Oral findings in Mexican AIDS patients with cancer

Oral findings of 42 Mexican AIDS patients with cancer were reviewed. Kaposi's sarcoma (KS) was the most frequent malignancy (81%) followed by non-Hodgkin's lymphoma (NHL) (12%). All cases of NHL were of high or intermediate grade and most of them were extranodal. Out of the 34 individuals with KS, 22 (65%) showed oral KS and in 21 of them the palate was involved. The clinical features of oral KS including site, appearance and size are described. Pseudomembranous candidosis (PC), hairy leukoplakia (HL) and exfoliative cheilitis (ECh) were also found in these patients. There was no association of these lesions with any type of cancer. A strong association of oral candidosis and history of this infection was found, RR = 7.0 (1.3-4.1). There was evidence of severe immunosuppression in most patients, with mean average CD4 counts of 116 mm3 (range 4-841/mm3). Oral KS, ECh, PC and HL were more common in patients with lower CD4 counts. Our findings illustrate the most frequent oral lesions associated with HIV-1 infection in patients with AIDS and cancer, and further support the importance of oral examination in HIV infected patients.

Detection of human cytomegalovirus in ocular tissue by polymerase chain reaction and in situ DNA hybridization

Rapid and sensitive techniques with a high degree of accuracy are necessary for the diagnosis and management of cytomegalovirus (CMV) retinitis presenting with atypical clinical manifestations. Light microscopy and immunohistochemical studies have limitations in the identification of this virus, but in situ DNA hybridization offers a rapid, highly specific, and easily interpretable means of identifying CMV. A new procedure of enzymatic amplification of DNA in vitro, called the polymerase chain reaction (PCR), has yielded excellent results in the identification of various viruses. In the study described herein, we evaluated the diagnostic usefulness of PCR and compared its reliability with that of in situ DNA hybridization for the detection of CMV in ocular tissues. We found that the reliability of the PCR method is similar to in situ DNA hybridization for the detection of CMV, although morphologic correlation is provided only by the latter technique. False-negative results can occur in PCR if the correct primer is not used.

Chronic hyperkeratotic herpes zoster and human immunodeficiency virus infection

A patient with human immunodeficiency virus infection had hyperkeratotic papules in the T 11 and T 12 dermatomes in which she previously had papulovesicular herpes zoster. Findings of a biopsy specimen and viral culture of these papules subsequently revealed varicella-zoster that eventually responded to prolonged high-dose acyclovir therapy and debridement. A review of reported cases of hyperkeratotic varicella-zoster infections is presented, in addition to our recommendations for the treatment of varicella-zoster infection in patients who have acquired immunodeficiency syndrome.

Toxoplasmic papillitis as the initial manifestation of acquired immunodeficiency syndrome

Toxoplasmic retinochoroiditis has been reported as the initial manifestation of acquired immunodeficiency syndrome (AIDS). Two authors have described two patients with AIDS and toxoplasmic papillitis. We report the case of a patient with a papillitis of unknown origin in whom the workup found systemic toxoplasmosis and subsequent positive human immunodeficiency virus status. To our knowledge, this is the first reported case of toxoplasmic papillitis as the initial manifestation of AIDS.

Disseminated adiaspiromycosis in a patient with AIDS

A case of disseminated adiaspiromycosis in an AIDS patient is described. The most notable characteristic of the infection was the extensive osteomyelitis exhibited by the patient. Positive cultures for Chrysosporium parvum var. parvum were obtained from pus taken from a lesion of the wrist during surgery as well as from sputum samples and a bone marrow aspirate. Treatment with amphotericin B controlled the fungal infection.

Cryptococcosis produced by a urease negative strain of Cryptococcus neoformans

A urease negative strain of Cryptococcus neoformans was isolated form a patient with AIDS. The identification of the yeast was confirmed by physiological and pathogenicity tests. Clinically, the disseminated cryptococcal infection in our patient was identical to those reported in other patients with AIDS.

Pathways to the impairment of human nutritional status by gastrointestinal pathogens

Gastrointestinal pathogens are of three varieties, those that can, and often do, take the life of the host, those that infect transiently and rarely are life-threatening, and those (parasites) that establish a relatively prolonged residence or colonization of the host's alimentary tract. In the case of the second form, if infections are recurrent, both catabolic effects during the episode and failure to digest foods and/or absorb nutrients results. Similarly, catabolic wastage through activation of the acute phase response, and interference with the host's acquisition of nutrients by maldigestion, malabsorption, intestinal losses and competition with the parasite burden can impair growth and nutrition with helminthic infections. Growth and nutrition with respect to all of the macronutrients and virtually all of the micronutrients have been documented to be adversely affected by gastrointestinal pathogens. For its burgeoning importance as a worldwide health problem, both with the HIV virus as a direct intestinal pathogen and with the opportunistic gut infections occurring in the immunocompromised host, AIDS represents the emerging context of the impairment of nutritional status by intestinal pathogens.

