Histoplasma capsulatum polysaccharide antigen detection in diagnosis and management of disseminated histoplasmosis in patients with acquired immunodeficiency syndrome

Article Abstract:

Patients with acquired immunodeficiency syndrome (AIDS) are especially vulnerable to infection because of the reduced ability of their immune systems to fight infection. Particular infections are considered to be opportunistic in that they are more likely to cause disease under certain conditions, such as a diminished immune response. Although it normally causes symptoms in only one to five percent of infected persons, histoplasmosis is a rapidly progressive opportunistic infection in AIDS patients, causing acute pneumonia in those it affects. It spreads throughout the body and infects the liver, spleen, meninges (tissue lining the brain and spinal cord), heart, abdominal cavity and adrenal glands. Rapid diagnosis is crucial in initiating treatment in AIDS patients. Histoplasma capsulatum polysaccharide antigen (HPA) is the histoplasmosis infection which causes an immune response, normally the production of antibody to fight the infection. Detection of HPA was tested by a slightly modified radioimmunoassay procedure which uses an antigen-antibody reaction to determine the concentration of a substance. High levels of HPA were detected in the urine in almost 97 percent and in the blood of 79 percent of the AIDS patients who had disseminated histoplasmosis. When patients were treated with the antibiotic amphotericin B the levels of HPA in their urine and blood decreased significantly. In the patients who suffered a relapse of histoplasmosis the levels of HPA again increased. Detection of HPA provides a rapid method for diagnosing histoplasmosis, but further testing is required to establish the reliability of HPA levels in monitoring treatment and relapse.

Health aspects, Diagnosis, Histoplasmosis, Radioimmunoassay, Amphotericin B

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Muscle weakness, seizures, coma, and death in a 33-year-old man with acquired immunodeficiency syndrome

Article Abstract:

A 33-year-old man, who was initially seen in the summer of 1986 for diarrhea and weight loss, tested positive for human immunodeficiency virus (HIV) infection in February 1987. He developed pneumocystis pneumonia, a complication of acquired immunodeficiency syndrome (AIDS) in May 1987. This opportunistic infection was followed by anemia, or an abnormal decrease in red blood cells, repeated infections, and central nervous system (CNS) disease. The patient died after a sudden illness that was associated with muscle weakness, increased mental disorder, and seizures. X-rays of the brain revealed ring-like lesions in the white matter, possibly resulting from infections by yeast, cytomegalovirus (CMV), papillomavirus, and HIV. CMV infection may also affect the lungs, adrenal glands, retina or inner lining of the eye, and the immune system, consisting of the body's natural defense mechanisms. Ganciclovir and phosphonoformate are two experimental drugs used to treat CMV disease, primarily in AIDS patients and transplant recipients. The CNS complications of HIV infection consist of CNS infections, neoplasms or abnormal growths, disorders of the blood vessels, and miscellaneous conditions, such as diseases of the retina and peripheral nervous system. After reviewing the case, the patient was diagnosed as having had primary CNS lymphoma, or tumor of the lymph tissue in the brain and spinal cord, associated with HIV, CMV, yeast, and papillomavirus infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Central nervous system

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Survival following mechanical ventilation for Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome: a different perspective

Article Abstract:

Lung infection causes severe episodic illness and death in patients with acquired immunodeficiency syndrome (AIDS). Pneumocystis carinii pneumonia (PCP) is the most commonly diagnosed lung infection in AIDS patients. Previous studies have reported that the mortality rate is between 87 and 100 percent for patients who develop respiratory failure (breathing stops) due to PCP. Considering the ultimately fatal outcome of AIDS and the medical costs involved in critical care, physicians have questioned the advisability of using mechanical breathing devices (intubation with a respirator) in the event of breathing cessation related to PCP. Records of the 33 AIDS patients who required mechanical breathing support for PCP between Dec 1984 and Jun 1988 were reviewed. Sixty-four percent of the 25 patients intubated for their first PCP infection survived, as did 25 percent of the eight patients intubated for their second infection. The authors assert that there is a reasonable chance of survival in AIDS patients who require mechanical ventilation for PCP. Because the patients are usually young and there is hope for improved treatments, patients should be encouraged while the short and long-term prognosis is explained honestly. Long-term survival for patients who survive intubation is similar to that of AIDS patients who have not developed respiratory failure.

Care and treatment, Prognosis, Ethical aspects, Pneumocystis carinii pneumonia, Respiratory insufficiency, Critical care medicine

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