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Sample records for hiv-associated cryptococcosis status

  1. Cryptococcosis.

    Science.gov (United States)

    Negroni, Ricardo

    2012-01-01

    Cryptococcosis is a systemic fungal infection, caused by encapsulated yeast of the genus Cryptococcus, C neoformans and C gattii. These environmental microorganisms live in pigeon and other bird droppings, as well as in the fruit and bark of various trees. Infection in humans and other animal species usually occurs by inhalation and less frequently through the skin and by ingestion of the fungus. Most infections have a benign course and resolve spontaneously; however, the incidence of cryptococcosis has increased considerably, mainly due to diverse causes of immunodeficiency, particularly AIDS. Cryptococcus neoformans infections are common, worldwide, and severe forms are seen in immunocompromised patients. Cases caused by C gattii predominate in tropical or subtropical regions. Cryptococcosis may present as an acute, subacute, or chronic lung disease, as a nonpurulent cerebrospinal fluid meningitis, or as a severe infection with fever, anemia, lymphadenopathy, and hepatosplenomegaly. The eye can be affected, with partial or total loss of vision. Diagnosis is by direct observation of the causative agent, in histopathologic studies, by isolation in culture, and by the presence of capsular antigen. Treatment is the intravenous administration of amphotericin B deoxycholate, alone or combined with 5-fluorocytosine or fluconazole, which can be given orally or intravenously. Itraconazole is less effective when the central nervous system is affected. Voriconazole appears to be a drug that can be used in these patients. In AIDS patients, secondary prophylaxis is administered with fluconazole or amphotericin B and is continued until CD4 cell counts exceed 200 cells/μL. Evaluation of intracranial pressure is important in the first weeks after diagnosis in AIDS patients.

  2. Miliary pulmonary cryptococcosis

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    Shane Kelly

    2014-10-01

    Imaging features of pulmonary cryptococcosis are generally of well-defined pleural-based nodules and less commonly alveolar infiltrates, lymphadenopathy, pleural effusions or cavitating lesions. Miliary pulmonary infiltrates are an exceptionally rare presentation.

  3. Cryptococcus neoformans population diversity and clinical outcomes of HIV-associated cryptococcal meningitis patients in Zimbabwe

    NARCIS (Netherlands)

    Nyazika, Tinashe K; Hagen, Ferry; Machiridza, Tendai; Kutepa, Melody; Masanganise, Faith; Hendrickx, Marijke; Boekhout, Teun; Magombei-Majinjiwa, Tricia; Siziba, Nonthokozo; Chin'ombe, Nyasha; Mateveke, Kudzanai; Meis, Jacques F; Robertson, Valerie J

    2016-01-01

    HIV and cryptococcal meningitis co-infection is a major public health problem in most developing countries. Cryptococcus neoformans sensu stricto is responsible for the majority of HIV-associated cryptococcosis cases in sub-Saharan Africa. Despite the available information, little is known about cry

  4. Miliary pulmonary cryptococcosis

    Science.gov (United States)

    Kelly, Shane; Marriott, Deborah

    2014-01-01

    A 32-year-old HIV positive male presents with fevers and a non-productive cough. Initial X-ray and subsequent computerised tomography of the chest shows a bilateral miliary pattern of pulmonary infiltration highly suggestive of disseminated tuberculosis. However subsequent results were consistent with disseminated cryptococcosis, including pulmonary involvement, with cryptococcus identified on transbronchial tissue biopsy, and on blood and cerebrospinal fluid cultures. Imaging features of pulmonary cryptococcosis are generally of well-defined pleural-based nodules and less commonly alveolar infiltrates, lymphadenopathy, pleural effusions or cavitating lesions. Miliary pulmonary infiltrates are an exceptionally rare presentation. PMID:25379393

  5. AIDS defining disease: Disseminated cryptococcosis

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    Roshan Anupama

    2006-01-01

    Full Text Available Disseminated cryptococcosis is one of the acquired immune deficiency syndrome defining criteria and the most common cause of life threatening meningitis. Disseminated lesions in the skin manifest as papules or nodules that mimic molluscum contagiosum (MC. We report here a human immunodeficiency virus positive patient who presented with MC like lesions. Disseminated cryptococcosis was confirmed by India ink preparation and histopathology. The condition of the patient improved with amphotercin B.

  6. Pulmonary cryptococcosis manifesting as diffuse air-space consolidations in an immunocompetent patient.

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    Choi, Hye Won; Chong, Semin; Kim, Mi Kyung; Park, In Won

    2017-02-01

    Pulmonary cryptococcosis is an opportunity infection commonly occurred in the immunocompromised patients. However pulmonary cryptococcosis in the immunocompetent was reported up to 35% and these cases tend to show confined and localized radiologic findings than in immunocompromised patients. To our knowledge, extensive air-space consolidations have not frequently occurred in the immunocompetent patient. Therefore, in this case, we report a rare case of a 73-year-old woman who was diagnosed with pulmonary cryptococcosis, manifesting as diffuse air-space consolidations even though normal immune status. Thus, the possibility of pulmonary cryptococcosis should be considered when a patient with a normal immune status presents without respiratory symptoms are accompanied by consolidation on imaging.

  7. Prostatic cryptococcosis: a case report

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    M. R. Chang

    2008-01-01

    Full Text Available Cryptococcosis is a systemic mycosis usually affecting immunodeficient individuals. In contrast, immunologically competent patients are rarely affected. Dissemination of cryptococcosis usually involves the central nervous system, manifesting as meningitis or meningoencephalitis. Prostatic lesions are not commonly found. A case of prostate cryptococcal infection is presented and cases of prostatic cryptococcosis in normal and immunocompromised hosts are reviewed. A fifty-year-old HIV-negative man with urinary retention and renal insufficiency underwent prostatectomy due to massive enlargement of the organ. Prostate histopathologic examination revealed encapsulated yeast-like structures. After 30 days, the patient's clinical manifestations worsened, with headache, neck stiffness, bradypsychia, vomiting and fever. Direct microscopy of the patient's urine with China ink preparations showed capsulated yeasts, and positive culture yielded Cryptococcus neoformans. This fungus was later isolated from cerebrospinal fluid and blood cultures, demonstrating thus its dissemination. The patient was discharged after 27 days in hospital and, despite a regimen of amphotericin B, he died four months later. This case points to cryptococcosis as a possible cause of prostatic disease and reinforces the importance of communication between the medical team and pathology and microbiology laboratories aiming at a more accurate diagnosis and successful treatment.