Radiographic imaging of sinusitis in HIV infection

Magnetic resonance images (MRI) of the brain from 75 homosexual men were reviewed to evaluate the frequency and severity of incidental sinus disease associated with human immunodeficiency virus (HIV). All scans had been performed for reasons other than a history of sinus disease. The opacification of each sinus cavity was scored such that 0 = normal, 1 = < 25%, 2 = 25% to 75%, and 3 = > 75% opacification. Subjects were then stratified by clinical status into four groups: HIV-, HIV+ without HIV-related symptoms, AIDS-related complex (ARC), or AIDS. Grade 1 mucosal thickening was present in 52% to 55% of HIV- and HIV+ subjects alike. Moderate disease (grade 2 or 3) was seen in seven of 52 HIV+ subjects, but none of the 23 HIV- controls. The incidence of maxillary sinus thickening was 69% in men with AIDS, compared to 30% in HIV- men (chi 2 = 4.1, p < 0.05). Mean maxillary sinus scores were 1.25 +/- 0.29 in those with AIDS compared to 0.43 +/- 0.15 in HIV- men (f = 5.11, p < 0.05). Our results suggest that maxillary sinus disease is more common and more severe in patients who have AIDS.

Tuberculosis: the return of an old enemy

Tuberculosis is an ancient human scourge that continues to be an important public health problem worldwide. The increasing number of multidrug-resistant (MDR) M. tuberculosis isolates from both AIDS and non-AIDS patients is an ominous trend that threatens tuberculosis eradication programs both in the U.S. and overseas. New antituberculosis vaccines with therapeutic properties are urgently needed for human immunodeficiency virus-infected individuals, as well as health care professionals likely to be exposed to MDR tubercle bacilli. Recombinant DNA vaccines bearing protective genes from virulent M. tuberculosis are being developed using shuttle phasmids to transfer genetic material from one mycobacterial species to another. Improved assay procedures are needed to measure the protection afforded by these new vaccines under experimental and field test conditions. Tuberculosis vaccine development should be given a high priority in current medical research goals.

Oral Candida in HIV infection and AIDS: new perspectives/new approaches

Oral candidosis has become an increasingly important problem in HIV-infected individuals. At present, the small body of published literature on the characterization of the Candida strains and species found in HIV+ patients is full of confusion and contradictions. Some of these difficulties are the result of the methodological shortcomings of a number of the techniques that have been used. Examples of the problems that may be encountered on primary isolation and subculture are described and the drawbacks associated with the systems used to date for phenotyping Candida are quoted. While molecular characterization techniques would appear to offer a reliable and objective alternative, they too have their strengths and weaknesses. An attempt is made to summarize the progress that has been made recently in the detection and identification of Candida albicans and also the non-albicans species from HIV-infected individuals. What emerges is that the commensal Candida species that inhabit the oral cavities of HIV+ patients are subjected to a number of significant pressures that probably promote the selection of organisms with unusual phenotypes and genotypes. These Candida are more difficult to characterize and behave differently compared to their counterparts in HIV- individuals. It is clear that uncovering the factors that are important for the selection of treatment regimens and will be predictive of outcome will not be easy. Candida organisms are neither as benign nor as simple as once thought.

Pasteurella multocida pneumonia in a man with AIDS and nontraumatic feline exposure

A case of acute pneumonia due to Pasteurella multocida ssp multocida occurred in a young man with AIDS and chronic sinusitis. The pneumonia was diagnosed by bronchoscopy and responded to treatment with aztreonam. Epidemiologic investigation revealed the case was temporally related to nontraumatic exposure to cat secretions that the patient presumably had acquired via an aerosol. The cat's oral cavity was cultured and an isolate of P multocida ssp multocida with identical biochemical reactions, DNA restriction patterns, and nearly identical fatty acid profile to that of the patient's isolate was obtained suggesting they were identical strains and therefore epidemiologically linked. A control strain with identical biochemical reactions and antibiotic sensitivities exhibited different patterns. To our knowledge, this is the first such reported infection in a patient infected with human immunodeficiency virus.

1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults

CDC has revised the classification system for HIV infection to emphasize the clinical importance of the CD4+ T-lymphocyte count in the categorization of HIV-related clinical conditions. This classification system replaces the system published by CDC in 1986 (1) and is primarily intended for use in public health practice. Consistent with the 1993 revised classification system, CDC has also expanded the AIDS surveillance case definition to include all HIV-infected persons who have < 200 CD4+ T-lymphocytes/microL, or a CD4+ T-lymphocyte percentage of total lymphocytes of < 14. This expansion includes the addition of three clinical conditions--pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer--and retains the 23 clinical conditions in the AIDS surveillance case definition published in 1987 (2); it is to be used by all states for AIDS case reporting effective January 1, 1993.