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Paytubí C, Negredo E, Ferrer S, Monmany J, Barrio JL. [Varicella pneumonia in the adult. Study of 9 cases]. An Med Interna 2001; 18:312-6. [PMID: 11503578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND In the adult, the primary infection by the varicella-zoster virus acquires an unusual severity due to several complications, the most frequent of them being pneumonia. We study the main characteristics of nine patients diagnosed of pneumonia varicellosa. METHODS Clinical, therapeutic and evolutive features of 9 adult patients, both immunocompetents and immunodepressed, diagnosed of pneumonia varicellosa are retrospectively reviewed, in the last ten years, at Hospital de Sant Pau, Barcelona. Diagnosis of varicella was established on the basis of the typical rash in the context of a feverish illness. The antecedents of smoking habit, pregnancy and underlying disease, evaluating especially arterial blood and platelet count at entrance, are assessed. RESULTS Nine patients (4 males and 5 women; mean age 38 years) were included in the study. Seventy-eight percent of patients were smokers of more than 20 cigarettes a day; one met criteria of simple chronic bronchitis, another suffered ankylosing spondylitis and three were known carriers of human immunodeficiency virus. None of the female patients was pregnant. Respiratory symptoms began from the third and fifth day after the skin rash, and the most common symptoms were cough (89%), dyspnea (67%) and hemoptysis (22%). Arterial blood gas determination showed hypoxemia in four patients (45%). Chest X-ray revealed an interstitial pattern predominantly at both bases, with a case of right pleural effusion. Intravenous acyclovir was started in 6 patients, foscarnet in one and symptomatic therapy in two patients. All patients had a favourable clinical course, none of them requiring entrance to the Intensive Care Unit. CONCLUSIONS Adult patients with varicella pneumonia that suffer respiratory insufficiency, thrombocytopenia or are carriers of base illnesses must be early treated with intravenous acyclovir. However, despite clinical, biological and radiological recovery is earlier with such treatment, the evolution seems equally favourable if it is only conducted, for instance, symptomatic therapy with antithermic and antihistaminic compounds.
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Affiliation(s)
- C Paytubí
- Servicios de Medicina Interna y Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, Barcelona
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Ricart E, Soriano G, Novella MT, Ortiz J, Sàbat M, Kolle L, Sola-Vera J, Miñana J, Dedéu JM, Gómez C, Barrio JL, Guarner C. Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients. J Hepatol 2000; 32:596-602. [PMID: 10782908 DOI: 10.1016/s0168-8278(00)80221-4] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM Cefotaxime is considered the first-choice antibiotic for empirical treatment in cirrhotic patients developing bacterial infections. It has been suggested that amoxicillin-clavulanic acid could be an alternative to cefotaxime, particularly in patients developing bacterial infections while on prophylactic norfloxacin. The aim of the present study was to compare amoxicillin-clavulanic acid with cefotaxime in the treatment of bacterial infections in cirrhosis. METHODS Ninety-six hospitalized cirrhotic patients with suspicion of bacterial infection were prospectively included and randomized into two groups: one group (n=48) received amoxicillin-clavulanic acid, first intravenously 1 g-0.2 g every 8 h, and then orally 500 mg-125 mg every 8 h, and the other group (n=48) received intravenous cefotaxime 1 g every 6 h. Patients were stratified for previous prophylaxis with norfloxacin and ascitic fluid infection. RESULTS Sixteen patients were excluded from the analysis because bacterial infection was not demonstrated or because of secondary peritonitis. Therefore, 38 patients from the amoxicillin-clavulanic acid group and 42 from the cefotaxime group were finally analyzed. There were 24 ascitic fluid infections in each group. Infection resolution (86.8% vs 88%, 95% CI: -0.15 to 0.13, p NS), spontaneous bacterial peritonitis resolution (87.5% vs 83.3%, 95% CI: -0.15 to 0.24, p NS), duration of treatment, incidence of complications, time of hospitalization and hospital mortality were similar in both groups. Considering patients on prophylactic norfloxacin, infection resolution was also similar (100% vs 83.3%, 95% CI: -0.04 to 0.37, p NS). No adverse events were observed in either of the two groups. The cost of antibiotics was statistically lower in the amoxicillin-clavulanic acid group (p<0.001). CONCLUSIONS Amoxicillin-clavulanic acid is as effective as cefotaxime in the treatment of bacterial infections in cirrhotic patients, but is less expensive and can be administered orally. These results suggest that amoxicillin-clavulanic acid is an effective alternative to cefotaxime for the empirical treatment of bacterial infections in cirrhosis.