  8. Pancytopenia and cutaneous cryptococcosis as an indicator disease of acquired immune deficiency syndrome

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    R Khuraijam

    2015-01-01

    Full Text Available We present a case of pancytopenia and cutaneous cryptococcosis in a young girl with no complaints of fever, headache and vomiting. Fine-needle aspiration cytology and further investigation for pancytopenia revealed presence of Cryptococcus in skin and bone marrow aspirates. Fungal cultures of the skin aspirates, blood and bone marrow confirmed cryptococcal infection. Counselling and human immunodeficiency virus (HIV test revealed the status of the patient to be retropositive. Although meningitis is the commonest manifestation of cryptococcosis among HIV-infected patients, rare cutaneous manifestation with pancytopenia but with no meningeal signs indicate the HIV status in an endemic area of penicilliosis, Manipur.

  9. HIV-associated anal cancer

    OpenAIRE

    Newsom-Davis, Thomas; Bower, Mark

    2010-01-01

    HIV-associated anal carcinoma, a non-AIDS-defining cancer, is a human papillomavirus-associated malignancy with a spectrum of preinvasive changes. The standardized incidence ratio for anal cancer in patients with HIV/AIDS is 20-50. Algorithms for anal cancer screening include anal cytology followed by high-resolution anoscopy for those with abnormal findings. Outpatient topical treatments for anal intraepithelial neoplasia include infrared coagulation therapy, trichloroacetic acid, and imiqui...

  10. HIV Associated Lupus Like Nephropathy

    OpenAIRE

    2014-01-01

    Background Human immunodeficiency virus type 1 (HIV-1)-seropositive patients are at a high risk for the development of a variety of acute and chronic renal diseases. Most patients with HIVAN are of African descent, presenting late in the course of their HIV-1 infection. The only reliable test to establish or rule out the presence of HIVAN (HIV associated nephropathy) is renal biopsy. The most common lesion associated with HIV is a focal segmental glomeruloscelerosis, but several times, other ...

  11. Role of Quantitative CSF Microscopy to Predict Culture Status and Outcome in HIV-Associated Cryptococcal Meningitis in a Brazilian Cohort

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    Vidal, José E.; Gerhardt, Juliana; Peixoto de Miranda, Érique J.; Dauar, Rafi F.; Oliveira Filho, Gilberto S.; Penalva de Oliveira, Augusto C.; Boulware, David R.

    2012-01-01

    Objectives To evaluate clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococcal cell counts for associations with in-hospital outcomes of HIV-infected patients with cryptococcal meningitis. Design Retrospective study. Methods 98 HIV-infected adult patients with CSF culture-proven cryptococcal meningitis admitted between January 2006 and June 2008 at a referral center in Sao Paulo, Brazil. Results Cryptococcal meningitis was the first AIDS-defining illness in 69% of whom 97% (95/98) had known prior HIV-infection. The median CD4+ T cell count was 39 cells/mcL (IQR: 17–87 cells/mcL). Prior antiretroviral therapy (ART) was reported in 50%. Failure to sterilize the CSF by 7–14 days was associated with baseline fungal burden of ≥10 yeasts/mcL by quantitative CSF microscopy (OR=15.3, 95% CI: 4.1–56.7;P14 days, altered mental status (P50,000 copies/mL (P=.036), ≥10 yeasts/mcL CSF at 7–14 days (P=.038), and intracranial pressure >50 cmH20 at 7–14 days (P=.007). Conclusion Most patients were aware of their HIV-status. Fungal burden of ≥10 yeasts/mcL by quantitative CSF microscopy predicted current CSF culture status and may be useful to customize the induction therapy. High uncontrolled intracranial pressure was associated with mortality. PMID:22578940

  12. Oral microbiome in HIV-associated periodontitis

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    Noguera-Julian, Marc; Guillén, Yolanda; Peterson, Jessica; Reznik, David; Harris, Erica V.; Joseph, Sandeep J.; Rivera, Javier; Kannanganat, Sunil; Amara, Rama; Nguyen, Minh Ly; Mutembo, Simon; Paredes, Roger; Read, Timothy D.; Marconi, Vincent C.

    2017-01-01

    Abstract HIV-associated periodontal diseases (PD) could serve as a source of chronic inflammation. Here, we sought to characterize the oral microbial signatures of HIV+ and HIV– individuals at different levels of PD severity. This cross-sectional study included both HIV+ and HIV– patients with varying degrees of PD. Two tooth, 2 cheek, and 1 saliva samples were obtained for microbiome analysis. Mothur/SILVADB were used to classify sequences. R/Bioconductor (Vegan, PhyloSeq, and DESeq2) was employed to assess overall microbiome structure differences and differential abundance of bacterial genera between groups. Polychromatic flow cytometry was used to assess immune activation in CD4 and CD8 cell populations. Around 250 cheek, tooth, and saliva samples from 50 participants (40 HIV+ and 10 HIV–) were included. Severity of PD was classified clinically as None/Mild (N), Moderate (M), and Severe (S) with 18 (36%), 16 (32%), and 16 (32%) participants in each category, respectively. Globally, ordination analysis demonstrated clustering by anatomic site (R2 = 0.25, P < 0.001). HIV status and PD severity showed a statistically significant impact on microbiome composition but only accounted for a combined 2% of variation. HIV+ samples were enriched in genera Abiotrophia, Neisseria, Kingella, and unclassified Neisseriaceae and depleted in Leptotrichia and Selenomonas. The Neisseria genus was consistently enriched in HIV+ participants regardless of sampling site and PD level. Immune markers were altered in HIV+ participants but did not show association with the oral microbiome. HIV-associated changes in oral microbiome result in subtle microbial signatures along different stages of PD that are common in independent oral anatomic sites. PMID:28328799

  13. Colliding Epidemics and the Rise of Cryptococcosis

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    Christina C. Chang

    2015-12-01

    Full Text Available Discovered more than 100 years ago as a human pathogen, the Cryptococcus neoformans–Cryptococcus gattii (C. neoformans–C. gattii complex has seen a large global resurgence in its association with clinical disease in the last 30 years. First isolated in fermenting peach juice, and identified as a human pathogen in 1894 in a patient with bone lesions, this environmental pathogen has now found niches in soil, trees, birds, and domestic pets. Cryptococcosis is well recognized as an opportunistic infection and was first noted to be associated with reticuloendothelial cancers in the 1950s. Since then, advances in transplant immunology, medical science and surgical techniques have led to increasing numbers of solid organ transplantations (SOT and hematological stem cell transplantations being performed, and the use of biological immunotherapeutics in increasingly high-risk and older individuals, have contributed to the further rise in cryptococcosis. Globally, however, the major driver for revivification of cryptococcosis is undoubtedly the HIV epidemic, particularly in Sub-Saharan Africa where access to care and antiretroviral therapy remains limited and advanced immunodeficiency, poverty and malnutrition remains the norm. As a zoonotic disease, environmental outbreaks of both human and animal cryptococcosis have been reported, possibly driven by climate change. This is best exemplified by the resurgence of C. gattii infection in Vancouver Island, Canada, and the Pacific Northwest of the United States since 1999. Here we describe how the colliding epidemics of HIV, transplantation and immunologics, climate change and migration have contributed to the rise of cryptococcosis.

