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Belard S, Taccari F, Kumwenda T, Huson MA, Wallrauch C, Heller T. Point-of-care ultrasound for tuberculosis and HIV-revisiting the focused assessment with sonography for HIV-associated tuberculosis (FASH) protocol and its differential diagnoses. Clin Microbiol Infect 2024; 30:320-327. [PMID: 37923216 DOI: 10.1016/j.cmi.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/10/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The 'Focused assessment with sonography for HIV-associated tuberculosis' (FASH) protocol has been applied and researched for over a decade in HIV-infected patients with suspected extra-pulmonary tuberculosis. Interpretation of target FASH features may be challenging as they can also indicate alternative opportunistic diseases. OBJECTIVES The primary aim of the review was summarizing the accumulated evidence on the diagnostic accuracy of the FASH protocol including description of diagnoses of target FASH features. SOURCES Literature was searched using PubMed, Google Scholar, and publications referencing the original FASH publications; data from identified studies were compiled with data from studies identified by a preceding Cochrane review. A meta-analysis was performed based on a generalized linearized mixed model. Data on differential diagnoses were compiled by literature review and retrospective evaluation of clinical data. CONTENT We identified ten studies; abdominal target FASH features were most studied. Sensitivity and specificity estimates were 39% (95% CI 25-54) and 89% (95% CI 83-96) for enlarged lymph nodes (ten studies), and 30% (95% CI 16-45%) and 93% (95% CI 89-98%) for hypoechoic spleen lesions (eight studies). In people living with HIV differential diagnoses of target FASH features are multiple and primarily include other opportunistic infections and malignancies such as non-tuberculous mycobacterial infection, bacillary angiomatosis, hepato-splenic brucellosis, meliodiosis, visceral leishmaniasis, invasive fungal infections, and lymphoma as well as Kaposi sarcoma. Ultrasound-guided diagnostic sampling may assist obtention of a definitive diagnosis. IMPLICATIONS On the basis of current evidence, although limited by methodology, and personal experience, we recommend basic ultrasound training, including the FASH protocol and ultrasound-guided diagnostic interventions, for all healthcare providers working with people living with HIV in resource-limited settings.
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Affiliation(s)
- Sabine Belard
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Partner Site Tübingen, German Center for Infection Research (DZIF), Tübingen, Germany.
| | - Francesco Taccari
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Michaëla Am Huson
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Tom Heller
- Lighthouse Clinic Trust, Lilongwe, Malawi; International Training and Education Center for Health, University of Washington, Seattle, WA, USA
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2
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Naeem M, Menias CO, Cail AJ, Zulfiqar M, Ballard DH, Pickhardt PJ, Kim DH, Lubner MG, Mellnick VM. Imaging Spectrum of Granulomatous Diseases of the Abdomen and Pelvis. Radiographics 2021; 41:783-801. [PMID: 33861648 DOI: 10.1148/rg.2021200172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A granuloma is a compact organization of mature macrophages that forms because of persistent antigenic stimulation. At the microscopic level, granulomas can undergo various morphologic changes, ranging from necrosis to fibrosis, which along with other specialized immune cells define the appearance of the granulomatous process. Accordingly, the imaging features of granulomatous diseases vary and can overlap with those of other diseases, such as malignancy, and lead to surgical excisions and biopsy. However, given the heterogeneity of granulomas as a disease group, it is often hard to make a diagnosis on the basis of the histopathologic features of granulomatous diseases alone owing to overlapping microscopic features. Instead, a multidisciplinary approach is often helpful. Radiologists need to be familiar with the salient clinical manifestations and imaging findings of granulomatous diseases to generate an appropriate differential diagnosis. ©RSNA, 2021.
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Affiliation(s)
- Muhammad Naeem
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Christine O Menias
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Austin J Cail
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Perry J Pickhardt
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - David H Kim
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Meghan G Lubner
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
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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.
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Beyond pyogenic liver abscess: a comprehensive review of liver infections in emergency settings. Emerg Radiol 2020; 27:307-320. [PMID: 32052222 DOI: 10.1007/s10140-020-01757-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 02/02/2020] [Indexed: 12/14/2022]
Abstract
Hepatobiliary infections are commonly encountered in emergency settings ranging from common pathology such as pyogenic abscess to relatively uncommon and rare etiologies. Since extensive literature is already available on imaging of more common bacterial infections, for the sake of focused discussion, this review will discuss radiological appearance of less commonly encountered hepatic infections of fungal, parasitic, viral, and tubercular etiologies. Epidemiological and clinical information remain extremely important for obtaining more accurate presumptive diagnosis. In the era of diverse population migration, a modern-era radiologist must be well versed about the imaging spectrum of liver infections.
