1
|
Nacher M, Alsibai KD, Adenis A, Blaizot R, Abboud P, Demar M, Djossou F, Epelboin L, Misslin C, Ntab B, Valdes A, Couppié P. Reduced Severity in Patients With HIV-Associated Disseminated Histoplasmosis With Deep Lymphadenopathies: A Trench War Remains Within the Lymph Nodes? Front Cell Infect Microbiol 2021; 10:598701. [PMID: 33628743 PMCID: PMC7897652 DOI: 10.3389/fcimb.2020.598701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background Disseminated histoplasmosis is a major killer of patients with advanced HIV. It is proteiform and often hard to diagnose in the absence of diagnostic tests. We aimed to describe disseminated histoplasmosis with lymphadenopathies in French Guiana and to compare survival and severity of those patients to patients without lymphadenopathies. Methods A retrospective cohort study was performed on data records collected between January 1, 1981 and October 1, 2014. Results Among 349 cases of disseminated histoplasmosis 168 (48.3%) had superficial lymphadenopathies and 133(38.1%) had deep lymphadenopathies. The median LDH concentration, ferritin concentration, TGO concentration, and WHO performance status were lower among patients with deep lymphadenopathies than those without deep lymphadenopathies. There was a significant decrease in the risk of early death (<1 month) among those with deep lymphadenopathies relative to those without (OR=0.26 (95%CI=0.10-0.60), P=0.0006) and in the overall risk of death (OR=0.33 (95%CI=0.20-0.55), P<0.0001). These associations remained strongly significant after adjusting for time period, CD4 counts, age, delay between beginning of symptoms and hospital admission, antifungal and antiretroviral treatment. Conclusions The present data show that in patients with advanced HIV and disseminated histoplasmosis, the presence of deep lymphadenopathies is associated with fewer markers of severity and a lower risk of death. To our knowledge it is the first study to show this. The presence of deep lymphadenopathies is hypothesized to reflect the patient's partially effective defense against H. capsulatum.
Collapse
Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Department of Pathology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Romain Blaizot
- DFR Santé, Université de Guyane, Cayenne, French Guiana.,Department of Dermatology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana.,UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Caroline Misslin
- Service de Médecine, Centre hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Balthazar Ntab
- Département d'Information Médicale, Centre hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Audrey Valdes
- Equipe Opérationnelle d'hygiène hospitalière, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Pierre Couppié
- DFR Santé, Université de Guyane, Cayenne, French Guiana.,Department of Dermatology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
| |
Collapse
|
2
|
Abstract
OBJECTIVE. The purpose of this article is to review important imaging and clinical features to help elucidate causes of lymphadenopathy in patients with HIV infection. CONCLUSION. HIV lymphadenopathy has various causes generally categorized as inflammatory or reactive, such as immune reconstitution syndrome; infectious, such as tuberculous and nontuberculous mycobacterial infections and HIV infection itself; and neoplastic, such as lymphoma, Kaposi sarcoma, and Castleman disease. It is important to consider patients' demographic characteristics, clinical presentations, CD4 lymphocyte counts, and radiologic features to identify likely causes of lymphadenopathy.
Collapse
|
3
|
Orofacial outcomes in adolescents with perinatally infected HIV in antiretroviral therapy. AIDS 2020; 34:1417-1423. [PMID: 32590437 DOI: 10.1097/qad.0000000000002569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the frequency of orofacial outcomes in adolescents with perinatally infected HIV in treatment with antiretroviral therapy (ART). DESIGN A Brazilian institution-based retrospective study analyzing medical charts and medication dispensing data. METHODS Medical records of 137 adolescents were reviewed. HIV viral load, CD4 T-cell count (CD4), ART regimen, nonadherence events, and prolonged ART discontinuation were recorded. The frequency of each outcome was determined. Associations between the most frequent outcomes and both records of undetectable viral load and CD4 at least 500 cells/μl were carried out. Associations of lymphadenitis, Group 1 orofacial manifestations and Group 2 orofacial manifestations with records of Center for Disease Control and Prevention (CDC) category C illness were also performed. Odds ratio (OR), confidence intervals (CI) and P values were provided. RESULTS Cervical and submandibular lymphadenitis (45.25%), dental caries (32.84%) and periodontal issues (11.67%) were the most frequent orofacial outcomes. A detectable viral load (OR = 2.61, 95% CI 1.16--5.88) and CD4 less than 500 cells/μl (OR = 2.34, 95% CI 1.13--4.82) were associated with a greater risk of lymphadenitis. Orofacial outcomes associated with HIV were found in adolescents with longer ART discontinuation and a greater number of ART discontinuation events (P < 0.05). No association was found between records of CDC category C illness and group 1 orofacial manifestations, group 2 manifestations or lymphadenitis (P > 0.05). CONCLUSION Orofacial outcomes, in particular, cervical and submandibular lymphadenitis were common among the adolescents assessed. Long-term ART and long-term exposure to HIV virus may have altered the orofacial outcome profile in adolescents perinatally infected by HIV.
