trimethoprim--sulfamethoxazole-drug-combination and Weight-Loss

Polymorphous hemangioendotheliomas (PH) are rare and borderline malignant tumors that are among the wide range of vascular tumors. We report here a 13-year-old male presenting with a history of weight loss, opportunistic infections, and lymphadenopathy. He was determined to be HIV positive and to have acquired immunodeficiency syndrome (AIDS). A biopsy of a femoral node was diagnostic of PH. His systemic lymphadenopathy appeared to resolve with anti-retroviral therapy. This tumor should be considered within the differential diagnoses of pediatric and immunocompromised patients.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Azithromycin; Fever; Hemangioendothelioma; Humans; Lymph Nodes; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss

To evaluate the prognostic value of selected laboratory and growth markers on the short-term risk of mortality in untreated HIV-infected children in resource-limited settings.. A meta-analysis of individual longitudinal data on children aged 12 months onwards from 10 studies (nine African, one Brazilian in the 3Cs4kids collaboration).. The risk of death within 12 months based on age and the most recent measurements of laboratory and growth markers was estimated using Poisson regression models, adjusted for cotrimoxazole prophylaxis use and study effects.. A total of 2510 children contributed 357 deaths during 3769 child-years-at-risk, with 81% follow-up occurring after start of cotrimoxazole. At first measurement, median age was 4.0 years (interquartile range, 2.2-7.0 years), median CD4% was 15% and weight-for-age z-score -1.9. CD4% and CD4 cell count were the strongest predictors of mortality, followed by weight-for-age and haemoglobin. After adjusting for these markers, the effects of total lymphocyte count and BMI-for-age were relatively small. Young children who were both severely malnourished and anaemic had high mortality regardless of CD4 values, particularly those aged 1-2 years. By contrast, high CD4% or CD4 cell count values predicted low mortality level amongst either children older than 5 years or those younger with neither severe malnutrition nor anaemia.. CD4 measurements are the most important indicator of mortality and wider access to affordable tests is needed in resource-limited settings. Evaluation of antiretroviral initiation in children also needs to consider weight-for-age and haemoglobin. Prevention and treatment of malnutrition and anaemia is integral to HIV paediatric care and could improve survival.

Topics: Africa; Anemia; Anti-Retroviral Agents; Biomarkers; Brazil; CD4 Lymphocyte Count; Child; Child Mortality; Child, Preschool; Hemoglobins; HIV; HIV Infections; Humans; Malnutrition; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss

In sub-Saharan Africa where weight loss is very difficult to estimate, cross-sectional anthropometric indicators could be useful to predict human immunodeficiency virus (HIV)-associated mortality. The study objective was to look for threshold values of baseline body mass index, arm muscle circumference, and fat mass to predict the risk of death in HIV-infected adults included in a 1996-1998 trial of early cotrimoxazole chemoprophylaxis in Abidjan, Côte d'Ivoire (COTRIMO-CI-ANRS 059 trial). The authors graphically determined if consecutive anthropometric categories with the closest hazards ratios of the risk of death could be clustered to obtain a unique threshold that distinctly separated two categories. When the threshold values were determined, the authors estimated the hazards ratio of mortality of this two-category model. A significant increase of mortality was observed for a body mass index of < or =20.3 in men (hazards ratio = 2.6; 95% confidence interval (CI): 1.4, 5.0) and of < or =18.5 in women (hazards ratio = 2.2; 95% CI: 1.05, 4.5) and for a fat mass of < or =6% in men (hazards ratio = 4.6; 95% CI: 2.3, 9.4) and of < or =18% in women (hazards ratio = 2.4; 95% CI: 1.2, 4.9). No simple threshold could be identified for arm muscle circumference. In Côte d'Ivoire where chemoprophylaxis of opportunistic infections has recently been recommended to be widely initiated on clinical criteria, such thresholds may help to screen patients with higher risks of mortality.

