phenylephrine-hydrochloride and AIDS-Related-Opportunistic-Infections

We describe five cases of parasitic sinusitis and otitis in patients infected with human immunodeficiency virus (HIV) and review 14 reported cases. The pathogens identified in our group of patients included agents such as Microsporidium, Cryptosporidium, and Acanthamoeba species. The clinical features common to these patients included a long history of HIV seropositivity associated with advanced immunosuppression and multiple opportunistic infections as well as long-standing local symptoms refractory to multiple courses of antibacterial agents. Symptoms often included fever and chills in addition to local tenderness and discharge. Invasive diagnostic procedures were necessary to obtain the final diagnosis and to initiate appropriate therapy. Although most patients responded at least partially to specific therapy, relapses and recurrences were frequent in patients who did not receive long-term suppressive therapy. The general outcome for HIV-infected patients with parasitic sinusitis and otitis was poor; however, deaths were generally associated with other complications of the underlying HIV infection.

Topics: Adult; AIDS-Related Opportunistic Infections; Albendazole; Amebiasis; Animals; Anthelmintics; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Antifungal Agents; Antiprotozoal Agents; Cryptosporidiosis; Ear, Middle; HIV Seropositivity; Homosexuality, Male; Humans; Male; Microsporida; Microsporidiosis; Nose; Otitis; Protozoan Infections; Recurrence; Sinusitis

To determine nasopharyngeal colonization rates of two vaccine preventable bacterial pathogens Hemophilus influenzae type b (Hib), and Streptococcus pneumoniae (Pneumococcus), antibiotic susceptibility of isolates, factors associated with their colonization, and immunization history in a cohort of HIV infected children.. The authors conducted a cross-sectional nasopharyngeal swab survey of 151 children affected with HIV presenting for routine outpatient care in West Bengal, India.. 151 HIV affected children were enrolled. The median age was 6, 148/151 children were HIV positive, 65% had moderate to severe malnutrition, 53% were moderately to severely immunosuppressed, 17% were on antiretroviral therapy (ART), 90% were on cotrimoxazole prophylaxis (TMP/SMX). None had received the pneumococcal or Hib conjugate vaccines. Hib prevalence was 13% and pneumococcal prevalence was 28%. Children with normal or moderate immune suppression had high rates of colonization compared to those with severe immunosuppression (71% Hib, 61% pneumococcus). Hib and pneumococcal isolates had high rates of resistance to tested antibiotics including TMP/SMX and third generation cephalosporins. Neither ART nor TMP/SMX prevented colonization. Children colonized with multidrug resistant isolates had high rates of exposure to TMP/SMX.. HIV infection, late access to ART, high rates of colonization to resistant organisms and lack of access to vaccines makes this population vulnerable to invasive disease from Hib and pneumococcus.

Topics: AIDS-Related Opportunistic Infections; Child; Child, Preschool; Cross-Sectional Studies; Female; Haemophilus Infections; Haemophilus influenzae type b; HIV Infections; Humans; India; Infant; Infant, Newborn; Male; Nose; Pneumococcal Infections; Streptococcus pneumoniae

Topics: AIDS-Related Opportunistic Infections; Bronchi; HIV Infections; Humans; Male; Middle Aged; Nose; Radiography, Thoracic; Sarcoma, Kaposi; Tomography, X-Ray Computed; Tongue

Risks for methicillin-resistant Staphylococcus aureus (MRSA) among those with HIV infection have been found to vary, and the epidemiology of USA-300 community-acquired (CA) MRSA has not been adequately described.. We conducted a retrospective review of HIV-infected out-patients from January 2002 to December 2007 and employed multivariate logistic regression (MLR) to identify risks for MRSA colonization or infection. Pulsed-field gel electrophoresis (PFGE) was used to identify USA-300 strains.. Seventy-two (8%) of 900 HIV-infected patients were colonized or infected with MRSA. MLR identified antibiotic exposure within the past year [odds ratio (OR) 3.4; 95% confidence interval (CI) 1.5-7.7] and nadir CD4 count <200 cells/microL (OR 2.5; 95% CI 1.2-5.3) as risks for MRSA colonization or infection. Receipt of antiretroviral therapy (ART) within the past year was associated with decreased risk (OR 0.16; 95% CI 0.07-0.4). Eighty-nine percent of available strains were USA-300. MLR identified skin or soft tissue infection (SSTI) as the only predictor for infection with USA-300 (OR 5.9; 95% CI 1.4-24.3).. Significant risks for MRSA among HIV-infected patients were CD4 count nadir <200 cells/microL and antibiotic exposure. Only the presence of an SSTI was associated with having USA-300, and thus the use of patient characteristics to predict those with USA-300 was limited. In addition, ART within the previous year significantly reduced the risk of MRSA colonization or infection.