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Mohamed Buhary T, Gayed SL, Hafeez I. Pericardial effusion with Mycobacterium avium complex in HIV-infected patients. BMJ Case Rep 2016; 2016:bcr-2016-215686. [PMID: 27389727 DOI: 10.1136/bcr-2016-215686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Disseminated atypical Mycobacterium infection is a well-known opportunistic infection in HIV-infected patients with advanced immune deficiency before the introduction of combination antiretroviral therapy. Although the disseminated infection is now rare, few cases of localised infections are reported. A 38-year-old man was diagnosed with HIV infection during asymptomatic sexual health screening. Although he was asymptomatic on diagnosis, he had advanced immunodeficiency; therefore, combination antiretroviral therapy was started immediately. After 5 months of treatment, he developed pericardial effusion. Mycobacterium was detected from a culture of the pericardial fluid and Mycobacterium avium complex was identified using a gene probe test. He was treated with combination therapy for Mycobacterium infection and he fully recovered. Treatment continued for 4 years until he achieved adequate immune recovery.
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Affiliation(s)
| | | | - Irfan Hafeez
- Department of General Medicine, East Lancashire Hospitals NHS Trust, Blackburn, UK
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6
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Nosocomial rapidly growing mycobacterial infections following laparoscopic surgery: CT imaging findings. Eur Radiol 2015; 25:2797-804. [PMID: 25773938 DOI: 10.1007/s00330-015-3674-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 02/09/2015] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify the distribution and frequency of computed tomography (CT) findings in patients with nosocomial rapidly growing mycobacterial (RGM) infection after laparoscopic surgery. METHOD A descriptive retrospective study in patients with RGM infection after laparoscopic surgery who underwent CT imaging prior to initiation of therapy. The images were analyzed by two radiologists in consensus, who evaluated the skin/subcutaneous tissues, the abdominal wall, and intraperitoneal region separately. The patterns of involvement were tabulated as: densification, collections, nodules (≥1.0 cm), small nodules (<1.0 cm), pseudocavitated nodules, and small pseudocavitated nodules. RESULTS Twenty-six patients met the established criteria. The subcutaneous findings were: densification (88.5%), small nodules (61.5%), small pseudocavitated nodules (23.1 %), nodules (38.5%), pseudocavitated nodules (15.4%), and collections (26.9%). The findings in the abdominal wall were: densification (61.5%), pseudocavitated nodules (3.8%), and collections (15.4%). The intraperitoneal findings were: densification (46.1%), small nodules (42.3%), nodules (15.4%), and collections (11.5%). CONCLUSION Subcutaneous CT findings in descending order of frequency were: densification, small nodules, nodules, small pseudocavitated nodules, pseudocavitated nodules, and collections. The musculo-fascial plane CT findings were: densification, collections, and pseudocavitated nodules. The intraperitoneal CT findings were: densification, small nodules, nodules, and collections. KEY POINTS • Rapidly growing mycobacterial infection may occur following laparoscopy. • Post-laparoscopy mycobacterial infection CT findings are densification, collection, and nodules. • Rapidly growing mycobacterial infection following laparoscopy may involve the peritoneal cavity. • Post-laparoscopy rapidly growing mycobacterial intraperitoneal infection is not associated with ascites or lymphadenopathy.
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7
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Katz DS, Scheirey CD, Bordia R, Hines JJ, Javors BR, Scholz FJ. Computed Tomography of Miscellaneous Regional and Diffuse Small Bowel Disorders. Radiol Clin North Am 2013. [DOI: 10.1016/j.rcl.2012.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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8
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Hibiya K, Tateyama M, Niimi M, Teruya H, Karimata Y, Hirai J, Tokeshi Y, Haranaga S, Tasato D, Nakamura H, Ihama Y, Haroon A, Cash HL, Higa F, Hokama A, Ogawa K, Fujita J. Acquired immune-deficiency syndrome with focal onset of Mycobacterium avium infection displaying a histological/genetic pattern of disseminated mycobacteria. Intern Med 2012; 51:3089-94. [PMID: 23124157 DOI: 10.2169/internalmedicine.51.8232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 66-year-old man with human immunodeficiency virus (HIV) infection was admitted for treatment of Pneumocystis pneumonia. Upon admission, a tumor mass adjacent to the thoracic descending aorta was revealed on computed tomography. Histology revealed an exudative granuloma with histiocytes packed with numerous acid-fast bacilli. Mycobacterium avium was isolated from the tissue. A genetic examination of the isolates demonstrated this strain to be located in the cluster consisting of strains that cause systemic infection. The patient's baseline CD4+ cell count was 9/μL and the HIV-RNA viral load was 43,800 copies/mL. This case suggests the possibility of a localized onset of disseminated M. avium infection.
