Acute HIV infection presenting with painful swallowing and esophageal ulcers

Article Abstract:

A discussion is presented of the cases of 16 homosexual men with acute infection with HIV (human immunodeficiency virus, the virus associated with AIDS), whose first symptoms were painful swallowing (odynophagia) of 2 to 10 days' duration. Blood samples from these patients did not show signs of HIV infection. Endoscopy (examination with a tube and bright light) showed the presence of ulcers in the esophagus (the tube through which food travels from mouth to stomach) and biopsy specimens were taken from the margins of these ulcers in 10 patients. The men experienced pain constantly, which was accentuated when food or drink was swallowed. Thirteen patients had also developed a rash within a few days of consulting a physician, and 11 had aching joints. The three whose temperatures were measured had a fever. The esophageal ulcers were round or oval, with diameters of 0.3 to 1.5 centimeters. Laboratory tests revealed decreased white blood cell counts in 10 men, with restoration of counts to normal by the time the other symptoms disappeared 10 days later. Biopsy specimens from eight patients showed the presence of viral particles when examined with an electron microscope. The number of T cells was normal for the majority of patients. HIV was not detected in blood sampled at the time of the first visit in 15 men, but was found in all samples on subsequent analysis several days or weeks later. HIV did grow in blood cells obtained from three (out of 11 attempts) patients at the time of the first visit, however. Tests for acute infection with herpes simplex virus and cytomegalovirus were negative. These cases constitute the first reported examples of early presentation of HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ulcers, Esophagus, Deglutition disorders

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Advances in early diagnosis of perinatal HIV infection

Article Abstract:

New treatments for HIV infection make early diagnosis of this infection a priority. This is a critical problem for children born to mothers infected with HIV. Less than half of these children actually become infected with the virus, but diagnosis may be delayed because maternal antibodies of the immunoglobulin G (IgG) type can cross the placenta. The commonly used HIV antibody test looks for IgG HIV antibodies. Children born to HIV-positive mothers, even when not infected themselves, may test positive for HIV antibodies for up to 15 months following birth due to the presence of maternal IgG. Because of the side effects of HIV treatments, these drugs can not be given to all children born to HIV-infected mothers. Presently, treatment is only given to children under the age of 15 months when they develop clinical signs of infection. It would be preferable to begin treatment prior to symptomatic HIV disease. Two studies in the December 25, 1991 issue of The Journal of the American Medical Association examine using an immunoglobulin A (IgA) HIV antibody test for these children. The IgA type of antibodies does not cross the placenta. Results from these studies demonstrate that IgA antibody tests were highly effective in identifying HIV-infected infants over three months of age. This test has proven to be as effective as HIV culture and polymerase chain reaction in detecting HIV infection transmitted perinatally to infants. Focus should be placed on developing these techniques for clinical use so that HIV-infected infants can be diagnosed and treated as early as possible. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Diagnosis, Measurement, HIV infection in children, Pediatric HIV infections, Immunoglobulin A, HIV antibodies

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Outbreaks of Cyclospora cayetanensis infection - United States, 1996

Article Abstract:

In June, 1996, the South Carolina health department began investigating an outbreak of Cyclospora infection. One outbreak was traced to a luncheon attended by 64 people, of whom 37 (58%) became infected. During the same time period, Cyclospora outbreaks were reported in 10 other states and Ontario, Canada. In many cases, the infection was traced to fresh fruit, although the specific fruit involved has not been determined. Many diagnostic labs do not routinely test stool samples for Cyclospora, so the sample should be sent to a specialized lab. The infection can be treated with 7 days of trimethoprim-sulfamethoxazole.

Health aspects, Coccidia, Cryptosporidium

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