  14. Two cases of cutaneous cryptococcosis.

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    Xiujiao, Xia; Ai'e, Xu

    2005-07-01

    We report two cases of cutaneous cryptococcosis in male patients without underlying disease. Case 1 had a granulomatous mass on his right neck, gradually enlarging for 3 months. After the mass was debrided surgically in a hospital, the incision wound gradually developed into a severe ulceration. Mycological examination revealed Cryptococcus neoformans infection. It was significant that histopathology of both pre-surgery granuloma and post-surgery ulceration revealed thick-walled spores with thick capsule. Chest X-ray revealed a shadow in the left lower lung. After treatment with amphotec for 21 days, the lesion healed. Case 2 had an approximately 2 x 2 cm solitary dull nodule on his right thigh, which had been present for 8 months. Mycological examination confirmed that the lesion was caused by C. neoformans. The patient's ratio of peripheral blood CD4(+) cell was slightly reduced. After 14 days of treatment with oral fluconazole, followed by oral itraconazole for 2 months, mycological and clinical cure were achieved. The two isolates were identified as C. neoformans var. gattii serotype C and C. neoformans var. grubii serotype A.

  15. Cutaneous Cryptococcosis: a marker of life threatening disseminated cryptococcosis in HIV AIDS

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    Hari Kishan Kumar Yadalla

    2011-10-01

    Full Text Available Cryptococcosis is an opportunistic infection caused by a ubiquitous encapsulated yeast, Cryptococcus neoformans. Affects 5 – 10 % of patients with HIV worldwide. Disseminated cryptococcosis is one of the AIDS defining criteria and the most common cause of life threatening meningitis. Upto 20% of patients with disseminated disease can have skin involvement. Cutaneous lesions in disseminated cryptococcosis are seldom pathognomonic and portent neurological involvement. The significance of skin lesions may provide the first evidence of dissemination and indicate a poor prognosis, however, earlier recognition and treatment would improve survival. Herein we report a case of cryptococcal meningitis with skin lesions in a HIV seropositive patient.

  16. Cryptococcus and cryptococcosis in Cuba. A minireview.

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    Illnait-Zaragozi, María T; Martínez-Machín, Gerardo F; Fernández-Andreu, Carlos M; Perurena-Lancha, Mayda R; Hagen, Ferry; Meis, Jacques F

    2014-12-01

    Cryptococcosis has emerged as an important public health problem in Africa, Asia and the Americas due to the increasing numbers of persons at risk of this infection and the adaptation of its aetiological agents to new environments. The proper management requires early recognition of Cryptococcus neoformans/C. gattii species complex infection, familiarity with the use and limitations of diagnostic tests and knowledge of the available treatment options. This review will address these issues with the goal of providing sufficient information to suspect, diagnose and treat patients with cryptococcosis based on Cuban data and review of the literature.

  17. Disturbed amino acid metabolism in HIV: association with neuropsychiatric symptoms

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    Johanna M Gostner

    2015-07-01

    Full Text Available Blood levels of the amino acid phenylalanine, as well as of the tryptophan breakdown product kynurenine, are found to be elevated in human immunodeficiency virus type 1 (HIV-1-infected patients. Both essential amino acids, tryptophan and phenylalanine are important precursor molecules for neurotransmitter biosynthesis. Thus, dysregulated amino acid metabolism may be related to disease-associated neuropsychiatric symptoms such as development of depression, fatigue, and cognitive impairment.Increased phenylalanine/tyrosine and kynurenine/tryptophan ratios are associated with immune activation in patients with HIV-1 infection and decrease upon effective antiretroviral therapy. Recent large-scale metabolic studies have confirmed the crucial involvement of tryptophan and phenylalanine metabolism in HIV-associated disease. Herein, we summarize the current status of the role of tryptophan and phenylalanine metabolism in HIV disease and discuss how inflammatory stress-associated dysregulation of amino acid metabolism may be part of the pathophysiology of common HIV-associated neuropsychiatric conditions.

  18. Criptococose em felino Cryptococcosis in cat

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    F.J.F. Sant’Ana

    1999-08-01

    Full Text Available A case of cryptococcosis in a cat refferred to the Hospital Veterinário da Universidade Federal Rural de Pernambuco is described. The cat was euthanized and the microscopic examination of a firm mass observed in the nasal cavity was accomplished. Cryptococcus sp. and a chronic inflammatory process was observed throughout the tissue.

  19. Primary laryngeal cryptococcosis resembling laryngeal carcinoma.

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    Tamagawa, Shunji; Hotomi, Muneki; Yuasa, Jun; Tuchihashi, Shigeki; Yamauchi, Kazuma; Togawa, Akihisa; Yamanaka, Noboru

    2015-08-01

    A case of an 82-year-old female with primary laryngeal cryptococcosis who had undergone long-term corticosteroid therapy for chronic obstructive pulmonary disease and rheumatoid arthritis is reported. She complained hoarseness with swallowing pain and irritability of the larynx for over a month. Endoscopic examination revealed a white, exudative irregular region on right arytenoid that mimicked a laryngeal carcinoma. Histological examination showed pseudoepitheliomatous hyperplasia and severe submucosal inflammation with ovoid budding yeasts by Grocott's stain. A serological study indicated a high titer of cryptococcal antigen. After treating with oral fluconazole for 3 months, her primary lesion of larynx turned to be clear. We implicate a long-term use of steroids as the significant risk factor in developing cryptococcosis of the larynx.

  20. Cryptococcus neoformans population diversity and clinical outcomes of HIV-associated cryptococcal meningitis patients in Zimbabwe.

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    Nyazika, Tinashe K; Hagen, Ferry; Machiridza, Tendai; Kutepa, Melody; Masanganise, Faith; Hendrickx, Marijke; Boekhout, Teun; Magombei-Majinjiwa, Tricia; Siziba, Nonthokozo; Chin'ombe, Nyasha; Mateveke, Kudzanai; Meis, Jacques F; Robertson, Valerie J