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Affiliation(s)
- Kenji Hibiya
- Department of Infections, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, and Department of Clinical Research, National Hospital Organization, Higashinagoya National Hospital, Japan.
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9
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Fisher M, Ong E, Pozniak A. 8 Mycobacterium avium complex and Mycobacterium kansasii. HIV Med 2011. [DOI: 10.1111/j.1468-1293.2011.00944_9.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Singla R, Hari S, Sharma SK. Diffuse small bowel thickening in AIDS patient--a case report. BMC Infect Dis 2010; 10:310. [PMID: 21029408 PMCID: PMC2988797 DOI: 10.1186/1471-2334-10-310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 10/28/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diarrhea is common in HIV/AIDS patients, caused by both classic enteric pathogens and different opportunistic agents. Infection with these different pathogens may lead to similar radiological findings, thus causing diagnostic confusion. CASE PRESENTATION A 30-yr-old female with AIDS presented with chronic diarrhea of 4 months duration. She had diffuse small bowel thickening present on CT scan of her abdomen, with stool examination showing no parasites. She was erroneously diagnosed as abdominal tuberculosis and given antituberculosis drugs with which she showed no improvement. Repeat stool examination later at a specialized laboratory revealed Cryptosporidium parvum infection.The patient was given an extended course of nitazoxanide treatment, as her stool examination was positive for Cryptosporidium parvum even after 2 weeks of drug consumption. Parasite clearance was documented after 10 weeks of treatment. Interestingly, the bowel thickening reversed with parasitological clearance. CONCLUSIONS Cryptosporidium parvum may lead to small bowel thickening in AIDS patients. This small bowel thickening may reverse following parasitological clearance.
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Affiliation(s)
- Rohit Singla
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Samriti Hari
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India, Study conducted at All India Institute of Medical Sciences, New Delhi-110029, India
| | - Surendra K Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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11
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Abstract
Ileitis, or inflammation of the ileum, is often caused by Crohn's disease. However, ileitis may be caused by a wide variety of other diseases. These include infectious diseases, spondyloarthropathies, vasculitides, ischemia, neoplasms, medication-induced, eosinophilic enteritis, and others. The clinical presentation of ileitis may vary from an acute and self-limited form of right lower quadrant pain and/or diarrhea, as in the majority of cases of bacterial ileitis, but some conditions (ie, vasculitis or Mycobacterium tuberculosis) follow a chronic and debilitating course complicated by obstructive symptoms, hemorrhage, and/or extraintestinal manifestations. Ileitis associated with spondylarthropathy or nonsteroidal anti-inflammatory drugs is typically subclinical and often escapes detection unless further testing is warranted by symptoms. In a minority of patients with long-standing Crohn's ileitis, the recrudescence of symptoms may represent a neoplasm involving the ileum. Distinguishing between the various forms of ileitis remains a test of clinical acumen. The diagnosis of the specific etiology is suggested by a detailed history and physical examination, laboratory testing, and ileocolonoscopy and/or radiologic data.
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Affiliation(s)
- Steven Dilauro
- Scripps Clinic Torrey Pines, Division of Gastroenterology, La Jolla, CA 92037, USA
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12
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Usefulness of F-18 FDG PET/CT in the assessment of disseminated Mycobacterium avium complex infection. Ann Nucl Med 2009; 23:757-62. [PMID: 19787313 DOI: 10.1007/s12149-009-0298-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 08/02/2009] [Indexed: 10/20/2022]
Abstract
A patient showing abnormal fluorine-18-fluorodeoxyglucose (FDG) uptake due to disseminated Mycobacterium avium complex (MAC) infection is presented. Increased focal FDG uptake was demonstrated in the cervical and supraclavicular lymph nodes, spleen, and diffuse bone marrow. FDG PET/CT is considered as a useful diagnostic tool to assess the exact extent and activity of disseminated MAC infection. Moreover, it is advantageous over CT and magnetic resonance imaging to assess the treatment response and time course of the disease.
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13
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The Imaging Features of Nontuberculous Mycobacterial Immune Reconstitution Syndrome. J Comput Assist Tomogr 2009; 33:242-6. [DOI: 10.1097/rct.0b013e31817ef448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
This article presents the differential diagnosis for small bowel ischemia. Clinical presentation of small bowel ischemia is variable, presenting with a myriad of specific or nonspecific clinical and laboratory findings. The imaging findings associated with small bowel ischemia are variable and combinations of findings may be necessary for definitive diagnosis. More specific imaging findings in patients with acute small intestine ischemia include bowel wall gas, mesenteric vessel occlusion, mesenteric venous gas, portal venous gas, or absence of bowel wall enhancement. Less specific imaging findings include small bowel wall thickening, mesenteric stranding, and mesenteric fluid. Further complicating the issue, several small intestinal disease processes may mimic ischemia both clinically and radiographically. These alternate diagnoses include infectious, inflammatory, and infiltrative processes.
