Tuberculosis in patients with human immunodeficiency virus infection

Article Abstract:

Tuberculosis is on the rise again in the United States; the resurgence of the disease is largely the result of the increasing number of patients with AIDS. Unlike some other diseases that are associated with AIDS, tuberculosis is of particular concern, since it can be transmitted from person to person through the air. It is also important for the disease to be rapidly recognized, since it is readily treatable, and exposed people may be supported with prophylactic drugs. The first step in the infection of the lungs with tuberculosis is the inhalation of Mycobacterium tuberculosis, the causative organism. Macrophages, protective white blood cells, in the lungs eat these bacteria and, in people with a healthy immune system, initiate a series of protective responses. In the majority of people infected with the organism, the infection is contained and the disease of tuberculosis does not develop. In some cases, although the infection is contained, it is not killed and a small reservoir of dormant bacteria remains. In about 10 percent of all cases, symptoms of tuberculosis develop, either as the result of a primary infection or the activation of a dormant one. Tuberculosis is more infectious than many of the other infections which plague AIDS patients. Therefore, it is more likely to appear earlier in the course of infection with the AIDS virus than are other AIDS-related infections. Tuberculosis is not limited to the lungs; extrapulmonary tuberculosis generally occurs in 24 to 45 percent of tuberculosis patients and may infect the blood, lymph nodes and even the brain. One of the striking features of tuberculosis in AIDS patients is the much higher rate of extrapulmonary tuberculosis. More than 70 percent of HIV-infected patients with tuberculosis have infections outside the lungs; tuberculosis abscesses (pus-filled pockets) are common in the brains of HIV-infected patients. Prolonged conventional antibiotic therapy is recommended for HIV-infected patients with tuberculosis. However, it is not yet certain that the chemotherapy is as effective in these patients as in those without HIV infection, so more extensive drug treatment for tuberculosis is recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diseases, AIDS patients, Tuberculosis

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A controlled study of early neurologic abnormalities in men with asymptomatic human immunodeficiency virus infection

Article Abstract:

Serious neurological disturbances are common among patients with AIDS; indeed, a great many AIDS patients are demented by the time they die. While some of the neurological consequences of AIDS may be due to opportunistic infections of the brain, some seem likely to be due directly to the AIDS virus itself. If human immunodeficiency virus (HIV) is capable of causing neurological damage, it may well be possible to detect subtle neurological changes in HIV-positive patients who do not yet have symptoms of AIDS. While studies have demonstrated some neurological abnormalities in asymptomatic HIV-positive patients, not all these studies included appropriate controls. Since seropositive patients may be drug abusers and may have other infections, it is not always possible to attribute the observed neurological abnormalities directly to the human immunodeficiency virus. To overcome these experimental problems, a study was conducted of 29 HIV-seropositive and 33 seronegative homosexual men carefully matched for age, education, and cultural background. The subjects were evaluated using electroencephalography (EEG), magnetic resonance imaging, neuropsychological testing, and other tests. The results showed that the magnetic resonance imaging was of no value in distinguishing between the HIV-positive and negative groups. Likewise, there were no clear abnormalities on neurologic function testing. However, the electroencephalograph showed abnormalities in 30 percent of the positive subjects at the time of the first test. A second exam six months later revealed electroencephalographic abnormalities in 40 of the positive subjects. Otoneurologic testing (involving the nerves of the inner ear) at the second testing demonstrated abnormalities in 44 percent of the positive and only 7 percent of the negative men. Taken together, the tests revealed electrophysiologic abnormalities in 67 percent of the HIV-seropositive men and 10 percent of the control subjects. The results indicate that electrophysiologic testing and electroencephalography may be the most sensitive indicators of neurological involvement in cases of HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Brain, Electrophysiology, Electroencephalography

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Osteomyelitis

Article Abstract:

Osteomyelitis may be a very difficult disease to treat and can substantially impact the patient's quality of life. Osteomyelitis is an infection of bone. It normally only occurs when a bone is fractured or injured in some way. It can also occur in patients who have had joint replacement surgery. Diabetics are also at risk because of their poor blood circulation. The best way to prevent these cases is to give patients antibiotics before and after surgery. Osteomyelitis can be diagnosed with X-rays, CT and MRI scans and nuclear imaging techniques. Treatment involves antibiotics and surgery.

Osteomyelitis

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