    2016-11-01

    HIV and cryptococcal meningitis co-infection is a major public health problem in most developing countries. Cryptococcus neoformans sensu stricto is responsible for the majority of HIV-associated cryptococcosis cases in sub-Saharan Africa. Despite the available information, little is known about cryptococcal population diversity and its association with clinical outcomes in patients with HIV-associated cryptococcal meningitis in sub-Saharan Africa. In a prospective cohort, we investigated the prevalence and clinical outcome of Cryptococcusneoformans sensu stricto meningitis among HIV-infected patients in Harare, Zimbabwe, and compared the genotypic diversity of the isolates with those collected from other parts of Africa. Molecular typing was done using amplified fragment length polymorphism genotyping and microsatellite typing. The majority of patients with HIV-associated Cryptococcusneoformans sensu stricto meningitis in this cohort were males (n=33/55; 60.0 %). The predominant Cryptococcus neoformans sensu stricto genotype among the Zimbabwean isolates was genotype AFLP1/VNI (n=40; 72.7 %), followed by AFLP1A/VNB/VNII (n=8; 14.6 %), and AFLP1B/VNII was the least isolated (n=7; 12.7 %). Most of the isolates were mating-type α (n=51; 92.7 %), and only four (7.3 %) were mating-type a. Overall in-hospital mortality was 55.6 % (n=30), and no difference between infecting genotype and clinical outcome of patient (P=0.73) or CD4+ counts (P=0.79) was observed. Zimbabwean Cryptococcusneoformans sensu stricto genotypes demonstrated a high level of genetic diversity by microsatellite typing, and 51 genotypes within the main molecular types AFLP1/VNI, AFLP1A/VNB/VNII and AFLP1B/VNII were identified. This study demonstrates that Cryptococcusneoformans sensu stricto in Zimbabwe has a high level of genetic diversity when compared to other regional isolates.

  1. Direct determination of cryptococcal antigen in transthoracic needle aspirate for diagnosis of pulmonary cryptococcosis.

    OpenAIRE

    Liaw, Y S; Yang, P C; Yu, C. J.; Chang, D B; Wang, H.J.; Lee, L N; Kuo, S H; Luh, K T

    1995-01-01

    Pulmonary cryptococcosis causes significant morbidity and mortality in immunocompromised patients. Definitive diagnosis of pulmonary cryptococcosis is usually difficult. The use of direct determination of cryptococcal antigen in transthoracic needle aspirate to diagnose pulmonary cryptococcosis was investigated. Over a 2-year period, we studied a total of 41 patients with respiratory symptoms and pulmonary infiltrates of unknown etiology who were suspected of having pulmonary cryptococcosis. ...

  2. Role of Natural Killer Cells in HIV-Associated Malignancies

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    Leal, Fabio E.; Premeaux, Thomas A.; Abdel-Mohsen, Mohamed; Ndhlovu, Lishomwa C.

    2017-01-01

    Now in its fourth decade, the burden of HIV disease still persists, despite significant milestone achievements in HIV prevention, diagnosis, treatment, care, and support. Even with long-term use of currently available antiretroviral therapies (ARTs), eradication of HIV remains elusive and now poses a unique set of challenges for the HIV-infected individual. The occurrence of HIV-associated non-AIDS-related comorbidities outside the scope of AIDS-defining illnesses, in particular non-AIDS-defining cancers, is much greater than the age-matched uninfected population. The underlying mechanism is now recognized in part to be related to the immune dysregulated and inflammatory status characteristic of HIV infection that persists despite ART. Natural killer (NK) cells are multifunctional effector immune cells that play a critical role in shaping the innate immune responses to viral infections and cancer. NK cells can modulate the adaptive immune response via their role in dendritic cell (DC) maturation, removal of immature tolerogenic DCs, and their ability to produce immunoregulatory cytokines. NK cells are therefore poised as attractive therapeutic targets that can be harnessed to control or clear both HIV and HIV-associated malignancies. To date, features of the tumor microenvironment and the evolution of NK-cell function among individuals with HIV-related malignancies remain unclear and may be distinct from malignancies observed in uninfected persons. This review intends to uncouple anti-HIV and antitumor NK-cell features that can be manipulated to halt the evolution of HIV disease and HIV-associated malignancies and serve as potential preventative and curative immunotherapeutic options. PMID:28377768

  3. Cryptococcosis in Colombian children and literature review

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    Jairo Lizarazo

    2014-09-01

    Full Text Available Cryptococcosis is reported in adults and is often acquired immune deficiency syndrome (AIDS-associated; however, its frequency in children is low. Based on the National Survey on Cryptococcosis conducted in Colombia, an epidemiological and clinical analysis was performed on cases of the disease observed in children less than 16 years old between 1993-2010. We found 41 affected children (2.6% prevalence from the 1,578 surveys received. The country mean annual incidence rate was 0.017 cases/100,000 children under 16 years, while in Norte de Santander the incidence rate was 0.122 cases/100,000 (p < 0.0001. The average age of infected children was 8.4 and 58.5% were male. In 46.3% of cases, a risk factor was not identified, while 24.4% had AIDS. The most frequent clinical manifestations were headache (78.1%, fever (68.8%, nausea and vomiting (65.6%, confusion (50% and meningeal signs (37.5%. Meningitis was the most frequent clinical presentation (87.8%. Amphotericin B was given to 93.5% of patients as an initial treatment. Positive microbiological identification was accomplished by India ink (94.7%, latex in cerebrospinal fluid (100% and culture (89.5%. Out of 34 isolates studied, Cryptococcus neoformans var. grubii (VNI 85.3%, VNII 8.8% was isolated in 94.1% of cases and Cryptococcus gattii (VGII was isolated in 5.9% of cases. These data are complemented by a literature review, which overall suggests that cryptococcosis in children is an unusual event worldwide.

  4. Pulmonary cryptococcosis in non-AIDS patients

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    Jin-Quan

    2012-12-01

    Full Text Available OBJECTIVE: To investigate the clinical features, management, and prognosis of pulmonary cryptococcosis in non-acquired immunodeficiency syndrome (AIDS patients. METHOD: 24 cases of pulmonary cryptococcosis with accurate pathological diagnosis were retrospectively studied. RESULTS: 15 male patients and nine female patients were diagnosed at the first affiliated hospital of Sun Yat-sen University from November 1999 to November 2011. The mean age at the time of diagnosis was 44.2 ± 11.3 years (range: 24 to 65 years. Among these patients, 13 had other comorbidities. 15 were symptomatic and the other nine were asymptomatic. The most common presenting symptoms were cough, chest tightness, expectoration, and fever. None had concurrent cryptococcal meningitis. The most frequent radiologic abnormalities on chest computed tomography (CT scans were solitary or multiple pulmonary nodules, and masses or consolidations, and most lesions were located in the lower lobes. All patients had biopsies for the accurate diagnosis. Among the 24 patients, nine patients underwent surgical resections (eight had pneumonectomy via thoracotomy and one had a pneumonectomy via thoracoscopy. Five of the patients who underwent surgery also received antifungal drug therapy (fluconazole for one to three months after the surgery. The other 15 only received antifungal drug therapy (fluconazole or voriconazole for three to six months (five patients are still on therapy. The follow-up observation of 19 patients who had already finished their treatments lasted from two to 11 years, and there was no relapse, dissemination, or death in any of these patients. CONCLUSION: Non-AIDS patients with pulmonary cryptococcosis have a good prognosis with appropriate management.