Topics: Adult; Aged; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-Retroviral Agents; Carrier State; CD4 Lymphocyte Count; Comorbidity; Electrophoresis, Gel, Pulsed-Field; Epidemiologic Methods; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Nose; Outpatients; Soft Tissue Infections; Staphylococcal Skin Infections; Viral Load; Young Adult

Pulmonary and disseminated forms of histoplasmosis are very common in AIDS, but primary cutaneous histoplasmosis is rare. We report a case of primary mucocutaneous histoplasmosis in the setting of HIV.

Topics: Adult; Agricultural Workers' Diseases; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Diagnostic Errors; Drug Resistance, Fungal; Ecthyma; Fluconazole; Histoplasmosis; Humans; Itraconazole; Male; Maxillary Sinus; Meningitis, Cryptococcal; Nose; Palate; Skin Ulcer; Tuberculosis, Miliary

The immediate prosthetic rehabilitation of a patient with erosive cutaneous cytomegalovirus (CMV) is presented. Although CMV is a major cause of morbidity and mortality in immunocompromised patients, skin lesions are rarely discussed in the literature. Recognition of the susceptibility of medically compromised patients to infections that can cause extraoral and intraoral deformity is essential to prevention, early diagnosis, and prompt intervention of a life-threatening destructive debilitation. A method for rapidly fabricating a nasal prosthesis is described, and the importance of prompt esthetic and psychological rehabilitation is reviewed.

Topics: Adult; AIDS-Related Opportunistic Infections; Cytomegalovirus Infections; Female; Humans; Nose; Nose Deformities, Acquired; Prosthesis Design; Time Factors

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antiprotozoal Agents; CD4 Lymphocyte Count; Diagnosis, Differential; Drug Resistance; HIV Infections; Humans; Leishmaniasis, Visceral; Male; Middle Aged; Nose; Skin Diseases, Parasitic

Staphylococcus aureus is a common cause of serious infection in patients infected with HIV.. To evaluate risk factors for and quantitative effect of S. aureus infection in HIV-infected patients, with special attention to nasal carriage.. Prospective, multihospital cohort study.. Three tertiary care Veterans Affairs Medical Centers.. 231 ambulatory HIV-infected patients.. Thirty-four percent of patients were nasal carriers of S. aureus. Of these patients, 38% were persistent carriers and 62% were intermittent carriers. Twenty-one episodes of infection occurred in 13 patients: Ten were bacteremias (including 2 cases of endocarditis), 1 was pneumonia, and 10 were cutaneous or subcutaneous infections. Seventeen (85%) of these episodes occurred in patients with CD4 counts less than 100 cells/mm3. Recurrent infections occurred in 3 of 7 patients who survived an initial S. aureus infection. The mortality rate was higher among patients with S. aureus infection than among those without infection (P = 0.03). Factors significantly associated with S. aureus infection were nasal carriage, presence of a vascular catheter, low CD4 count, and neutropenia. Molecular strain typing indicated that for 6 of 7 infected patients, the strain of S. aureus isolated from the infected sites was the same as that previously cultured from the nares.. Nasal carriage is an important risk factor for S. aureus infection in HIV-infected patients. Controlled studies are indicated to determine whether eradication of nasal carriage in a selected subset of patients (for example, those with a low CD4 cell count) might prevent invasive S. aureus infection in patients with HIV infection.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Analysis of Variance; CD4 Lymphocyte Count; Humans; Neutropenia; Nose; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus