RESUMO
To examine the epidemiological spectrum of human listeriosis at a large municipal hospital in Miami, we reviewed the cases of Listeria monocytogenes infection seen at the University of Miami Medical Center over a nine-year period (1986-94). Twenty-four patients (13 adults, 11 neonates) with bacteriologically proven Listeria monocytogenes infections were identified. The annual rate of listeriosis for the entire period 1986-1994 was 0.042 cases/1,000 hospital admissions. The rates of listeriosis during the first half of the study period (0.0628/1,000 admissions) were three times higher than the rates observed during the second half of the study (0.0214/1,000 admissions). Four (57%) of the 7 adult cases of listeriosis seen after 1987 occurred in HIV-seropositive patients. Compared with the hospital population, the annual rates of listeriosis were several fold higher in patients post-renal transplant (4.65 cases/1,000 renal transplant-related admissions) and patients with HIV/AIDS (0.27 cases/1,000 HIV-related admissions). No deaths were recorded. The decline in the annual rate of listeriosis noted in our study parallels national trends recently reported by the Centers for Disease Control and Prevention.
Assuntos
Listeriose/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adolescente , Corticosteroides/efeitos adversos , Adulto , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Feminino , Florida/epidemiologia , Hospitais Municipais/estatística & dados numéricos , Humanos , Hospedeiro Imunocomprometido , Incidência , Recém-Nascido , Transplante de Rim , Masculino , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/microbiologia , Pessoa de Meia-Idade , Morbidade/tendências , Complicações Pós-Operatórias/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos RetrospectivosRESUMO
Thirty-six patients with AIDS and culture-proven nontuberculous mycobacteriosis were compared to 20 patients with acquired immunodeficiency syndrome (AIDS) and tuberculosis with regard to clinical signs, symptoms, and diagnostic methods. Patients with nontuberculous mycobacteriosis were more often younger and homosexuals, while patients with tuberculosis were usually Haitian-American or users of intravenous drugs. A majority of patients with tuberculosis presented with fever and weight loss. These symptoms were seen in approximately 50 percent of the patients with nontuberculous mycobacteriosis. A distinct syndrome of dyspnea, chills, hemoptysis, and chest pain was seen in a significant minority of patients with nontuberculous mycobacteriosis. Lymphadenopathy was seen almost exclusively in patients with tuberculosis. Pulmonary sources (expectorated sputum or bronchoscopy specimens) were the most common source of diagnosis in both groups. Patients in both groups in whom the diagnosis was obtained from pulmonary sources frequently had negative chest x-ray films on presentation. Cavitary disease was absent from both groups.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Infecções por Mycobacterium não Tuberculosas/etiologia , Infecções por Mycobacterium/etiologia , Infecções Oportunistas/etiologia , Tuberculose Pulmonar/etiologia , Adulto , Fatores Etários , Broncoscopia , Feminino , Haiti/etnologia , Homossexualidade , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Fatores de Risco , Escarro/microbiologia , Transtornos Relacionados ao Uso de Substâncias , Tuberculose Pulmonar/diagnóstico , Estados UnidosRESUMO
Neurologic disease was the harbinger of the acquired immunodeficiency syndrome (AIDS) in 26 (20%) of 132 patients and ultimately developed in 83 (63%). The most common neurologic disorder heralding AIDS was toxoplasmic encephalitis (17 cases) followed by cryptococcal meningitis (six), retinitis (three), progressive multifocal leukoencephalopathy (two), neuropathy (one), myopathy (one), and subacute "viral" encephalitis (one). In four patients, more than one neurologic disorder coexisted at presentation. Recognition of underlying human T cell lymphotropic virus type III (HTLV-III) infection may allow a more expedient determination of the cause of the neurologic disease. Our study emphasizes the importance of testing for the presence of HTLV-III antibody and assessing the immunologic status of all patients at risk for AIDS who have neurologic illness.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Doenças do Sistema Nervoso/etiologia , Síndrome da Imunodeficiência Adquirida/imunologia , Adolescente , Adulto , Anticorpos Antivirais/análise , Criança , Pré-Escolar , Criptococose/etiologia , Encefalite/etiologia , Feminino , Florida , Anticorpos Anti-HIV , Haiti/etnologia , Homossexualidade , Humanos , Lactente , Recém-Nascido , Masculino , Meningite/etiologia , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/imunologia , Estudos Prospectivos , Retinite/etiologia , Toxoplasmose/etiologiaRESUMO
The computed tomographic (CT) scans of 10 patients with acquired immunodeficiency syndrome who had central nervous system (CNS) involvement by cytomegalovirus (CMV) were retrospectively reviewed and correlated with clinical data and pathologic findings. Diagnosis was established in all 10 patients by autopsy, which showed the pathognomonic "owl's eye" intracellular inclusions of CMV. In six patients CMV caused an initial CNS infection that was directly responsible for the patient's progressive encephalopathy and death. In four patients CMV caused a superimposed nondominant CNS infection that had no clinical expression in two. Cortical atrophy and mild hydrocephalus ex vacuo were seen on CT in all 10 patients. Positive findings on CT that could be attributed to infection with CMV were present in only three of the 10 patients, and in these three symptomatic cases autopsy correlation revealed that CT underestimated the degree of CNS involvement. In the other three symptomatic patients, CT showed no parenchymal abnormalities, while autopsy demonstrated diffuse cerebral involvement. In the four patients whose CNS was secondarily involved by CMV, CT showed changes proven at autopsy to be related only to the dominant infection with Toxoplasma gondii and to postoperative hematomas. CT did not demonstrate any abnormalities at the sites of CMV involvement, which were found at autopsy in this latter group. It was concluded that CT is not very sensitive for the detection of CMV encephalitis.