  5. Neuroimaging of HIV-associated neurocognitive disorders

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    Michel Elyas Jung Haziot

    Full Text Available ABSTRACT A significant increase in the incidence of cognitive impairment in HIV/AIDS patients has been continuously observed. Consequently, three classification categories of cognitive impairment have been proposed: asymptomatic neurocognitive impairment (ANI and mild neurocognitive disorder (MND, that correspond to the mild and intermediate forms, and HIV-associated dementia (HAD for the most severe cases. HIV-associated neurocognitive disorders (HAND is a broad term that encompasses these three categories. Moreover, the application of neuroimaging methods has led to a major breakthrough in understanding of the neurological changes in HIV, providing greater reliability in the exclusion of associated diseases and allowing earlier diagnosis. Therefore, abnormalities and/or specific neuroimaging elements may soon be incorporated into the HAND classification criteria, which will be of great value in the management of these diseases, including in the optimization of high CNS penetration antiretroviral regimens.

  6. Cryptococcosis outbreak in psittacine birds in Brazil.

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    Raso, T F; Werther, K; Miranda, E T; Mendes-Giannini, M J S

    2004-08-01

    An outbreak of cryptococcosis occurred in a breeding aviary in São Paulo, Brazil. Seven psittacine birds (of species Charmosyna papou, Lorius lory, Trichoglossus goldiei, Psittacula krameri and Psittacus erithacus) died of disseminated cryptococcosis. Incoordination, progressive paralysis and difficulty in flying were seen in five birds, whereas superficial lesions coincident with respiratory alterations were seen in two birds. Encapsulated yeasts suggestive of Cryptococcus sp. were seen in faecal smears stained with India ink in two cases. Histological examination of the birds showed cryptococcal cells in various tissues, including the beak, choana, sinus, lungs, air sacs, heart, liver, spleen, kidneys, intestines and central nervous system. High titres of cryptococcal antigen were observed in the serum of an affected bird. In this case, titres increased during treatment and the bird eventually died. Yeasts were isolated from the nasal mass, faeces and liver of one bird. Cryptococcus neoformans var. gattii serovar B was identified based on biochemical, physiological and serological tests. These strains were resistant (minimum inhibitory concentration 64 microg/ml) to fluconazole. This is the first report of C. neoformans var. gattii occurring in psittacine birds in Brazil.

  7. Disseminated cryptococcosis with cutaneous involvement in an immunocompetent patient*

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    Sacht, Gabriely Lessa; de Lima, Alexandre Moretti; Perdomo, Yuri Chiarelli; Boigues, Rafaela Suguimoto; Takita, Luiz Carlos; Hans Filho, Günter

    2016-01-01

    Cryptococcosis is a fungal infection of opportunistic behavior that is unusual in immunocompetent patients. We report a rare case of disseminated cryptococcosis with cutaneous involvement in an immunocompetent individual. During hospitalization, Cryptococcus gattii was isolated from skin lesions, lung and spinal fluid. The diagnosis of disseminated cryptococcosis was confirmed and treatment was established. The patient showed improvement. Due to the probable clinical severity of the disease and the possibility that skin lesions may be the first manifestation of this illness, prompt diagnosis must be established and treatment provided. PMID:28099613

  8. Biliary cryptococcosis in a child: MR imaging findings

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    Jyoti Das, Chandan; Hari, Smriti [All India Institute of Medical Science, Department of Radiology, New Delhi (India); Shyam Pangtey, Ghan [All India Institute of Medical Science, Department of Medicine, New Delhi (India); Hari, Pankaj [All India Institute of Medical Science, Department of Paediatrics, New Delhi (India); Kumar Das, Anup [All India Institute of Medical Science, Department of Pathology, New Delhi (India)

    2006-08-15

    Cryptococcosis is a systemic mycosis with a worldwide distribution. It frequently occurs in patients who are immunologically compromised or chronically ill. Clinical manifestations are usually confined to the central nervous system, lungs and skin. Involvement of the hepatobiliary system is very rare. We describe the MR imaging appearance of a rare case of disseminated cryptococcosis in an immunocompetent child in whom the clinical presentation was dominated by biliary and lymph nodal involvement. (orig.)

  9. HIV-associated memory B cell perturbations.

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    Hu, Zhiliang; Luo, Zhenwu; Wan, Zhuang; Wu, Hao; Li, Wei; Zhang, Tong; Jiang, Wei

    2015-05-21

    Memory B-cell depletion, hyperimmunoglobulinemia, and impaired vaccine responses are the hallmark of B cell perturbations inhuman immunodeficiency virus (HIV) disease. Although B cells are not the targets for HIV infection, there is evidence for B cell, especially memory B cell dysfunction in HIV disease mediated by other cells or HIV itself. This review will focus on HIV-associated phenotypic and functional alterations in memory B cells. Additionally, we will discuss the mechanism underlying these perturbations and the effect of anti-retroviral therapy (ART) on these perturbations.

  10. Pulmonary cryptococcosis induces chitinase in the rat

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    Casadevall Arturo

    2008-05-01

    Full Text Available Abstract Background We previously demonstrated that chronic pulmonary infection with Cryptococcus neoformans results in enhanced allergic inflammation and airway hyperreactivity in a rat model. Because the cell wall of C. neoformans consists of chitin, and since acidic mammalian chitinase (AMCase has recently been implicated as a novel mediator of asthma, we sought to determine whether such infection induces chitinase activity and expression of AMCase in the rat. Methods We utilized a previously-established model of chronic C. neoformans pulmonary infection in the rat to analyze the activity, expression and localization of AMCase. Results Our studies indicate that intratracheal inoculation of C. neoformans induces chitinase activity within the lung and bronchoalveolar lavage fluid of infected rats. Chitinase activity is also elicited by pulmonary infection with other fungi (e.g. C. albicans, but not by the inoculation of dead organisms. Enhanced chitinase activity reflects increased AMCase expression by airway epithelial cells and alveolar macrophages. Systemic cryptococcosis is not associated with increased pulmonary chitinase activity or AMCase expression. Conclusion Our findings indicate a possible link between respiratory fungal infections, including C. neoformans, and asthma through the induction of AMCase.