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Immune-reconstitution Syndrome Related to Atypical Mycobacterial Infection in AIDS. J Thorac Imaging 2008; 23:182-7. [DOI: 10.1097/rti.0b013e3181653c25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mazzie JP, Wilson SR, Sadler MA, Khalili M, Javors BR, Weston SR, Katz DS. Imaging of Gastrointestinal Tract Infection. Semin Roentgenol 2007; 42:102-16. [PMID: 17394923 DOI: 10.1053/j.ro.2006.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joseph P Mazzie
- Department of Radiology, St. Vincent's Catholic Medical Center-Manhattan, New York, NY, USA
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Koh DM, Bell JR, Burkill GJ, Padley SP, Healy JC. Mycobacterial infections: still a millennium bug--the imaging features of mycobacterial infections. Clin Radiol 2001; 56:535-44. [PMID: 11446750 DOI: 10.1053/crad.2001.0755] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mycobacterial infection is re-emerging as a major health care concern. Although Mycobacterium tuberculosis(MTB) is still the most important pathogen, atypical mycobacterium (AMB) infections are becoming increasingly common. We present a pictorial review of the imaging features of these infections in the chest, abdomen, brain and musculoskeletal system. Imaging similarities and differences between the normal and the immunocompromised host will be highlighted.
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Affiliation(s)
- D M Koh
- Department of Radiology, Chelsea and Westminster Hospital, London, UK
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Nalaboff KM, Rozenshtein A, Kaplan MH. Imaging of Mycobacterium avium-intracellulare infection in AIDS patients on highly active antiretroviral therapy: reversal syndrome. AJR Am J Roentgenol 2000; 175:387-90. [PMID: 10915680 DOI: 10.2214/ajr.175.2.1750387] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We recently encountered six patients with AIDS and an unusual complication of disseminated infection with Mycobacterium avium-intracellulare, which developed after the initiation of highly active antiretroviral therapy, including protease inhibitors and two new nucleoside analogues. Each patient had a febrile illness after the initiation of therapy and then developed mass lesions containing mycobacterial organisms in various organ systems, including bone, skin, and mesenteric and mediastinal nodes. All these patients suddenly experienced improvement in immunologic status as evidenced by decreasing viral loads and increasing CD4 cell counts. We chose to call this reaction "M. avium-intracellulare reversal syndrome." We describe the radiologic appearance of this unusual manifestation of infection with M. avium-intracellulare in patients with AIDS. CONCLUSION New or enlarging lymphadenopathy or unusual musculoskeletal and cutaneous infections in patients with AIDS who are receiving highly active antiretroviral therapy may represent a response of the recovering immune system to a new or previously subclinical infection with M. avium-intracellulare.
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Affiliation(s)
- K M Nalaboff
- Department of Radiology, North Shore University Hospital, Manhasset, NY 11030, USA
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20
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 5-2000. A 35-year-old man with a painful abdominal mass and fever. N Engl J Med 2000; 342:493-500. [PMID: 10675431 DOI: 10.1056/nejm200002173420708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Pantongrag-Brown L, Krebs TL, Daly BD, Wong-You-Cheong JJ, Beiser C, Krause B, Brown AE. Frequency of abdominal CT findings in AIDS patients with M. avium complex bacteraemia. Clin Radiol 1998; 53:816-9. [PMID: 9833784 DOI: 10.1016/s0009-9260(98)80192-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Use of blood culture studies for early diagnosis of Mycobacterium avium complex (MAC) infection has become important due to the recent development of effective antibiotic therapy for this condition. This study assessed the abdominal computed tomography (CT) findings in patients with AIDS who presented with bacteraemic MAC infection. METHODS A retrospective analysis of abdominal CT scans was performed in 24 patients who presented with MAC-positive blood culture. CT images were reviewed specifically to evaluate for lymph node enlargement and attenuation, hepatomegaly, splenomegaly, bowel wall abnormality and for any other pathological changes. Comparison was made to prior reports of the CT findings in this disease process. RESULT Enlarged intra-abdominal mesenteric and/or retroperitoneal lymph nodes were found in 10 patients (42%). These nodes were characterized by homogeneous, soft-tissue attenuation in eight of the 10 patients. Hepatomegaly, splenomegaly and small bowel wall thickening were noted in 12 (50%), 11 (46%) and four (14%) patients, respectively. CT findings were evaluated as normal in six (25%) patients. CONCLUSIONS Enlarged mesenteric and/or retroperitoneal lymph nodes in AIDS patients with bacteraemic MAC were observed much less frequently on CT than previously reported in AIDS patient populations. Normal abdominal CT findings do not exclude this diagnosis and may reflect a trend towards earlier detection of MAC disease.
