zithromax and Lymphoma--AIDS-Related

Mycoplasma pneumoniae is a frequent cause of community-acquired respiratory infections, especially in young children and adolescents. The significance of M. pneumoniae infection in HIV-positive patients, particularly children, is not well described. This report describes an HIV-positive female child with recurrent B-cell lymphoma and recurrent or relapsing pulmonary infections with M. Pneumoniae.

Topics: AIDS-Related Opportunistic Infections; Anti-HIV Agents; Antineoplastic Combined Chemotherapy Protocols; Azithromycin; Child; Doxycycline; Fatal Outcome; Female; HIV Infections; Humans; Lymphoma, AIDS-Related; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Polymerase Chain Reaction; Recurrence; Sepsis; Zidovudine

Nineteen cases of cerebral toxoplasmosis (CTOX) are reported from a group of Edinburgh AIDS patients. All patients were severely immunodeficient at the time of presentation with CD4 count < 50 cells/mm3. Thirteen patients had suffered a previous AIDS-defining illness. In Edinburgh, CTOX has developed in 48% of patients who are seropositive for toxoplasma and have a CD4 count < 50 cells/mm3. It is estimated that at least half of the toxoplasma seropositive patients will develop CTOX if they survive for 21 months after reaching a time in their illness when the CD4 count = 50 cells/mm3. The incidence of CTOX in toxoplasma-seronegative patients with a CD4 count < 50 cells/mm3 is 1.3%. All patients showed improvement on treatment and there was no correlation between clinical or radiological features and patient survival. Those patients unable to tolerate first choice anti-toxoplasma therapy had a significantly shorter survival than the remainder but there was no single therapeutic regimen which conferred a survival advantage. Eighteen patients had died at the time of study and the median survival following diagnosis of cerebral toxoplasmosis was 10 months (range 3-38 months). Postmortem examination of the brain was available in 8, 4 of whom had concomitant cerebral lymphoma. The survival from AIDS or CD4 count = 50 cells/mm3 did not differ significantly between those with treated CTOX and a control group who had no toxoplasma infection, suggesting that treatment is reasonably effective. CTOX is a disease associated with severe HIV-related immunodeficiency and, in those with a CD4 count < 50 cells/mm3, occurs more than 35 times as frequently in toxoplasma-seropositive than toxoplasma-seronegative patients. Treatment is effective but the outcome of treated disease cannot be predicted from presenting clinical or radiological features. Concomitant space-occupying cerebral pathology is evident in 50% of post-mortem examinations.

Topics: Acquired Immunodeficiency Syndrome; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Antifungal Agents; Atovaquone; Autopsy; Azithromycin; Brain; CD4 Lymphocyte Count; Clindamycin; Drug Therapy, Combination; Female; Humans; Incidence; Lymphoma, AIDS-Related; Male; Middle Aged; Naphthoquinones; Pyrimethamine; Retrospective Studies; Sulfadiazine; Toxoplasmosis, Cerebral; United Kingdom