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Affiliation(s)
- E Ricart
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
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Baraldès MA, Domingo P, Barrio JL, Pericas R, Gurguí M, Vazquez G. Meningitis due to Neisseria subflava: case report and review. Clin Infect Dis 2000; 30:615-7. [PMID: 10722463 DOI: 10.1086/313700] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- M A Baraldès
- Department of Internal Medicine (Infectious Disease Unit), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Pascual-Sedano B, Iranzo A, Marti-Fàbregas J, Domingo P, Escartin A, Fuster M, Barrio JL, Sambeat MA. Prospective study of new-onset seizures in patients with human immunodeficiency virus infection: etiologic and clinical aspects. Arch Neurol 1999; 56:609-12. [PMID: 10328257 DOI: 10.1001/archneur.56.5.609] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the frequency and etiologic and clinical aspects of new-onset seizures in patients with human immunodeficiency virus (HIV) infection. DESIGN A prospective survey of an HIV-infected patient cohort. SETTING Outpatients and inpatients in a university hospital in Barcelona, Spain. PATIENTS Five hundred fifty HIV-infected patients recruited over 1 year. MAIN OUTCOME MEASURE Analysis of new-onset seizures, with detailed medical history and appropriate workup. RESULTS Seventeen HIV-infected patients (3%) had a new-onset seizure during the study period. Fourteen (82%) of 17 patients had acquired immunodeficiency syndrome diagnosed according to the 1993 CDC Expanded AIDS Definition. Mean latency (+/-SD) between diagnosis of HIV infection and the first seizure was 60.7+/-37.6 months. Seizure cause was drug toxicity in 8 patients (47%) and intracranial lesion in 6 patients (35.3%). Two patients had seizures related to metabolic derangements. No cause was found in 1 case. The first seizure was generalized in 12 patients (70.6%), simple partial motor seizure in 2 (11.8%), and simple partial seizure evolving to generalized seizure in 3 (17.6%). We found partial seizures in 66.6% of patients who had intracranial lesions. Most patients were treated with phenytoin, which was well tolerated and effective in controlling seizures. CONCLUSIONS New-onset seizures are infrequent in patients with HIV. In most cases a definite or probable cause is identified, which is usually related to toxic and/or metabolic factors. Most seizures are generalized, and partial seizures suggest a focal cerebral lesion.