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Affiliation(s)
- L Pantongrag-Brown
- Department of Diagnostic Radiology, University of Maryland Medical System, Baltimore 21201-1595, USA
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Warshauer DM, Molina PL, Worawattanakul S. The spotted spleen: CT and clinical correlation in a tertiary care center. J Comput Assist Tomogr 1998; 22:694-702. [PMID: 9754100 DOI: 10.1097/00004728-199809000-00005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The goal of our study was to examine the prevalence of multiple hypodense splenic nodules and their associated diagnoses and to correlate CT appearance with clinical presentation and diagnosis. METHOD Records of all patients undergoing contrast-enhanced CT from July 1994 through September 1997 were reviewed. Charts and CT scans of patients with multiple (more than five) hypodense splenic nodules were then evaluated. RESULTS During the search period, there were 8,764 patients examined. Multiple hypodense splenic nodules were identified in 45 patients. Sixteen patients had malignant neoplasia as an etiology, with two patients having a benign tumor. Ten patients had an infectious etiology; nine patients had an inflammatory but noninfectious etiology; in eight patients, a diagnosis was not established; five of these patients were followed for > 18 months. CONCLUSION Multiple hypodense splenic nodules are uncommon. Lymphoma, infection, and sarcoid were the three most common disorders in the symptomatic patient, with infection strongly correlated with a compromised immune system. In the asymptomatic patient, nonlymphomatous metastatic disease, benign tumor, and sarcoid were most common. Although overlap exists between diagnostic groups, lymphoma tends to have larger, more variable nodules, whereas infection tends to occur with smaller, more uniform nodules. Sarcoid is intermediate in appearance.
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Affiliation(s)
- D M Warshauer
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill 27599-7510, USA
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Sansom H, Seddon B, Padley SP. Clinical utility of abdominal CT scanning in patients with HIV disease. Clin Radiol 1997; 52:698-703. [PMID: 9313736 DOI: 10.1016/s0009-9260(97)80035-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To evaluate the yield of abdominal computed tomography (CT) in patients with human immunodeficiency virus (HIV) infection and to assess the influence of CT scanning on patient management and diagnosis. METHOD A retrospective analysis of 216 abdominal CT scans, performed on 156 patients (147 men, nine women; age range 22-57 years), between March 1992 and October 1994 was undertaken. Clinical information, including the indication for performing the scan and the eventual diagnosis, was obtained from the case notes and the contribution of CT scanning to patient management assessed. RESULTS Indications for CT fell into five main groups: investigation of pyrexia of unknown origin (PUO) (n = 82), staging and response to treatment of previously diagnosed neoplasms (n = 46), investigation of abdominal pain (n = 20), CT undertaken to clarify the results of other imaging investigations (n = 20) and miscellaneous indications (n = 48). An eventual diagnosis thought to account for the clinical presentation was made in 150 cases (68%), reflecting the high level of underlying pathology. CT contributed to patient management in a large proportion of cases (62%), but only led directly to a diagnosis in a minority (12%). CONCLUSION With the exception of patients presenting with PUO, abdominal CT remains an important investigation in the management of patients with HIV infection. In patients presenting with PUO a thorough infection screen should be undertaken prior to CT scanning. Whilst frequently contributing to patient management, CT rarely leads directly to a diagnosis.
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Affiliation(s)
- H Sansom
- Department of Radiology, Chelsea and Westminster Hospital, London, UK
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25
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Monill-Serra JM, Martinez-Noguera A, Montserrat E, Maideu J, Sabaté JM. Abdominal ultrasound findings of disseminated tuberculosis in AIDS. JOURNAL OF CLINICAL ULTRASOUND : JCU 1997; 25:1-6. [PMID: 9010801 DOI: 10.1002/(sici)1097-0096(199701)25:1<1::aid-jcu1>3.0.co;2-m] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The sonographic findings of 76 patients with tuberculosis and HIV infection are described. These findings were compared with a control group of 76 HIV-positive patients without associated pathology. Those patients with tuberculosis and positive HIV titers commonly (p = 0.05) showed retroperitoneal and mesenteric adenopathies with node diameters greater than 1.5 cm (n = 27), and multiple, splenic, hypoechoic nodules between 0.5 cm and 1 cm (n = 11). Additional findings include hepatic hyperechoic nodules (n = 1) and retroperitoneal abscess (n = 1). The combination of ultrasound features can help in the diagnosis of abdominal tuberculosis in HIV-positive patients with non-specific clinical infections.