Topics: Adult; AIDS-Related Opportunistic Infections; Anthropometry; Anti-Infective Agents; Body Mass Index; Chi-Square Distribution; Cote d'Ivoire; Cross-Sectional Studies; Female; HIV Infections; HIV-1; Humans; Male; Prognosis; Risk Factors; Skinfold Thickness; Survival Analysis; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss

Topics: Anti-Bacterial Agents; Cough; Diagnosis, Differential; Fever; Humans; Lung Neoplasms; Malaysia; Male; Melioidosis; Middle Aged; Neoplasms; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss

Whipple's disease is a rare chronic multi-systemic infection, caused by Gram-positive bacillus Tropheryma whipplei. The infection usually involves the small bowel, but other organs may also be involved. The diagnosis is often challenging and can only be made on histopathological examination. This report describes 2 patients presenting with abdominal pain and weight loss who finally were diagnosed to have Whipple's disease. One of the patients was a renal transplant recipient. To the best of authors' knowledge, no case of Whipple's disease has yet been reported in Pakistan. The diagnosis were made on the basis of histopathological evaluation of duodenal biopsies. The cases underscore the need for diligent histopathological evaluation of the upper gastrointestinal biopsies and a high index of suspicion for an accurate diagnosis of the condition. The approach to the diagnosis and management of the condition is discussed.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Biopsy; Ceftriaxone; Female; Humans; Intestine, Small; Male; Pakistan; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Weight Loss; Whipple Disease

Topics: Acquired Immunodeficiency Syndrome; Amikacin; Anti-Bacterial Agents; Antiretroviral Therapy, Highly Active; Bronchoscopy; Clindamycin; Comorbidity; Fever; Hemoptysis; Humans; Imipenem; Immunocompromised Host; Lung Abscess; Male; Middle Aged; Neuroimaging; Nocardia Infections; Pneumonia, Bacterial; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss

Topics: Anti-Infective Agents; Back; Biopsy; Diagnosis, Differential; Elephantiasis; Humans; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Bronchoalveolar Lavage Fluid; Cough; Dyspnea; Fluorescent Antibody Technique, Direct; Humans; Male; Microscopy; Mycology; Pneumocystis carinii; Pneumonia, Pneumocystis; Prednisone; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss

Topics: Adult; Anti-Bacterial Agents; Biopsy; Capsule Endoscopy; Ceftriaxone; Colonoscopy; Diarrhea; Humans; Male; Periodic Acid-Schiff Reaction; Rare Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss; Whipple Disease

Whipple's disease is a rare systemic infectious disease caused by the bacterium Tropheryma whippelii. Early diagnosis is essential. Whipple's disease is potentially fatal but responds dramatically to antibiotic treatment. The diagnosis is confirmed by means of polymerase chain reaction (PCR) technology. This analysis may be useful for monitoring the efficacy of therapy. The recommended treatment al present is administration of cotrimoxazole twice daily for one year. When CNS involvement occurs, it is recommended initial treatment with daily parenteral administration of streptomycin 1 g and 1.2 million units of benzyl penicillin (Penicillin G) over a period of 14 days.

Topics: Aged; Anemia; Arthritis, Infectious; Biopsy; Diarrhea; DNA, Bacterial; Duodenal Diseases; Female; Folic Acid; Gastrointestinal Hemorrhage; Gram-Positive Bacteria; Heart Failure; Heart Valve Diseases; Humans; Laparotomy; Male; Penicillin G; Polymerase Chain Reaction; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss; Whipple Disease

Two patients, a woman aged 66 and a man aged 56 years, with an inflammatory syndrome, weight loss, joint pain and abdominal lymphadenopathy received long-term treatment with corticosteroids for alleged sarcoidosis. No long-term remission was induced and the patients were referred for a second opinion. Eventually the diagnosis of Whipple's disease was established 5 years after the appearance of the first symptoms in the case of the female patient and 4 years after in the case of the male patient. Both patients showed a marked clinical improvement after treatment with trimethoprim-sulfamethoxazole. An atypical presentation of alleged sarcoidosis should suggest the possibility of Whipple's disease, especially in the case of gastrointestinal symptoms and the failure to respond to corticosteroids, and warrants duodenal biopsy. The presence of granulomas with an elevated angiotensin-converting enzyme level is not pathognomonic for sarcoidosis. It is vitally important to distinguish the two disorders, as Whipple's disease is an infectious disorder that requires antibiotic therapy to prevent a fatal outcome.