  11. Acupuncture to Reduce HIV-Associated Inflammation

    Directory of Open Access Journals (Sweden)

    Barbara Swanson

    2015-01-01

    Full Text Available Background. HIV infection is associated with systemic inflammation that can increase risk for cardiovascular events. Acupuncture has been shown to have immunomodulatory effects and to improve symptoms in persons with inflammatory conditions. Objective. To test the anti-inflammatory effects of an acupuncture protocol that targets the cholinergic anti-inflammatory pathway (CAIP, a neural mechanism whose activation has been shown to reduce the release of proinflammatory cytokines, in persons with HIV-associated inflammation. Design, Setting, Participants, and Interventions. Double-blind, placebo-controlled clinical trial conducted in an outpatient clinic located in a medically underserved urban neighborhood. Twenty-five clinically-stable HIV-infected persons on antiretroviral therapy were randomized to receive once weekly CAIP-based acupuncture or sham acupuncture. Main Outcome Measures. Outcomes included plasma concentrations of high sensitivity C-reactive protein and D-dimer and fasting lipids. Results. Twenty-five participants completed the protocol (treatment group n=12, control group n=13. No adverse events related to the acupuncture protocol were observed. Compared to baseline values, the two groups did not significantly differ in any outcome measures at the end of the acupuncture protocol. Conclusions. CAIP-based acupuncture did not favorably modulate inflammatory or lipid parameters. Additional studies are warranted of CAIP-based protocols of different frequencies/durations.

  12. Isavuconazole Treatment of Cryptococcosis and Dimorphic Mycoses

    Science.gov (United States)

    Thompson, George R.; Rendon, Adrian; Ribeiro dos Santos, Rodrigo; Queiroz-Telles, Flavio; Ostrosky-Zeichner, Luis; Azie, Nkechi; Maher, Rochelle; Lee, Misun; Kovanda, Laura; Engelhardt, Marc; Vazquez, Jose A.; Cornely, Oliver A.; Perfect, John R.

    2016-01-01

    Background. Invasive fungal diseases (IFD) caused by Cryptococcus and dimorphic fungi are associated with significant morbidity and mortality. Isavuconazole (ISAV) is a novel, broad-spectrum, triazole antifungal agent (IV and by mouth [PO]) developed for the treatment of IFD. It displays potent activity in vitro against these pathogens and in this report we examine outcomes of patients with cryptococcosis or dimorphic fungal infections treated with ISAV. Methods. The VITAL study was an open-label nonrandomized phase 3 trial conducted to evaluate the efficacy and safety of ISAV treatment in management of rare IFD. Patients received ISAV 200 mg 3 times daily for 2 days followed by 200 mg once-daily (IV or PO). Proven IFD and overall response at end of treatment (EOT) were determined by an independent, data-review committee. Mortality and safety were also assessed. Results. Thirty-eight patients received ISAV for IFD caused by Cryptococcus spp. (n = 9), Paracoccidioides spp. (n = 10), Coccidioides spp. (n = 9), Histoplasma spp. (n = 7) and Blastomyces spp. (n = 3). The median length of therapy was 180 days (range 2–331 days). At EOT 24/38 (63%) patients exhibited a successful overall response. Furthermore, 8 of 38 (21%) had stable IFD at the end of therapy without progression of disease, and 6 (16%) patients had progressive IFD despite this antifungal therapy. Thirty-three (87%) patients experienced adverse events. Conclusions. ISAV was well tolerated and demonstrated clinical activity against these endemic fungi with a safety profile similar to that observed in larger studies, validating its broad-spectrum in vitro activity and suggesting it may be a valuable alternative to currently available agents. Clinical Trials Registration. NCT00634049. PMID:27169478

  13. Pulmonary cryptococcosis in rheumatoid arthritis (RA) patients: Comparison of imaging characteristics among RA, acquired immunodeficiency syndrome, and immunocompetent patients

    Energy Technology Data Exchange (ETDEWEB)

    Yanagawa, Noriyo, E-mail: noriyo_yana@ybb.ne.jp [Departments of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-8-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677 (Japan); Sakai, Fumikazu [Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama 350-1298 (Japan); Takemura, Tamiko [Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935 (Japan); Ishikawa, Satoru [Department of Respiratory Medicine, National Hospital Organization Chiba-East-Hospital, 673 Nitona-cho, Chuo-ku, Chiba-shi, Chiba 260-8712 (Japan); Takaki, Yasunobu [Departments of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-8-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677 (Japan); Hishima, Tsunekazu [Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-8-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677 (Japan); Kamata, Noriko [Departments of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-8-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677 (Japan)

    2013-11-01

    Purpose: The imaging characteristics of cryptococcosis in rheumatoid arthritis (RA) patients were analyzed by comparing them with those of acquired immunodeficiency syndrome (AIDS) and immunocompetent patients, and the imaging findings were correlated with pathological findings. Methods: Two radiologists retrospectively compared the computed tomographic (CT) findings of 35 episodes of pulmonary cryptococcosis in 31 patients with 3 kinds of underlying states (10 RA, 12 AIDS, 13 immunocompetent), focusing on the nature, number, and distribution of lesions. The pathological findings of 18 patients (8 RA, 2 AIDS, 8 immunocompetent) were analyzed by two pathologists, and then correlated with imaging findings. Results: The frequencies of consolidation and ground glass attenuation (GGA) were significantly higher, and the frequency of peripheral distribution was significantly lower in the RA group than in the immunocompetent group. Peripheral distribution was less common and generalized distribution was more frequent in the RA group than in the AIDS group. The pathological findings of the AIDS and immunocompetent groups reflected their immune status: There was lack of a granuloma reaction in the AIDS group, and a complete granuloma reaction in the immunocompetent group, while the findings of the RA group varied, including a complete granuloma reaction, a loose granuloma reaction and a hyper-immune reaction. Cases with the last two pathologic findings were symptomatic and showed generalized or central distribution on CT. Conclusion: Cryptococcosis in the RA group showed characteristic radiological and pathological findings compared with the other 2 groups.

  14. Prevalence of HIV associated neurocognitive deficit among HIV ...

    African Journals Online (AJOL)

    ... of HIV associated neurocognitive deficit among HIV positive people in Ethiopia: ... the factors associated with cognitive impairment among HIV positive people in ... activity of daily living scale and Hospital Anxiety and Depression scale were ...

  15. Apolipoprotein E4 genotype does not increase risk of HIV-associated neurocognitive disorders.

    Science.gov (United States)

    Morgan, E E; Woods, S P; Letendre, S L; Franklin, D R; Bloss, C; Goate, A; Heaton, R K; Collier, A C; Marra, C M; Gelman, B B; McArthur, J C; Morgello, S; Simpson, D M; McCutchan, J A; Ellis, R J; Abramson, I; Gamst, A; Fennema-Notestine, C; Smith, D M; Grant, I; Vaida, F; Clifford, D B

    2013-04-01

    This is a cross-sectional, observational study to evaluate the hypothesis that HIV-seropositive (HIV+) apolipoprotein E4 (APOE4) carriers are at increased risk for HIV-associated neurocognitive disorders (HAND) compared to APOE4 noncarriers with HIV in the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) Group sample. APOE genotype was determined in 466 CHARTER participants with varying disease stages and histories of antiretroviral treatment who did not have severe psychiatric or medical comorbid conditions that preclude diagnosis of HAND. HAND diagnoses were based on results of comprehensive neurobehavioral evaluation and use of current neuroAIDS diagnostic criteria. HAND status consists of two levels: neuropsychologically normal status (i.e., no HAND) and any HAND diagnosis (i.e., asymptomatic neurocognitive impairment, minor neurocognitive disorder, HIV-associated dementia). Logistic regression analyses revealed no association between APOE4 carrier status and HAND, and there were no interactions between APOE4 carrier status and ethnicity, age, substance use disorders, duration of infection, or nadir CD4. Results did not differ when analysis was restricted to symptomatic HAND, and no APOE4 gene dose-dependent relationship to HAND emerged. APOE4 status was not associated with concurrent HAND in this large, well-characterized sample. This does not preclude emergence of an association between APOE4 status and HAND as this population ages. Prospective, longitudinal studies are needed to examine APOE4 as a risk factor for neurocognitive decline, incident HAND at older ages, and potential associations with cerebrospinal fluid amyloid.