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26
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Stoane JM, Haller JO, Orentlicher RJ. THE GASTROINTESTINAL MANIFESTATIONS OF PEDIATRIC AIDS. Radiol Clin North Am 1996. [DOI: 10.1016/s0033-8389(22)00508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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27
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28
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Lasseur C, Maugein J, Pellegrin JL, Dupon M, Ragnaud JM, Morlat P, Pellegrin I, Constans J, Monlun E, Chene G. [Disseminated Mycobacterium avium complex infections in AIDS. Apropos of 100 cases. Groupe d'Epidémiologie clinique du SIDA en Aquitaine]. Rev Med Interne 1995; 16:110-20. [PMID: 7709100 DOI: 10.1016/0248-8663(96)80675-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The improvement of survival of AIDS patients allowed the emergence of disseminated Mycobacterium avium Complex infections (D.MAC). Here we report the experience of the group of "Epidémiologie clinique du sida en Aquitaine (GECSA)" about 100 patients. There were no differences according to sex, age and route of acquisition of HIV. Clinical and biological characteristics of the infections were not specific. The mean TCD4+ lymphocytes count was 18/mm3. The diagnostic was generally established by systematic blood culture on Septi-Chek in patients with TCD4+ lymphocytes count below 75/mm3. The recommendations on therapy for D.MAC are to use regimen containing azithromycin or clarithromycin, ethambutol and one of the following drugs, rifabutin, clofazimine, amikacin, or ciprofloxacin. Rifabutin is recommended for prophylaxis in patients with lymphocytes TCD4+ count below 100/mm3.
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Affiliation(s)
- C Lasseur
- Groupe d'Epidémiologie clinique du sida en Aquitaine, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
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29
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Affiliation(s)
- J O Haller
- Department of Radiology, State University of New York, Health Science Center at Brooklyn (Downstate Medical Center) 11203, USA
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30
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Affiliation(s)
- P J Feczko
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, MI 48073
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31
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Affiliation(s)
- J E Kuhlman
- Department of Radiology, Johns Hopkins Outpatient Center, Baltimore, MD 21287
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32
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Abstract
Mycobacterium avium complex (MAC) disease emerged early in the epidemic of AIDS as one of the common opportunistic infections afflicting human immunodeficiency virus-infected patients. However, only over the past few years has a consensus developed about its significance to the morbidity and mortality of AIDS. M. avium was well known to mycobacteriologists decades before AIDS, and the MAC was known to cause disease, albeit uncommon, in humans and animals. The early interest in the MAC provided a basis for an explosion of studies over the past 10 years largely in response to the role of the MAC in AIDS opportunistic infection. Molecular techniques have been applied to the epidemiology of MAC disease as well as to a better understanding of the genetics of antimicrobial resistance. The interaction of the MAC with the immune system is complex, and putative MAC virulence factors appear to have a direct effect on the components of cellular immunity, including the regulation of cytokine expression and function. There now is compelling evidence that disseminated MAC disease in humans contributes to both a decrease in the quality of life and survival. Disseminated disease most commonly develops late in the course of AIDS as the CD4 cells are depleted below a critical threshold, but new therapies for prophylaxis and treatment offer considerable promise. These new therapeutic modalities are likely to be useful in the treatment of other forms of MAC disease in patients without AIDS. The laboratory diagnosis of MAC disease has focused on the detection of mycobacteria in the blood and tissues, and although the existing methods are largely adequate, there is need for improvement. Indeed, the successful treatment of MAC disease clearly will require an early and rapid detection of the MAC in clinical specimens long before the establishment of the characteristic overwhelming infection of bone marrow, liver, spleen, and other tissue. Also, a standard method of susceptibility testing is of increasing interest and importance as new effective antimicrobial agents are identified and evaluated. Antimicrobial resistance has already emerged as an important problem, and methods for circumventing resistance that use combination therapies are now being studied.
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Affiliation(s)
- C B Inderlied
- Department of Pathology and Laboratory Medicine, Childrens Hospital, Los Angeles, California 90027
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33
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Ang GA, Janda WM, Novak RM, Gerardo L. Negative images of mycobacteria in aspiration biopsy smears from the lymph node of a patient with acquired immunodeficiency syndrome (AIDS): report of a case and a review of the literature. Diagn Cytopathol 1993; 9:325-8. [PMID: 7686095 DOI: 10.1002/dc.2840090317] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Negative images of acid-fast bacilli were observed in Diff-Quik-stained smears of lymph node aspirates from a patient with acquired immunodeficiency syndrome (AIDS) and disseminated Mycobacterium avium-intracellulare infection. The significance of this finding in relation to the diagnosis and treatment of this infection is discussed and the literature pertaining to this observation is reviewed.
