Delayed diagnosis of tuberculosis in patients with human immunodeficiency virus infection
Article Abstract:
Tuberculosis (TB) is a common complication in patients infected with human immunodeficiency virus (HIV; the cause of AIDS). Early diagnosis is important not only for the patient's health, but also to prevent the transmission of TB, which is moderately contagious. The frequency in the delay of TB diagnosis in HIV-infected patients was studied. Fifty-two patients were evaluated. Early treatment, initiated up to 15 days after the start of symptoms, was given to 27 patients, while 25 patients were diagnosed and treated 23 to 112 days after the onset of symptoms. The frequency of symptoms and abnormal physical findings were not lower in the late-treatment group, nor did atypical X-ray findings explain the delayed diagnoses. Laboratory values were similar in both groups. Avoidable errors in patient management accounted for 84 percent of the late-treatment group: obtaining less than three sputum samples in spite of suggestive X-ray and respiratory symptoms; positive results not reported quickly to physicians; and failure to examine bone marrow in spite of suggestive blood work. In four of the HIV-infected patients, delayed TB diagnosis appeared to be unavoidable. Among patients for whom follow-up was available, 45 percent of the late-treatment patients died of TB, while only 19 percent of early-treatment patients died of TB. This suggests that delayed therapy results in increased mortality, but other factors may also have been important. The authors recommend that HIV-infected patients should be given antitubercular therapy based on symptoms, while the process of diagnosis is still ongoing. Increased awareness of the symptoms of TB should also decrease both the severity of illness and mortality due to this treatable complication of HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Dysphagia and an abdominal mass in a 43-year-old man with acquired immunodeficiency syndrome
Article Abstract:
A case is reviewed in which a patient with difficulty swallowing (dysphagia), vomiting, dehydration, and an abdominal mass was admitted to the hospital four months after being diagnosed with human immunodeficiency virus (HIV) infection, the cause of AIDS. One month before admission, a mass at the junction of the stomach and esophagus had been found, but no ulcers were evident, and the patient's symptoms responded to histamine blockers, which are used to treat ulcers. The patient also had scaling red patches on the abdomen and extremities, but biopsy showed only chronic inflammatory changes. The patient also had a yeast infection of the mouth and windpipe, commonly found in patients with HIV infection. After admission, the patient developed fevers, and the abdominal mass was found to be larger. X-rays showed nodules near the colon and stomach, enlarged abdominal lymph nodes, enlarged bile ducts, and lung patches. The patient's symptoms were typical of those with HIV infection, but not full-blown AIDS. This patient's risk for rapid development of AIDS was high due to immunodepletion and the presence of AIDS-related complex (ARC), which includes yeast infection, weight loss, non-localized shingles, and persistent diarrhea. Anemia developed in the patient when taking zidovudine, the only approved treatment for HIV infection. The gastrointestinal findings, tumor, and skin lesions indicated a diagnosis of Kaposi's sarcoma; aspects concerning this diagnosis are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Visceral leishmaniasis with malabsorption syndrome in a patient with acquired immunodeficiency syndrome
Article Abstract:
Leishmaniasis is an infection with the parasitic protozoa Leishmania, which affects the skin, nasal cavities, and pharynx. The visceral form of leishmaniasis is endemic to the Mediterranean area. In Spain, an increase in the incidence of visceral leishmaniasis has been associated with the increased prevalence of infection with human immunodeficiency virus (HIV). The development of unusual forms of the disease and sites of infection has also been reported. A case is described of a 27-year-old man with AIDS, who developed a severe infection of the intestinal tract with Leishmania, resulting in diarrhea and impaired absorption. The control of Leishmaniasis requires the collaboration of immune T cells and macrophages. Patients with deficient immune systems, such as those with AIDS, are at increased risk of developing Leishmaniasis and recurrent infection. Leishmania should be considered as a possible infective agent in opportunistic infections associated with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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