  16. Multiple osseous involvements in a case of disseminated cryptococcosis

    Directory of Open Access Journals (Sweden)

    Singh Rakesh

    2010-01-01

    Full Text Available Osseous involvement occurs in 5-10% of patients with disseminated cryptococcosis. We are reporting an unusual case of disseminated cryptococcosis involving the sternum and lumbar vertebra with the formation of psoas abscess with pulmonary tuberculosis. The patient presented with fever for 3 months. A diagnosis of pulmonary tuberculosis was made on thoracic contrast-enhanced computerized tomography and she was put on antituberculosis treatment. She was immunocompetent with negative human immunodeficiency virus. She conceived subsequently and had complaints of backache and swelling over the sternum. Magnetic resonance imaging showed destruction of L5 vertebra with psoas abscess. Vertebral cryptococcosis may mimic tuberculosis and malignancy. She had a bad obstetric history and experienced five, first-trimester spontaneous abortions in each successive year since 2001. This pregnancy again resulted in spontaneous abortion. Cryptococcus neoformans was isolated from two different sites: pus-involving the sternum and ultrasound-guided psoas abscess aspirate. Serum latex agglutination test for cryptococcal capsular polysaccharide antigen was positive. The diagnosis of cryptococcosis was delayed because the patient was diagnosed as a case of pulmonary tuberculosis, wherein clinical signs, symptoms and radiological findings in both the conditions are similar. Amphotericin B was started but she developed varicella infection and expired due to cardiac failure.

  17. Disseminated cryptococcosis with extensive subcutaneous nodules in a renal transplant recipient

    Institute of Scientific and Technical Information of China (English)

    桑红; 周文泉; 石群立; 张新华; 倪容之

    2004-01-01

    @@ Patients with disseminated cryptococcosis infrequently present with cutaneous involvement. A 34-year-old woman who had a renal transplant developed disseminated cryptococcosis with an unusual cutaneous presentation. Extensive subcutaneous nodules are rare in disseminated cryptococcosis, but the patient belonged to a high-risk group. Fluconazole 200 mg/d was administered intravenously. After a total dose of 1800 mg of fluconazole was given, the patient ' s situation improved.

  18. Plasma sphingolipids in HIV-associated chronic obstructive pulmonary disease

    Science.gov (United States)

    Hodgson, Shane; Griffin, Timothy J; Reilly, Cavan; Harvey, Stephen; Witthuhn, Bruce A; Sandri, Brian J; Wendt, Chris H

    2017-01-01

    Introduction Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity in persons living with HIV (PLWH) and HIV appears to uniquely cause COPD, independent of smoking. The mechanisms by which HIV leads to COPD are not clear. The objective of this study was to identify metabolomic biomarkers and potential mechanistic pathways of HIV-associated COPD (HIV-COPD). Methods We performed case–control metabolite profiling via mass spectrometry in plasma from 38 individuals with HIV-COPD (cases), comparing to matched controls with/without HIV and with/without COPD. Untargeted metabolites of interest were identified with liquid chromatography with mass spectrometry (LC-MS/mass spectrometry (MS)), and targeted metabolomics for tryptophan (Trp) and kynurenine (Kyn) were measured by selective reaction monitoring (SRM) with LC-MS/MS. We used mixed-effects models to compare metabolite concentrations in cases compared with controls while controlling for relevant biological variables. Results We identified 1689 analytes associated with HIV-COPD at a false discovery rate (FDR) of 10%. In PLWH, we identified 263 analytes (10% FDR) between those with and without COPD. LC MS/MS identified Trp and 17 lipids, including sphingolipids and diacylglycerol. After adjusting for relevant covariates, the Kyn/Trp ratio measured by SRM was significantly higher in PLWH (p=0.022), but was not associated with COPD status (p=0.95). Conclusions There is a unique metabolite profile in HIV-COPD that includes sphingolipids. Trp metabolism is increased in HIV, but does not appear to independently contribute to HIV-COPD. Trial registration numbers NCT01810289, NCT01797367, NCT00608764.

  19. Early onset primary pulmonary cryptococcosis in a renal transplant patient

    Directory of Open Access Journals (Sweden)

    Tarai B

    2010-01-01

    Full Text Available We report a case of primary pulmonary cryptococcosis in a post-renal transplant patient. A 65-year-old male renal transplant patient was admitted to the hospital with a low grade fever of 1 month, radiologically mimicking tuberculosis (TB. Broncho-alveolar fluid (BAL shows capsulated yeast, and Cryptococcus neoformans was grown on culture supported by cytology and histopathological examination. Cryptococcal antigen was positive (32-fold in serum and was negative in cerebrospinal fluid (CSF. The patient was given amphotericin B and 5-flucytosine and clinical improvement was seen on a weekly follow up. The serum cryptococcal antigen test might contribute to the early detection and treatment of pulmonary cryptococcosis. The results of antifungal susceptibility were aid in selecting the drug of choice for treatment.

  20. Opportunistic yeast infections: candidiasis, cryptococcosis, trichosporonosis and geotrichosis.

    Science.gov (United States)

    Vázquez-González, Denisse; Perusquía-Ortiz, Ana María; Hundeiker, Max; Bonifaz, Alexandro

    2013-05-01

    Opportunistic yeast infections are diseases caused by fungi which normally are saprophytic and do not cause disease in humans or animals. The prevalence of these diseases has been increasing due to immunosuppressive, corticosteroid, and long-term antibiotic treatment following organ transplantation or after serious metabolic, hematological, or immunological diseases. We review epidemiological, clinical, diagnostic, and therapeutic aspects of the four "big" opportunistic yeast infections: candidiasis, cryptococcosis, trichosporonosis, and geotrichosis.

  1. Urease as a Virulence Factor in Experimental Cryptococcosis

    OpenAIRE

    Cox, Gary M.; Mukherjee, Jean; Cole, Garry T.; Casadevall, Arturo; Perfect, John R.