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Affiliation(s)
- G A Ang
- Department of Pathology, College of Medicine, University of Illinois, Chicago 60612
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34
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Wetton CW, McCarty M, Tomlinson D, Rosbotham J, Crofton ME. Ultrasound findings in hepatic mycobacterial infections in patients with acquired immune deficiency syndrome (AIDS). Clin Radiol 1993; 47:36-8. [PMID: 8428415 DOI: 10.1016/s0009-9260(05)81211-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Ultrasound findings in 12 AIDS patients with abdominal mycobacterial infections were reviewed and correlated with liver histology. Liver ultrasound abnormalities were common--present in 4/5 patients with Mycobacterium avium-intracellulare (MAI) and 7/7 patients with Mycobacterium tuberculosis (MTB) infection. The commonest ultrasound abnormality of the liver was a generally 'bright' liver, seen in 7/12 patients. Focal liver lesions were seen in 5/7 patients with MTB but were not seen in any patients with MAI infection. Both hyperechoic (two patients) and hypoechoic (three patients) lesions were seen. Lymphadenopathy as demonstrated on abdominal ultrasound was a relatively infrequent finding--only seen in three patients with MTB, all of whom also had focal liver lesions. On histology, 8/12 patients showed fatty infiltration and 8/12 showed granuloma. Abnormalities are commonly seen on ultrasound examination of the liver in AIDS patients with abdominal mycobacterial infections but are non-specific and ultrasound guided biopsy is indicated to confirm the diagnosis and exclude other disease.
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Affiliation(s)
- C W Wetton
- Department of Radiology, St Mary's Hospital, London
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35
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Pombo F, Rodríguez E, Mato J, Pérez-Fontán J, Rivera E, Valvuena L. Patterns of contrast enhancement of tuberculous lymph nodes demonstrated by computed tomography. Clin Radiol 1992; 46:13-7. [PMID: 1643775 DOI: 10.1016/s0009-9260(05)80026-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to evaluate the contrast-enhanced CT characteristics of pathologic thoraco-abdominal lymph nodes in 38 patients infected with Mycobacterium tuberculosis (30 without AIDS and eight with AIDS). Unenhanced scans of chest, abdomen and pelvis were also done in all cases. The CT attenuation values and the enhancement characteristics of the largest node or group of lymph nodes were evaluated in a dynamic sequence over a period of 10 min. On unenhanced CT the nodes were of low attenuation (less than 30 HU) in 18 cases and of soft tissue attenuation (greater than 35 HU) in 20 cases. Four post-contrast patterns of enhancement were found: (i) peripheral rim enhancement (n = 22); (ii) inhomogeneous enhancement (n = 8); (iii) homogeneous enhancement (n = 6); and (iv) homogeneous nonenhancing nodes (n = 2). Increase of attenuation and obliteration of perinodal fat was found in 13 cases, most of them with the peripheral rim enhancement pattern. Seven cases had a combination of enhancing patterns in the same nodal group. The central enhancement was usually moderate (mean, 30 HU) but was marked (greater than 60 HU) in three patients with the homogeneous enhancement pattern. Neither the nodal attenuation values nor the patterns of enhancement are characteristic of tuberculosis, however adenopathy showing peripheral rim-enhancement with relative low attenuation centres can suggest a diagnosis of tuberculosis in the appropriate clinical setting.