Topics: Abdomen; Adrenal Cortex Hormones; Aged; Anti-Infective Agents; Arthralgia; Diagnosis, Differential; Female; Humans; Lymphatic Diseases; Male; Middle Aged; Sarcoidosis; Treatment Failure; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss; Whipple Disease

A 39-year-old man, who had made a cycling tour from Tibet to Nepal, visited the outpatients' clinic one month later because of prolonged diarrhoea, abdominal complaints and serious weight loss. Parasitological examination of the stool revealed oocysts of Cyclospora cayetanensis and the patient was treated with trimethoprim-sulfamethoxazole (co-trimoxazole) with good result. C. cayetanensis has only recently been discovered as a protozoal cause of diarrhoea. Infections are primarily reported from areas with a low hygienic standard e.g. Central and South America, the Indian subcontinent (Nepal), Indonesia and South-East Asia. Clinical symptoms of infection are diarrhoea (usually watery), abdominal cramps and discomfort. The infection can have a prolonged course. Diagnosis is made by parasitological examination of the stool (one should be cautious not to confuse with cryptosporidia) and treatment with trimethoprim-sulfamethoxazole is effective.

Topics: Adult; Animals; Antimalarials; Cyclospora; Cyclosporiasis; Diarrhea; Feces; Humans; Male; Nepal; Tibet; Travel; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss

Topics: Adult; Anti-Infective Agents; Diagnosis, Differential; Fever; Humans; Male; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss

In a 45-year-old man with diarrhoea, upper abdominal pain and malabsorption Whipple's disease was diagnosed by gastroduodenoscopy with small bowel biopsies. The disease is rare and can present with gastrointestinal problems but also with cardiac or neurological complaints. Tropheryma whippelii, the aetiological organism, can be demonstrated by pathological investigation of biopsies and with the polymerase chain reaction (PCR). Treatment with trimethoprim-sulfamethoxazole 160-800 mg twice daily is the therapy of choice: it must be continued for a year, otherwise there is a high possibility of relapse. Correct diagnosis, based mostly on gastroduodenoscopy, can lead to the right therapy and recovery of the patient.

Topics: Biopsy; Diarrhea; Duodenum; Humans; Male; Middle Aged; Periodic Acid-Schiff Reaction; Polymerase Chain Reaction; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss; Whipple Disease

We describe patients with and without AIDS who had Cyclospora cayetanensis infection; these patients were seen at a tertiary care teaching hospital in Mexico City because of diarrheal disease. C. cayetanensis was detected by examination of fresh fecal preparations and acid-fast staining of fecal smears; the presence of other bacteria and parasites was excluded by standard methods. Fecal specimens from 12 patients contained C. cayetanensis. The overall mean duration of illness was 94 days. Seven of the 12 patients had AIDS; these patients presented with more weight loss than did patients without AIDS (P = .04). The patients with AIDS also tended to have a more prolonged illness. Two patients with AIDS had biliary disease that resolved when they received therapy with trimethoprim-sulfamethoxazole for cyclospora infection; the excretion of oocysts also ceased. Our data confirm that C. cayetanensis causes diarrhea in humans and a significant weight loss in patients with AIDS. In addition, Cyclospora could be involved in biliary disease in patients with AIDS.

Topics: Adult; Aged; AIDS-Related Opportunistic Infections; Animals; Biliary Tract Diseases; Coccidiosis; Diarrhea; Eucoccidiida; Feces; Female; Humans; Male; Mexico; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Weight Loss