsy specimens of AIDS patients. The most common cancer seen in this study were malignant lymphomas (4% of cases) with development of extensive extranodal lymphomatous involvement from the outset. Although a preponderance of high grade B-cell pathologic subtypes is found in AIDS-associated lymphoma, we also report the first case of T-lymphoblastic lymphoma with a picture of acute lymphoblastic leukemia (T-ALL). Tuberculosis (34% of cases) was the most common opportunistic infection presented in tissue sections, and the majority of tissue biopsies revealed poorly organized granulomas and extensive necrosis with numerous bacilli. Penicilliosis (20% of cases) appeared to be the most common cutaneous lesion with multiple organ involvement. The involved organs showed a partially anergic tissue reaction characterized by poorly formed granulomas with diffuse infiltrate of fungi-laden macrophages and lymphoid cell depletion. This organism has to be distinguished from Histoplasma capsulatum and other yeast-form fungi. Co-existing cytomegalovirus and P. carinii infections were the predominant findings in lung necropsy specimens from pediatric patients who died from AIDS. A major pathologic feature in this group was diffuse alveolar damage stage II to III with heavy loads of organism and extensive lymphoplasmacytic infiltration.

Adrenergic urticaria: a first report from Thailand.

A 22-year-old, female patient came to see the allergists because of a 10-year history of chronic urticaria. Widespread pruritic, urticarial papules developed at times of stress and exercise, each papule being surrounded by a striking blanched vasoconstricted halo. The halo hives could be replicated with an intradermal injection of adrenaline. This is the first report of adrenergic urticaria from Thailand.

A case of hypomagnesemia hypocalcemia as a complication of aminoglycoside and review of the literature.

A 28-year-old woman was admitted to the ENT Department of the Faculty of Medicine, Chiang Mai University because of left otitis externa, chronic mastoiditis and facial nerve palsy (lower motor neurone). Left radical mastoidectomy with wide debridement of granulation and necrotic tissue at ear canal, dura, sigmoid sinus, ossicle and facial nerve were done two weeks after admission. Multiple pus culture from the lesion revealed different types of organisms e.g. proteus mirabilis, beta strep non group A, and enterococci beta type. Several aminoglycosides were alternately given for two months without improvement of ear infection. She developed carpopedal spasm with hypocalcemia after three weeks of such treatment. Hypomagnesemia was recognized. Calcium and milk supplement gave temporary relief, but permanent relief was obtained after aminoglycoside was discontinued. Serum electrolyte had reversed to normal on follow-up.

First report case of cryoglobulinemia and cryofibrinogenemia in Thailand.

A 43-year-old monk had generalized purpura, arthritis of both shoulders, erythrocyanosis of lip and oral mucous membrane, Raynaud's phenomenon and uveitis. Platelets were normal. Cryoglobulin and cryofibrinogen were positive. Biopsy revealed vasculitis. No underlying infection, collagen vascular disease, lymphoproliferative, myeloproliferative and malignancy were found. He was diagnosed as having essential cryoglobulinemia and cryofibrinogenemia.

Human immunodeficiency virus type 1 subtype E envelope recombinant peptides containing naturally immunogenic epitopes.

A series of recombinant peptides of the human immunodeficiency virus type 1 (HIV-1) subtype E envelope were used to address the question of whether immunogenic epitopes similar to those described for the subtype B envelope are also present in structurally analogous regions of another HIV-1 subtype with divergent sequences. Five recombinant peptides, covering the V2 and V3 domains of gp120, the cysteine-loop region of gp41, a gp41 region involved in oligomerization, and the cytoplasmic tail of gp41, were found to react with >50% of the serum samples analyzed. All but the V2 region in the HIV-1 subtype B envelope have been reported to contain continuous epitopes that are highly immunogenic during natural infection. This finding suggests that, despite the sequence divergence between subtype E and B envelopes, most of the continuous epitopes that are highly immunogenic during natural infection are located at structurally analogous regions of the envelope.

Ethnic and geographic differences and similarities of HIV/AIDS-related mucocutaneous diseases. Danida Study Groups.

BACKGROUND: A study on HIV/AIDS-related mucocutaneous manifestations has been carried out in three different ethnic and geographic areas, namely Brazil, Denmark, and Thailand. METHODS: The Brazil cohort comprised 110 patients, the Danish cohort 150, and the Thai cohort 206 patients. The majority of the Brazil and Thai cohort patients belonged to groups III and IV according to the CDC clinical staging system, whereas the patients in Denmark called their doctors earlier and only 8% were classified in groups III and IV. RESULTS: In all three areas the number of mucocutaneous diseases correlated well with the progression of the HIV disease. Ethnic differences were not identified, whereas geographic differences related to skin infections were marked. In the Asian cohort a generalized fungal infection was detected with characteristic mucocutaneous symptoms caused by Penicillium marneffei. CONCLUSIONS: Teaching efforts about mucocutaneous signs as markers of HIV infection may be of value, particularly in developing areas, to allow earlier diagnosis. In future guidelines for classification of HIV/AIDS-related mucocutaneous diseases geographic considerations should be included.

Soluble serum interleukin 2 receptor levels in leprosy patients.

Soluble interleukin 2 receptors (IL-2R) in sera of leprosy patients from Chiang Mai, Thailand, were quantified with a solid phase enzyme immunoassay using two monoclonal antibodies to the IL-2R. The IL-2R levels of untreated lepromatous, borderline lepromatous or midborderline patients and treated lepromatous and borderline lepromatous or treated borderline tuberculoid and tuberculoid patients were comparable to those of the Thai household or nonhousehold contacts; and they were significantly higher than the levels of USA control subjects. In contrast, IL-2R of untreated tuberculoid or borderline tuberculoid patients were significantly reduced. Patients with ongoing reversal reaction had very high circulating IL-2R, the levels of which correlated with fever and extent of skin lesions. Although erythema nodosum leprosum patients also had elevated IL-2R levels, they were significantly below those of patients with reversal reaction. When treated with corticosteroid, precipitous reduction of IL-2R was noted in all patients with reversal reaction but not in patients with erythema nodosum leprosum.