Progressive multifocal leukoencephalopathy in AIDS

Article Abstract:

The case study of a 42-year-old patient with AIDS is presented. His condition had been diagnosed one year before the current episode, and he had been treated with several drugs (but not zidovudine). The patient had also been treated for Kaposi's sarcoma (a type of cell proliferation associated with AIDS) and for Pneumocystis pneumonia. Current symptoms included motor aphasia (inability to say words, although the patient knows what he wants to say) and incomplete sentences with poor syntax. Also, weakness was observed in the facial muscles on the right side. Computerized tomography (a method of obtaining an X-ray of the brain) showed a lesion extending throughout a large region of the patient's brain. Examination of tissue biopsy specimens from the brain led to the diagnosis of progressive multifocal leukoencephalopathy (PML), a disease associated with loss of myelin (the substance that surrounds nerves and insulates them so they can conduct electrical impulses normally). The diagnosis is discussed and explained, and other conditions with similar symptoms are described. The most common cause of large brain lesions among HIV (the virus associated with AIDS)-infected individuals is toxoplasmosis, another disorder. When presented with symptoms such as those described in this case study, the physician must decide whether to treat for toxoplasmosis, or to perform a brain biopsy, a procedure with considerable risk. In general, biopsies are indicated when a patient has a lesion that is accessible and is not typical of toxoplasmosis, or when other infections or malignancies of the central nervous system are present. PML is a viral disease (from one of two recognized human polyomaviruses), and its characteristics are described. The virus that causes PML, JC virus, is present in most adults, and is perhaps activated and enters the brain when the host is immunocompromized. A hypothesis regarding the way this virus infects glial cells (the cells that manufacture myelin) is presented. Verifying the diagnosis of PML allows appropriate medical and supportive therapies to be instituted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Causes of, Complications and side effects, AIDS (Disease), Leukoencephalopathy, Progressive multifocal, Progressive multifocal leukoencephalopathy

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Eleven years of community-based directly observed therapy for tuberculosis

Article Abstract:

The use of community-based directly observed therapy (DOT) for tuberculosis (TB) appears to control the incidence of tuberculosis in cities with high case rates. Directly observed therapy involves watching the patient take the medication in his home, workplace, school, clinic, or other designated location, and complete treatment. Researchers studied TB case rates in Baltimore from 1981 to 1992 and compared those rates to five other major US cities which did not have DOT programs. Baltimore's incidence of TB declined 29%, which was the greatest decrease among the cities studied. TB incidence in Baltimore decreased from 35.6 cases per 100,000 people in 1981 to 17.2 cases per 100,000 in 1992. Baltimore, which had ranked sixth place nationwide for TB cases in 1981 dropped to 28th in 1992, even though the city's AIDS case rate increased 171.5% from 1987 to 1992, the largest AIDS case increase of the five cities. HIV, AIDS, poverty, and injection drug use are considered risk factors for contracting TB.

Care and treatment, Demographic aspects, Communicable diseases, Baltimore, Maryland

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Effect of routine isoniazid preventive therapy on tuberculosis incidence among HIV-infected men in South Africa

Article Abstract:

A study is conducted to determine the effect on tuberculosis incidence of a clinic providing isoniazid preventive therapy to human immunodeficiency virus (HIV)-infected adults under routine conditions. The findings indicate that tuberculosis incidence remained high despite isoniazid preventive therapy and additional interventions are suggested in order to effectively reduce morbidity and mortality in HIV-infected patients.

South Africa, Usage, Risk factors, Drug therapy, HIV patients, Isoniazid

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