"The fact that men were dying more could be because they present to hospitals late in a state of advanced immune depression most especially as very low CD4 cell count was a factor in this study, strongly associated with death. Another study similarly found that most patients with CM had less 100 CD4 cells. "
[Show abstract][Hide abstract] ABSTRACT: Cryptococcal meningoencephalitis (CM) kills about half a million human immunodeficiency virus (HIV) patients per year, mostly in Africa.
The aim of this study was to determine the prevalence, clinical presentation and in-hospital outcome of CM among HIV-infected patients in Douala.
A cross-sectional clinical note review of 672 HIV-1 patients' files admitted from January 1 (st) 2004 to December 31 (st) 2009 at the Internal Medicine unit of the Douala General Hospital, Cameroon was performed. Only patients diagnosed of CM by microscopy of Indian ink stained cerebrospinal fluid (CSF) were studied.
The prevalence of CM in the study was 11.2%. Mean age of patients was 36.9 12.7 years. Median cluster of differentiation 4 (CD4) cell count was 23 cells/μL, (interquartile range [IQR]: 10-61) and 62.7% of CD4 cell counts were >50 cells/μL. The most prevalent symptom was headache in 97.3% of patients. In CSF, median proteins was 0.9 g/L (IQR: 0.6-1); median glucose 0.2 g/L (IQR: 0.1-0.3) and median leucocyte count 54 cells/μL (IQR: 34-76) mostly of mixed cellularity. The case fatality rate was 52% and low CD4 cell count was strongly associated with death, odd ratio 4.6 (95% confidence interval: 2.6-8.0, P > 0.001).
The high case fatality of CM in Douala warrants adequate diagnostic measures and optimization of standardized treatment to reduce mortality.
North American Journal of Medical Sciences 08/2013; 5(8):486-491. DOI:10.4103/1947-2714.117318
"HIV infection increases the risk of developing active TB by 15-30 times. According to National AIDS Control Organization (NACO), TB is the commonest opportunistic infection, both pulmonary and extrapulmonary (62.2%) in India, which can explain its high incidence in HIV-infected individuals in India as compared to western countries. In HIV positive patients, the incidence of skeletal TB increases to 60%. "
[Show abstract][Hide abstract] ABSTRACT: Spinal tuberculosis (TB) or Pott's spine is the commonest extrapulmonary manifestation of TB. It spreads through hematogenous route. Clinically, it presents with constitutional symptoms, back pain, tenderness, paraplegia or paraparesis, and kyphotic or scoliotic deformities. Pott's spine accounts for 2% of all cases of TB, 15% of extrapulmonary, and 50% of skeletal TB. The paradiscal, central, anterior subligamentous, and neural arch are the common vertebral lesions. Thoracic vertebrae are commonly affected followed by lumbar and cervical vertebrae. Plain radiographs are usually the initial investigation in spinal TB. For a radiolucent lesion to be apparent on a plain radiograph there should be 30% of bone mineral loss. Computed tomographic scanning provides much better bony detail of irregular lytic lesions, sclerosis, disc collapse, and disruption of bone circumference than plain radiograph. Magnetic resonance imaging (MRI) is the best diagnostic modality for Pott's spine and is more sensitive than other modalities. MRI frequently demonstrates disc collapse/destruction, cold abscess, vertebral wedging/collapse, marrow edema, and spinal deformities. Ultrasound and computed tomographic guided needle aspiration or biopsy is the technique for early histopathological diagnosis. Recently, the coexistence of human immunodeficiency virus infections and TB has been increased globally. In recent years, diffusion-weighted MRI (DW-MRI) and apparent diffusion coefficient values in combination with MRI are used to some extent in the diagnosis of spinal TB. We have reviewed related literature through internet. The terms searched on Google scholar and PubMed are TB, extrapulmonary TB, skeletal TB, spinal TB, Pott's spine, Pott's paraplegia, MRI, and computed tomography (CT).
North American Journal of Medical Sciences 07/2013; 5(7):404-411. DOI:10.4103/1947-2714.115775
"AIDS-related Primary CNS lymphoma (PCNSL) almost always occurs in patients with a CD4 count of less than 50 cells/mm3. CNS involvement in HIV patients apart from lymphoma can be due to meningitis, viral encephalitis, AIDS dementia complex, progressive multifocal leukoencephalopathy and toxoplasmosis. Definitive diagnosis of PCNSL requires stereotactic biopsy. "
[Show abstract][Hide abstract] ABSTRACT: Human immunodeficiency virus (HIV) associated lymphoma is an important public health concern; however, the epidemiological data available from India is sparse.
The present study was carried out at a tertiary cancer care center in South India to analyze the scenario of HIV-associated lymphoma.
This was a retrospective observational study conducted at our center, on consecutive patients diagnosed with HIV-associated lymphoma, from January 2008 to December 2012.
A total of 44 patients were diagnosed with HIV-associated lymphoma, of which 18 opted for treatment. There were 11 males and 7 females in the study population. Median interval from the diagnosis of HIV infection to diagnosis of lymphoma was 18 months. Median CD4 count at the time of lymphoma diagnosis was 218/mm(3). Five patients had Hodgkin's lymphoma, and the rest had non-Hodgkin's lymphoma. Five out of 18 (28%) patients in the present study expired during treatment. Ten (55.5%) patients are alive and lymphoma free, with a median follow up of 18 months.
More than half of our treated patients are lymphoma free with a median follow up of 18 months; hence treatment of patients with HIV-associated lymphoma should be encouraged.
North American Journal of Medical Sciences 07/2013; 5(7):432-7. DOI:10.4103/1947-2714.115772
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