minocycline and AIDS-Related-Opportunistic-Infections

Nocardia usually infects immunosuppressed patients, particularly with cellular immunity deficiency. Nevertheless, despite severe immunosuppression in patients infected with HIV, nocardiosis is rare among these patients. We report here two cases of nocardiosis in patients with HIV infection and review spanish literature up to 1993, with an analysis of the characteristics of this infection in our country.. The two patients consumed drugs parenterally and Nocardia organism were recovered in blood cultures after 48 hours of inoculation in standard culture media. The source of the infection was cutaneous in one patient, over an area of venipuncture, and pulmonary in the other patient. Previously, eleven cases of nocardiosis had been reported in the spanish literature in patients infected with HIV. Eighty-four percent were males, and all of them consumed drugs parenterally and displayed a severe cellular immunodepression; the total CD4 lymphocyte count was lower than 100/mm3 in patients when this finding was available (6/13). At diagnosis only one patient received prophylaxis against other type of infection with antibiotics theoretically effective against Nocardia at diagnosis. The Nocardia species recovered more frequently was asteroides (77%) and the most common location was the skin (54%). Treatments more frequently employed were sulfametoxazole-trimethoprim (45%) and sulfadiazine (36%), with a good response except in those with cerebral involvement.. Nocardiosis in patients with HIV infection is rare in Spain. In contrast with other geographical areas skin involvement was the more common form of infection. Prophylaxis with sulfametoxazole-trimethoprim against other infections could be responsible for a lower than expected incidence among this type of patients.

Topics: Adult; AIDS-Related Opportunistic Infections; Fatal Outcome; HIV-1; Humans; Male; Microbial Sensitivity Tests; Minocycline; Nocardia asteroides; Nocardia Infections; Spain; Substance Abuse, Intravenous; Sulfadiazine

No treatment was established for disseminated M. avium intracellulare (MAC) infection, a common disease of end stage of AIDS. An open study was conducted to assess in 173 AIDS patients, the activity of clarithromycin. Initial bacteriologic eradication from blood was observed in 136/147 evaluable patients (93%). Acquired resistance to clarithromycin associated with relapse appeared to develop after 2 to 7 months of drug treatment in 31/136 patients with initial success. Early bacteriological relapse was associated with clinical deterioration. Side effects of drug treatment were elevated liver enzymes (26%) and impaired hearing (4%). Side effects conducted to stop treatment in 14 cases (8%) to modified treatment in 8 cases (5%). Our study gave new argues for activity of clarithromycin in disseminated MAC infection.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Antitubercular Agents; Child; Clarithromycin; Clofazimine; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Fluoroquinolones; Hearing Disorders; Humans; Liver Function Tests; Male; Middle Aged; Minocycline; Mycobacterium avium-intracellulare Infection; Recurrence; Treatment Outcome

Acinetobacter baumannii is a Gram-negative coccobacillus causing serious nosocomial infections. The recent emergence of strains of bacteria, which are resistant to common antibiotics, has made the treatment of these infections increasingly complex. We report the case of a young patient affected by AIDS, who suffered brain toxoplasmosis and sepsis due to multidrug-resistant A baumannii. This bacterial infection was successfully treated with colistin and tigecycline. In addition, we review recent literature on this topic, from the year 2000 to date.

Topics: Acinetobacter baumannii; Acinetobacter Infections; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-HIV Agents; Child; Colistin; Diagnosis, Differential; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Electroencephalography; Enzyme-Linked Immunosorbent Assay; Humans; Magnetic Resonance Imaging; Male; Minocycline; Tigecycline; Tomography, X-Ray Computed

This case report describes Nocardia pericarditis in a newly diagnosed human immunodeficiency virus (HIV) patient as an initial manifestation. Previously, two cases of Nocardia pericarditis were reported in patients with established HIV infection. To our knowledge this is the first case of Nocardia pericarditis as an initial manifestation of HIV infection. This case substantiates and emphasizes the importance of identifying Nocardia as an infectious cause of pericarditis in patients with acquired immunodeficiency. Long-term survival may be achieved with a combined medical and surgical approach.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Chest Pain; Combined Modality Therapy; Cough; Drug Therapy, Combination; Dyspnea; Humans; Male; Minocycline; Nocardia asteroides; Nocardia Infections; Pericardial Effusion; Pericardial Window Techniques; Pericarditis

The presence of Ureaplasma urealyticum was evaluated on 1912 vaginal and urethral swabs from HIV-1 seronegative (HIV-) inpatients (210) and outpatients (503) suffering from acute urethritis or vaginitis; asymptomatic HIV- outpatients (201); and asymptomatic HIV-1 seropositive (HIV+) inpatients (120). The study reported an increased frequency of Ureaplasma urealyticum isolates in asymptomatic HIV+ compared to asymptomatic HIV- subjects. As expected, the frequency of Ureaplasma urealyticum isolates increased in symptomatic HIV- subjects. Strains of Ureaplasma urealyticum resistant to ciprofloxacin, tetracycline and minocycline were more frequently isolated in HIV+ (34.1%) than HIV- (3.8%) subjects; on the other hand, only 1 out of 704 (0.1%) strains isolated from outpatients was resistant to ciprofloxacin. We found no association in HIV+ patients between Ureaplasma urealyticum infection and CD4 count or HIV-1 p24 antigenemia.

Topics: AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-Infective Agents; Ciprofloxacin; Drug Resistance, Microbial; Female; HIV Infections; HIV-1; Humans; Male; Minocycline; Tetracycline; Ureaplasma urealyticum; Urethra; Vagina

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Clarithromycin; Drug Therapy, Combination; Humans; Male; Minocycline; Toxoplasmosis, Cerebral

Topics: Adult; AIDS-Related Opportunistic Infections; Clarithromycin; Drug Combinations; Female; Humans; Male; Minocycline; Salvage Therapy; Toxoplasmosis

The efficacy of clarithromycin combined with either pyrimethamine or minocycline for treatment of experimental Toxoplasma gondii infection was investigated. Mice were infected intraperitoneally with 2 x 10(3) to 2 x 10(4) T. gondii strain RH or TS4 tachyzoites. Mortality was recorded for 35 days postinfection. Latency was evaluated by inoculation of brain homogenates from surviving mice into naive untreated mice. The combination of clarithromycin and pyrimethamine therapy caused a significantly greater reduction in mortality than did either drug alone. Similar synergy was observed between clarithromycin and minocycline. A 100% cure rate of active and latent infection was achieved in mice treated with the clarithromycin based combinations. Clarithromycin in combination with either pyrimethamine or minocycline produced efficacy comparable to combined therapy of pyrimethamine with sulfamethoxazole. The in vitro potency of clarithromycin, pyrimethamine, or minocycline against T. gondii on a mouse macrophage monolayer was not predictive of the in vivo efficacy in mice. Clarithromycin combined with minocycline or pyrimethamine could allow greater flexability for treatment of patients predisposed to the toxicity associated with standard pyrimethamine-sulfonamide or pyrimethamine-nonsulfonamide therapy. This therapy could be especially useful since clarithromycin-based therapy provides safe and effective treatment against Mycobacterium avium complex infections associated with AIDS patients.

Topics: AIDS-Related Opportunistic Infections; Animals; Clarithromycin; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Synergism; Drug Therapy, Combination; Female; Mice; Minocycline; Pyrimethamine; Sulfamethoxazole; Toxoplasma; Toxoplasmosis, Animal

Topics: Actinomycetales Infections; Adult; AIDS-Related Opportunistic Infections; Clarithromycin; Drug Therapy, Combination; Female; Humans; Minocycline; Rhodococcus equi