Collapse
|
4
|
Jha DK, Jha AK, Singh RK. An atypical initial presentation of AIDS as cryptococcal lymphadenitis. Oxf Med Case Reports 2018; 2018:omy083. [PMID: 30364356 PMCID: PMC6194182 DOI: 10.1093/omcr/omy083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/25/2018] [Accepted: 08/24/2018] [Indexed: 11/22/2022] Open
Abstract
A patient complained of fever on and off, difficulty in swallowing and cough (with scanty expectoration) since one and a half months and weight loss over 2 months. On examination, pallor was found to be present. Then ultrasonography of abdomen was done and it showed mesenteric and retroperitoneal lymphadenopathy. Sputum for acid-fast Bacilli was examined and found to be negative but despite this, based on the epidemiological data, antitubercular therapy (ATT) was started but after 2 weeks no clinical improvement was found. Then, fine-needle aspiration cytology of lymph node was done and it resulted in the presence of cryptococcal lymphadenitis as the final report. Antifungal therapy was initiated with amphotericin B followed by fluconazole and there was clinical improvement. Ultrasonographical findings also supported it. Though it is a rare case (but not impossible) that cryptococcus is the cause of lymphadenopathy. Thus, in initial presentation of acquired immuno deficiency syndrome it should always be kept in mind that such cases may happen. In India, presuming Mycobacterium tuberculosis as the leading cause exposes the patient to unwanted hepatic and renal toxicity of ATT.
Collapse
Affiliation(s)
- Dharmendra Kumar Jha
- Department of Medicine, Patliputra Medical College and Hospital, Saraidhela, Post Office- Koyla Nagar, Dhanbad, Jharkhand, India
| | - Anshu Kumar Jha
- Department of Medicine, Assam Medical College and Hospital, Dibrugarh, Assam 786002, India
| | - Rajeev Kumar Singh
- ART Centre, Patliputra Medical College and Hospital Saraidhela, Post Office-Koyla Nagar, Dhanbad, Jharkhand, India
| |
Collapse
|
5
|
[Pathological findings in patients with HIV infection and lymphadenopathies]. BIOMEDICA 2017; 37:79-85. [PMID: 28527251 DOI: 10.7705/biomedica.v37i1.3293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/31/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Lymphadenopathy is a frequent clinical finding in HIV-infected patients. The differential diagnosis includes infection, malignancy or reactive changes. Currently, there are no data on this topic in the region. OBJECTIVES To describe the etiology of lymph node pathology in HIV-infected patients from the Hospital La María in Medellín, Colombia. MATERIALS AND METHODS The medical records of HIV-infected patients with lymphadenopathy who underwent excisional lymph node biopsy between June 2009 and October 2011 were retrospectively evaluated. The data were registered according to immune status, antiretroviral therapy and final diagnosis. RESULTS The evaluation of 120 medical records revealed the following diagnosis distribution: 58% of the cases were attributable to infectious causes, 32.5% were attributable to reactive changes, 6.6% were attributable to neoplastic disease, and 2.5% were normal. The most frequent diagnosis was tuberculosis, which was found in 48.3% of the patients. The lymph node biopsy was useful for identifying additional opportunistic infections in different organs in 14.1% of the patients. CONCLUSION A lymph node biopsy in HIV-infected patients is a useful aid in the diagnosis of serious neoplastic and infectious diseases and should be routinely performed in such patients with lymphadenopathy.
Collapse
|
6
|
Are there HIV-specific Differences for Anal Cancer Patients Treated with Standard Chemoradiotherapy in the Era of Combined Antiretroviral Therapy? Clin Oncol (R Coll Radiol) 2016; 29:248-255. [PMID: 28049602 DOI: 10.1016/j.clon.2016.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 02/04/2023]
Abstract
AIMS Contradicting evidence exists regarding the safety and clinical outcome of standard treatment in HIV-positive patients with anal cancer. We report on our large, single-centre experience in HIV-positive versus HIV-negative patients treated in the era of combined antiretroviral therapy (CART). MATERIALS AND METHODS Between 1997 and 2015, 142 patients (42 HIV-positive versus 100 HIV-negative) with anal cancer were treated with standard chemoradiotherapy. Patients received a median dose of 50.4 Gy to the planning target volume; 91 (64%) patients received an external boost to the primary tumour and/or enlarged lymph nodes of 5.4-10.8 Gy. Concurrent chemotherapy was scheduled in the first and fifth weeks of radiotherapy using 5-fluorouracil and mitomycin C. The median follow-up was 51 (range 0-325) months. RESULTS HIV-positive patients were predominantly male (P<0.001), younger (P<0.001) and had more advanced nodal disease (P=0.042). A dose reduction of chemotherapy was necessary in 38% of HIV-positive patients and in 24% of HIV-negative patients (P=0.39). There was no significant difference in total dose or duration of radiotherapy (median 43 versus 44 days, P=0.59). Complete response (81% versus 87%, P=0.088), 5 year rates of local failure (26.2% versus 14.9%, P=0.176), 5 year rates of distant failure (14.3% versus 8.4%, P=0.371) and 5 year overall survival (70.7% versus 78.4%, P=0.491) were not significantly different. HIV-positive patients had worse 5 year cancer-specific survival (80.5% versus 93.8%, P=0.029) in univariate but not in multivariate analysis (P=0.276). CONCLUSIONS In the CART era, tolerance and clinical outcome are similar between HIV-positive and HIV-negative patients with anal cancer after standard chemoradiotherapy.
Collapse
|