Assuntos
Síndrome da Imunodeficiência Adquirida/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Infecções por Citomegalovirus/diagnóstico por imagem , Encefalite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/patologia , Adulto , Encéfalo/patologia , Citomegalovirus , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/patologia , Encefalite/microbiologia , Encefalite/patologia , Feminino , Florida , Haiti/etnologia , Homossexualidade , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Papillomaviridae , Polyomaviridae , Estudos Retrospectivos , Toxoplasma , Infecções Tumorais por Vírus/diagnóstico por imagemAssuntos
Abscesso/etiologia , Síndrome da Imunodeficiência Adquirida/complicações , Encefalite/etiologia , Toxoplasmose/etiologia , Tuberculose/etiologia , Abscesso/diagnóstico por imagem , Adulto , Feminino , Haiti/etnologia , Humanos , Tomografia Computadorizada por Raios X , Tuberculose/diagnóstico por imagemRESUMO
To study the association between mycobacterial disease and the acquired immunodeficiency syndrome, we reviewed the records of all cases of tuberculosis and all cases of the syndrome reported in Dade County, Florida, from January 1980 through June 1983. Tuberculosis was diagnosed in 27 of 45 Haitians with the syndrome, but in only 1 of 37 non-Haitians with the syndrome (p less than 0.001). Among the 27 Haitians with the syndrome and tuberculosis, 19 had extrapulmonary tuberculosis, whereas among 286 Haitian patients with tuberculosis without the syndrome, only 56 had extrapulmonary tuberculosis (p less than 0.001). Tuberculosis preceded the syndrome by 1 to 17 months (mean, 6) in 22 patients. In 10 patients with the syndrome and positive sputum cultures who were treated with conventional antituberculosis drugs, the cultures became negative within 1 to 4 months and tuberculosis did not recur. The frequency of disseminated atypical mycobacteriosis or positive sputum cultures for atypical mycobacteria was not significantly different between Haitian (11.3%) and non-Haitian (8.3%) patients with the syndrome.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium/epidemiologia , Tuberculose/epidemiologia , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Negro ou Afro-Americano , Antituberculosos/uso terapêutico , Aspartato Aminotransferases/sangue , Cuba/etnologia , Florida , Haiti/etnologia , Humanos , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Pneumonia por Pneumocystis/epidemiologia , Sarcoma de Kaposi/epidemiologia , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , População BrancaAssuntos
Síndrome da Imunodeficiência Adquirida/fisiopatologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/imunologia , Síndrome da Imunodeficiência Adquirida/mortalidade , Adulto , Feminino , Florida , Haiti/etnologia , Hospitalização , Humanos , Imunidade Celular , Recém-Nascido , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoma de Kaposi/complicações , Linfócitos T Auxiliares-Indutores , Linfócitos T Reguladores , Tuberculose/complicaçõesRESUMO
Twenty Haitian patients, hospitalized from 1 April 1980 to 20 June 1982, had Pneumocystis carinii pneumonia, central nervous system toxoplasmosis, esophageal candidiasis, cryptococcosis, disseminated cytomegalovirus, progressive herpes simplex virus, chronic enteric coccidiosis, or invasive Kaposi's sarcoma. Ten patients died. Opportunistic infections were frequently multiple and were recurrent in three patients. In seven patients disseminated tuberculosis preceded the other infections by 2 to 15 months. There was no evidence of an underlying immunosuppressive disease, and no history of homosexuality or intravenous drug abuse. At least three patients probably acquired the syndrome in Haiti. Lymphadenopathy was common. Seventeen patients tested had anergy, and 18 had lymphopenia. Monoclonal antibody analysis of peripheral-blood T-cell subsets done on 11 patients showed a marked decrease in T-helper cells and an inversion of the normal ratio of T-helper cells to T-suppressor cells. This syndrome among heterosexual Haitians is strikingly similar to the syndrome of immunodeficiency described recently among American homosexuals.