The HIV epidemic and training in internal medicine: challenges and recommendations

Article Abstract:

Acquired immunodeficiency syndrome (AIDS) is a disease compromising the ability to fight off disease. How the AIDS epidemic is affecting medical education has not been studied. Training programs in internal medicine are faced with some new issues concerning the AIDS epidemic. Medical personnel are rightfully concerned about contracting the disease while caring for infected patients. This is the first time in many years that healthcare professionals have been at increased risk while caring for patients. There is some concern that one effect of the epidemic will be reduced educational experience of medical students with caring for similar patients. The high numbers of AIDS patients at hospitals serving medical schools may discourage prospective medical students from applying. There are many prejudices against caring for AIDS patients. Because the disease is not curable, the caretakers often feel frustrated and anxious; additional anxiety can arise from caring for homosexuals and drug addicts. Individuals being trained are faced with new ethical issues and responsibilities. On the other hand, caring for AIDS patients can help restore the wounded physician-patient relationship, and can contribute to experience with technological approaches and in collaborating with other healthcare professionals. The special challenge of caring for AIDS patients must be dealt with by the medical community and efforts should be made to reduce the associated stress, frustration and discouragement experienced in medical training programs.

Medical students, Beliefs, opinions and attitudes, Ethical aspects, Study and teaching, Medical education, Internal medicine, AIDS phobia

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Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome

Article Abstract:

Cryptococcus neoformans is a common fungal infection in people having acquired immunodeficiency syndrome (AIDS). It can affect skin, lungs and other parts of the body, but most often affects the meninges, the membranes covering the brain and spinal cord, causing meningitis. Anti-fungal drugs such as amphotericin B and flucytosine are given on a long-term basis in an effort to prevent recurrent infections, but flucytosine can cause a severe reduction in the number of blood cells. To determine the effectiveness of amphotericin B alone and in combination with flucytosine, patients with cryptococcal meningitis (89 patients) and other cryptococcal infections (14 patients) were evaluated. When administered in combination with amphotericin, flocytosine offered no advantage in survival or in preventing infection recurrence over amphotericin B alone. Its use had to be discontinued in half of the patients due to blood cell reduction. Continuous therapy with ketoconazole or amphotericin B, aimed at long-term suppression of the infection, improved survival. Patients with cryptococcal meningitis and other cryptococcal infections had the same survival rates. It appears that flucytosine does not improve survival but long-term suppression therapy benefits patients with cryptococcal infections.

Case studies, Antifungal agents, Cryptococcus, Amphotericin B, Flucytosine

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Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome

Article Abstract:

Toxoplasmosis is an infection of the central nervous system affecting up to 40% of all AIDS patients. Mild cases of toxoplasmosis are similar to mononucleosis, and more severe cases can damage the brain, eyes, muscles, liver and lungs. Between 1981 and 1990, 115 AIDS patients were diagnosed with toxoplasmosis at San Francisco General Hospital. The most frequently observed symptoms in these patients were headaches, confusion and fevers. Neurological problems, including partial paralysis, poor muscle coordination and sensory deficits were seen in 69%. Toxoplasmosis antibodies, normally an indicator of the infection and used for diagnosis, were not seen in some patients who actually had toxoplasmosis. The drugs pyrimethamine, sulfadiazine and leucovorin were used to treat 114 patients and 96 showed some improvement. However, drug side effects occurred in 62% of the patients, and in 44%, the reactions were so severe they had to switch treatment.

Statistics, Toxoplasmosis

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