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Gil A, González A, Dal-Ré R, Dominguez V, Ortega P, Barrio JL, Aguilar L. Prevalence of hepatitis A in an institution for the mentally retarded in an intermediate endemicity area: influence of age length of institutionalization. J Infect 1999; 38:120-3. [PMID: 10342653 DOI: 10.1016/s0163-4453(99)90080-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to examine the prevalence of antibodies against hepatitis A (anti-HAV) in a population of institutionalized mentally retarded persons compared with that of institutionalized non-mentally retarded persons in an area with moderate endemicity of HAV infection. METHODS The study population was a group of mentally retarded persons aged between 10 and 30 years, institutionalized in one residence in Madrid, Spain. A group of non-mentally retarded subjects in the same age range was chosen as controls. Information about demography and duration of institutionalization was obtained by the investigator. Four drops of whole blood were obtained from each person by finger-stick, collected on filter paper, air-dried and stored at +4 degrees C until antibody determination. Eluates were tested by an ELISA method. RESULTS A total of 314 institutionalized subjects were included: 157 mentally retarded (mean age and mean duration of institutionalization were 24.4+/-3 and 9.7+/-5 years respectively) and 157 non-mentally retarded (mean age and mean duration of institutionalization were 19.2+/-5 and 4.6+/-3 years respectively). The prevalence of anti-HAV antibody was 54% (95% confidence interval (CI) 50-58) in mentally retarded and 22% (95% CI 19-25) in non-mentally retarded [P<0.001; odds ratio (OR): 4.2 (95% CI 2.5-7)]. In both groups, these differences were not statistically significant for anti-HAV antibody prevalence between persons institutionalized for >5 years compared with those institutionalized for < or = 5 years. CONCLUSIONS There results indicate that in an area of moderate endemicity the institutionalized mentally retarded are at increased risk of having acquired hepatitis A infection compared to the non-mentally retarded. In these institutionalized persons, regardless whether they are mentally retarded or not, prevalence is not influenced by age or length of stay in institutions.
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Affiliation(s)
- A Gil
- Preventive Medicine and Public Health Department, School of Medicine, Complutense University, Madrid, Spain
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Madrid F, Romero C, Barrio JL. [HIV infection at an advanced or terminal stage]. An Med Interna 1997; 14:595-6; author reply 596-7. [PMID: 9445593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Cortés P, Cardeñosa N, Romaní J, Gállego M, Muñoz C, Barrio JL, Riera C, Portús M. Oral leishmaniasis in an HIV-positive patient caused by two different zymodemes of Leishmania infantum. Trans R Soc Trop Med Hyg 1997; 91:438-9. [PMID: 9373646 DOI: 10.1016/s0035-9203(97)90273-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- P Cortés
- Servicio de Microbiología, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain
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Abstract
A second case of rosacea-like demodicosis in an HIV-positive child was seen at our center. No such cases have previously been published. The present case is a 2-year-old boy, the son of an HIV-positive mother, who responded well to oral erythromycin and topical metronidazole. The frequency of rosacea-like eruptions in HIV-negative children is very low. However, the incidence of these eruptions in HIV-positive children may have been underestimated. The pathogenic role of Demodex mites is discussed as well as the possible mechanisms for an exaggerated reaction.
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Affiliation(s)
- J Barrio
- Dermatology, Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Ferrer S, Fuentes I, Domingo P, Muñoz C, Iranzo A, Barrio JL, Fuster M, Ris J, Sambeat MA, Cadafalch J, Nolla J. [Cerebral toxoplasmosis in patients with human immunodeficiency virus (HIV) infection. Clinico-radiological and therapeutic aspects in 63 patients]. An Med Interna 1996; 13:4-8. [PMID: 8679824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We have retrospectively reviewed 63 cases of encephalic toxoplasmosis (ET) in HIV-infected patients in order to determine clinical and radiological characteristics, the diagnostic value of serologic determinations, and the response to antioxoplasmic therapy. ET was the AIDS-defining condition in 44% of the patients. Eighty of the patients had a CD4 cell count < 100/microliters when ET was diagnosed. Only 4.8% of the patients had been taking anti-Pneumocytis carinii prophylaxis with cotrimoxazol. The most frequent clinical presentation was focal neurologic signs in 80.9% of the patients, with headache and fever in 53.3% and 42.4%, respectively. The most frequent cerebral CT finding was hipodense lesions (92%) with ring enhancement (68.9%). They were most frequently had a hemisferic location. Seroconversion was detected in two patients (6%), whereas 55 patients had serologic evidence of latent infection by Toxoplasma gondii (87.3%). Ninety eight percent of the patients were treated with sulphadiazine plus pyrimethamine. However, such therapy should be discontinued in 22% of them and switched to clindamycin plus pyrimethamine. The overall mortality rate during the acute phase of the disease was 7.9%, but 41.4% of the survivors exhibited neurologic sequelae. Relapsing ET was detected in 33.3% of the patients, and it was usually due to discontinuation of treatment. The mean survival time after the diagnosis of ET was 11.5 months. ET is the most common opportunistic infection of the central nervous system among our AIDS patients. Primary prophylaxis for toxoplasmic infection seems advisable in our epidemiologic environment, when CD4 cell count is less than 200/microliters and there is serologic evidence of latent infection. Acute ET usually has a good response to therapy, and the acute mortality rate is low. However, most of the survivors will remain with neurologic sequelae. The high frequency of adverse effects to sulphamide therapy with clindamycin make the need of alternative treatment strategies urgent.