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Affiliation(s)
- F Pombo
- Department of Radiology, Hospital Juan Canalejo, La Coruña, Spain
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36
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Jeffrey RB. ABDOMINAL IMAGING IN THE IMMUNOCOMPROMISED PATIENT. Radiol Clin North Am 1992. [DOI: 10.1016/s0033-8389(22)02510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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Dodd GD, Greenler DP, Confer SR. THORACIC AND ABDOMINAL MANIFESTATIONS OF LYMPHOMA OCCURRING IN THE IMMUNOCOMPROMISED PATIENT. Radiol Clin North Am 1992. [DOI: 10.1016/s0033-8389(22)02511-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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38
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Abstract
The Acquired Immunodeficiency Syndrome (AIDS) has involved the pediatric age group and is especially prevalent in babies born of mothers who are intravenous drug abusers or prostitutes. Approximately 30% of children born to mothers who are seropositive for the human immunodeficiency virus (HIV) will develop HIV infection. There are several important differences in children and adults with AIDS. The incubation period of the disease is shorter, and initial clinical manifestations occur earlier in children. In addition, certain infections are more common in children, and the different types of malignancy, especially Kaposi's sarcoma, are unusual in the pediatric age group. The altered immune system involves both T cells and humoral immunity and increases susceptibility to a variety of infections, particularly opportunistic organisms. In this publication the complications of pediatric AIDS involving the lungs, cardiovascular system, gastrointestinal tract, genitourinary system, and neurological system are described. The most common pulmonary complications in our experience are Pneumocystis carinii pneumonia and pulmonary lymphoid hyperplasia. The spectrum of cardiovascular involvement in pediatric AIDS includes myocarditis, pericarditis, and infectious endocarditis. Gastrointestinal tract involvement is usually due to opportunistic organisms that produce esophagitis, gastritis, and colitis. Abdominal lymphadenopathy is a common finding either due to disseminating Mycobacterium avium-intracellulare infection or nonspecific lymphadenopathy. Although cholangitis is more commonly seen in adults, it may occur in children with AIDS and, in most cases, is due to related opportunistic infections. Genitourinary infections may be the first evidence of HIV disease. Cystitis, pyelonephritis, renal abscesses, and nephropathy with renal insufficiency are complications of pediatric AIDS. A variety of neurological abnormalities may occur in pediatric AIDS. The most common cause of neurological dysfunction in children with AIDS is HIV neuropathy. We present the many complications of AIDS in children demonstrated by a variety of imaging modalities, emphasizing the importance of diagnostic imaging in children with this disease.
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Affiliation(s)
- D Grattan-Smith
- Department of Radiology, Royal Children's Hospital, Melbourne, Australia
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39
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EVALUATION AND TREATMENT OF LATER MANIFESTATIONS OF HIV INFECTION. Prim Care 1992. [DOI: 10.1016/s0095-4543(21)00121-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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40
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Pitchenik AE, Fertel D. Medical management of AIDS patients. Tuberculosis and nontuberculous mycobacterial disease. Med Clin North Am 1992; 76:121-71. [PMID: 1727535 DOI: 10.1016/s0025-7125(16)30375-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIDS has been responsible for a significant increase in mycobacterial disease, which in this setting is often extrapulmonary. In contrast to HIV-associated Mycobacterium avium complex disease, HIV-associated tuberculosis is normally transmissible between humans by the aerosol route, occurs earlier than most AIDS-related infections, and is readily treatable and preventable with conventional drugs.
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Affiliation(s)
- A E Pitchenik
- Department of Medicine, University of Miami, Florida
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41
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42
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43
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Sathe SS, Reichman LB. Mycobacterial Disease in Patients Infected with the Human Immunodeficiency Virus. Clin Chest Med 1989. [DOI: 10.1016/s0272-5231(21)00646-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Jones B, Fishman EK. CT of the Gut in the Immunocompromised Host. Radiol Clin North Am 1989. [DOI: 10.1016/s0033-8389(22)02160-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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45
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Pitchenik AE, Fertel D, Bloch AB. Mycobacterial Disease: Epidemiology, Diagnosis, Treatment, and Prevention. Clin Chest Med 1988. [DOI: 10.1016/s0272-5231(21)00520-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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46
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Glatt AE, Chirgwin K, Landesman SH. Current concepts. Treatment of infections associated with human immunodeficiency virus. N Engl J Med 1988; 318:1439-48. [PMID: 3285211 DOI: 10.1056/nejm198806023182206] [Citation(s) in RCA: 156] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- A E Glatt
- Department of Medicine, State University of New York Health Science Center, Brooklyn
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47
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Abstract
The acquired immunodeficiency syndrome (AIDS) is an increasingly important disease that has become a social phenomenon. Although our therapeutic options for treating AIDS patients are limited at present, radiologic investigation is often of crucial importance in determining the extent and stage of opportunistic infections and neoplasms. This manuscript deals in depth with the manifestations of AIDS in the chest, abdomen, and central nervous system. It emphasizes the importance of cross-sectional imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound as well as guided fine needle aspiration biopsy. The first chapter is a brief overview of the general management of AIDS patients in the radiology department. It seeks to emphasize a careful caring approach to patients with this disease. It also emphasizes the importance of educating all radiology personnel to an awareness of how precautions can be taken to avoid the spread of AIDS while dealing with patients in a professional, courteous manner.
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48
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Gastrointestinal radiology of AIDS. Curr Probl Diagn Radiol 1988. [DOI: 10.1016/0363-0188(88)90011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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49
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Affiliation(s)
- S H Lee
- Department of Radiology, Middlesex Hospital, London
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50
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Affiliation(s)
- N Kawamura
- Department of Radiology, Kyushu Chuo Hospital, Fukuoka, Japan
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