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Affiliation(s)
- S Ferrer
- Servicio de Medicina Interna, Universidad Autónoma, Barcelona
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Ferrer S, Baselga E, Domingo P, Puig M, Ris J, Barrio JL, Nolla J. [Eosinophilic pustular folliculitis in acquired immunodeficiency syndrome. Report of 6 cases]. Rev Clin Esp 1995; 195:92-6. [PMID: 7732194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Eosinophilic pustulous foliculitis (EPF) is a rare dermatosis which has been reported in association with the human immunodeficiency virus infection. Six patients infected with HIV are reported with advanced disease in whom the diagnosis of EPF was made. All patients has a highly pruritic follicular papular rash. In all cases the pathology study revealed a mixed inflammatory infiltrate with predominance of eosinophils at the infundibulum of the pilous folliculi. Two patients had eosinophilia in peripheral blood. Therapy with antihistaminic agents and topical corticosteroids was ineffective in all cases. A favourable therapeutic response was achieved with phototherapy associated with the topic application of disodium cromoglycate 4%.
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Affiliation(s)
- S Ferrer
- Servicios de Medicina Interna y Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona
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Pi-Suñer T, Barrio JL. [Intrahospital epidemic outbreaks. Their study and control]. Rev Enferm 1992; 15:14-6. [PMID: 1411109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Pi-Suñer MT, Barrio JL. [Surveillance and control studies of nosocomial infection (II)]. Rev Enferm 1992; 15:12-4. [PMID: 1641557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Pi-Suñer MT, Barrio JL. [Surveillance and control studies of nosocomial infection (I)]. Rev Enferm 1992; 15:13-6. [PMID: 1641548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Barrio JL, Pi-Suñer T. [The means for preventing nosocomial infection (II)]. Rev Enferm 1992; 15:14-8. [PMID: 1609201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Barrio JL, Pi-Suñer T. [The means for preventing nosocomial infection (I)]. Rev Enferm 1992; 15:14-7. [PMID: 1585116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Moas C, Barrio JL, Inchausti BC, Krieger BP. Bronchoalveolar lavage in a patient with malignant histiocytosis and the adult respiratory distress syndrome. Mt Sinai J Med 1988; 55:414-6. [PMID: 3265186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
The affinity of treponemes for bone tissue is well known, but the incidence of bone infection in the early stages of syphilis is uncertain. Although case reports of early bone invasion are few, reviews of large numbers of patients with early syphilis indicate that the incidence is probably greater than at present believed. Two case reports are presented.
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Affiliation(s)
- J E Ollé-Goig
- Department of Medicine, Beth Israel Medical Center, New York
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Barrio JL, Harcup C, Baier HJ, Pitchenik AE. Value of repeat fiberoptic bronchoscopies and significance of nondiagnostic bronchoscopic results in patients with the acquired immunodeficiency syndrome. Am Rev Respir Dis 1987; 135:422-5. [PMID: 3813206 DOI: 10.1164/arrd.1987.135.2.422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Out of 286 patients with the acquired immunodeficiency syndrome (AIDS) who had fiberoptic bronchoscopies performed for the diagnosis of pulmonary disease, 21 (7.3%) patients (Group I) had repeat procedures after 1 to 30 days (mean, 14.8 days) because of persistent pulmonary infiltrates despite therapy, and 46 (15.9%) patients (Group II) had repeat procedures after 2 to 32 months (mean, 7.5 months) because of recurrent pulmonary infiltrates after initial clinical and radiographic improvement. Pneumocystis carinii pneumonia was the most common diagnosis in both groups on initial evaluation, being found in 55% of the patients. Repeat bronchoscopy yielded a new treatable diagnosis in 1 (5%) of 21 patients in Group I and in 27 (59%) of 46 patients in group II. Sixty-two percent of patients in Group I died within 1 month. It appears that in patients with AIDS who have persistent or worsening pulmonary infiltrates despite therapy, repeat bronchoscopy after a short interval (i.e., less than 1 month) is unlikely to have therapeutic implications. In contrast, those patients whose pulmonary involvement resolves initially may benefit from an aggressive diagnostic approach if new pulmonary infiltrates appear. In both groups, nondiagnostic bronchoscopies were common (29% overall). The most commonly missed bronchoscopic diagnoses (proved by open lung biopsy) were cytomegalovirus pneumonia and Kaposi's sarcoma, and neither had much therapeutic implication. Further, 12 patients in Group II with nondiagnostic bronchoscopies improved both radiographically and clinically even though no treatment was given.
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Barrio JL, Feinerman D, Hesla PE, Kovacs A. Diaphragmatic flutter in a patient with lymphoma. Mt Sinai J Med 1987; 54:188-90. [PMID: 3494938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Rodriguez JL, Barrio JL, Pitchenik AE. Pulmonary nocardiosis in the acquired immunodeficiency syndrome. Diagnosis with bronchoalveolar lavage and treatment with non-sulphur containing drugs. Chest 1986; 90:912-4. [PMID: 3536345 DOI: 10.1378/chest.90.6.912] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A patient with the acquired immunodeficiency syndrome (AIDS) presented with Pneumocystis carinii pneumonia and pulmonary nocardiosis. The nocardial lesions appeared small and localized on chest radiograph. On two separate occasions, nocardial organisms were absent in transbronchial lung biopsy specimens, but were identified in bronchoalveolar lavage fluid probably because the latter specimen sampled a larger area of lung. The patient was initially treated with trimethoprim-sulfamethoxazole (TMP/SMX) for both infections. When TMP/SMX was discontinued because of an adverse reaction, the nocardiosis promptly exacerbated but was then easily controlled with minocycline and amikacin followed by minocycline and cycloserine. Among patients with AIDS who have sulfamethoxazole hypersensitivity during treatment for nocardiosis, alternative drugs may be efficacious and may be particularly important in this setting because they have a lower incidence of toxicity.
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Barrio JL, Suarez M, Rodriguez JL, Saldana MJ, Pitchenik AE. Pneumocystis carinii pneumonia presenting as cavitating and noncavitating solitary pulmonary nodules in patients with the acquired immunodeficiency syndrome. Am Rev Respir Dis 1986; 134:1094-6. [PMID: 3490810 DOI: 10.1164/arrd.1986.134.5.1094] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Among 150 cases of microscopically proved Pneumocystis carinii pneumonia secondary to the acquired immunodeficiency syndrome (AIDS) seen by our pulmonary service from January 1982 to January 1986, P. carinii presented roentgenographically as a solitary pulmonary nodule in 2 patients (1.3%). It was the sole cause of the nodules as determined by clinical and roentgenographic response to specific drug therapy, examination of specimens obtained at fiberoptic bronchoscopy, and examination of lung specimens obtained at autopsy. In one of the patients, the nodule appeared to develop a large central cavity, which was confirmed at autopsy. In patients with AIDS, a solitary pulmonary nodule with or without cavitation may rarely represent P. carinii pneumonia.
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