    2000-01-01

    Urease catalyzes the hydrolysis of urea to ammonia and carbamate and has been found to be an important pathogenic factor for certain bacteria. Cryptococcus neoformans is a significant human pathogenic fungus that produces large amounts of urease; thus we wanted to investigate the importance of urease in the pathogenesis of cryptococcosis. We cloned and sequenced the genomic locus containing the single-copy C. neoformans urease gene (URE1) and used this to disrupt the native URE1 in the seroty...

  2. First case of disseminated cryptococcosis in a Gorilla gorilla.

    Science.gov (United States)

    Mischnik, Alexander; Stockklausner, Julia; Hohneder, Nicole; Jensen, Henrik E; Zimmermann, Stefan; Reuss, David E; Rickerts, Volker; Tintelnot, Kathrin; Stockklausner, Clemens

    2014-11-01

    In humans, Cryptococcus mainly infects individuals with HIV infection or other types of immunosuppression. Here, we report the first case of disseminated cryptococcosis in a simian immunodeficiency virus-negative 27-year-old female Gorilla gorilla presenting with lethargy, progressive weight loss and productive cough. The diagnosis was confirmed by positive lung biopsy culture, serum cryptococcal antigen, and cerebral histopathology demonstrating encapsulated yeasts. Molecular characterisation of lung culture isolate yielded Cryptococcus neoformans var. grubii. An immune-deficiency could not be demonstrated.

  3. Case of cerebral cryptococcosis. Mainly computerized tomographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Yamagami, Tatsuhito; Nomura, Takayoshi; Imagawa, Kenji; Asai, Akira; Kawasaki, Michiro (National Hospital of Nagoya (Japan))

    1984-05-01

    A 66-year-old female was admitted to our hospital with chief complaint of vertigo, gait disturbance and dysarthria. These symptoms started about one year before admission and worsened. Vomiting and urinary incontinence appeared. Neurological examination revealed left cerebellar ataxia and dysarthria. In plain CT (computerized tomography) irregular ill-defined low density area was noted in the cerebellar vermis and bilateral cerebellar hemispheres. And slight ventricular dilatation was found. Irregular shape of ring-like enhancement corresponding to capsule and patchy or mottled enhancement inside the tumor were seen. Suboccipital craniectomy was performed and yellowish necrotic tumor with hard capsule was removed. Histological diagnosis was not neoplasm or tuberculoma. Postoperatively liver function progressively worsened. She died due to disseminated intravascular coagulation. Autopsy revealed typical liver cirrhosis without malignant change. 3.0 x 2.5 cm sized, slightly hard, yellowish lesion was found on upper part of cerebellar hemispheres. This had extremely necrotic tissue and a great number of cryptococcus neoformans were found. And other intracranial lesion was not confirmed. Finding of pulmonary cryptococcosis was not gained. Our case is very rare because of solitary cerebellar abscess and absence of meningitic episode or pulmonary cryptococcosis. There are three types of inflammation in cerebral cryptococcosis. The commonest manifestation is the meningitic type, the second mode is granulomatous lesion and the third and the least presentation is intracranial abscess formation. CT reveals various finidngs according to clinical stage. CT findings are those of meningitis, meningoencephalitis, granuloma and abscess. Cryptococcal granuloma or abscess often simulates brain abscess, glioma and metastatic brain tumor. We discussed CT findings of cerebral cryptococcosis and examined the CT number of our case.

  4. Lipid-based amphotericin B in the treatment of cryptococcosis.

    Science.gov (United States)

    Viviani, M A; Rizzardini, G; Tortorano, A M; Fasan, M; Capetti, A; Roverselli, A M; Gringeri, A; Suter, F

    1994-01-01

    Amphotericin B is the only antifungal drug which, despite its dose-limiting toxicity, can be given intravenously when an aggressive treatment is required. In an attempt to reduce the drug toxicity while retaining its therapeutic efficacy, new formulations of amphotericin B have been developed. The most promising have employed lipid vehicles such as liposomes. Three lipid-based amphotericin B formulations have been developed by pharmaceutical companies and are under active clinical investigation. Efficacy and safety data of these derivatives in animals and humans are reviewed, with particular concern to cryptococcal infection. The authors' experience with a small unilamellar liposomal amphotericin B formulation, AmBisome, in the primary therapy of cryptococcosis is reported. Nine AIDS patients affected with cryptococcosis, seven of whom had meningitis, were given AmBisome (3 mg/kg/day) for 3-6 weeks. Complete response was obtained in six patients, marked improvement in two, and failure in one. AmBisome was well tolerated and shortened the time to clinical and mycological response suggesting a further improvement in the management of cryptococcosis in AIDS patients.

  5. Influence of antituberculosis drug resistance and Mycobacterium tuberculosis lineage on outcome in HIV-associated tuberculous meningitis.

    Science.gov (United States)

    Tho, Dau Quang; Török, M Estée; Yen, Nguyen Thi Bich; Bang, Nguyen Duc; Lan, Nguyen Thi Ngoc; Kiet, Vo Sy; van Vinh Chau, Nguyen; Dung, Nguyen Huy; Day, Jeremy; Farrar, Jeremy; Wolbers, Marcel; Caws, Maxine

    2012-06-01

    HIV-associated tuberculous meningitis (TBM) has high mortality. Aside from the devastating impact of multidrug resistance (MDR) on survival, little is understood about the influence of other bacterial factors on outcome. This study examined the influence of Mycobacterium tuberculosis drug resistance, bacterial lineage, and host vaccination status on outcome in patients with HIV-associated TBM. Mycobacterium tuberculosis isolates from the cerebrospinal fluid of 186 patients enrolled in two studies of HIV-associated TBM in Ho Chi Minh City, Vietnam, were tested for resistance to first-line antituberculosis drugs. Lineage genotyping was available for 122 patients. The influence of antituberculosis drug resistance and M. tuberculosis lineage on 9-month mortality was analyzed using Kaplan-Meier survival analysis and Cox multiple regression models. Isoniazid (INH) resistance without rifampin resistance was associated with increased mortality (adjusted hazard ratio [HR], 1.78, 95% confidence interval [CI], 1.18 to 2.66; P = 0.005), and multidrug resistance was uniformly fatal (n = 8/8; adjusted HR, 5.21, 95% CI, 2.38 to 11.42; P tuberculosis lineage are important determinants of mortality in patients with HIV-associated TBM. Interventions which target these factors may help reduce the unacceptably high mortality in patients with TBM.

  6. CRYPTOCOCCAL MENINGITIS AND PULMONARY CRYPTOCOCCOSIS IN A NON-HIV INFECTED PATIENT

    OpenAIRE

    2006-01-01

    Pulmonary cryptococcosis associated with cryptococcal meningitis in non-HIV infected patients is an uncommon finding. We report a case of polymyositis who developed pulmonary cryptococcosis and cryptococcal meningitis while she was on long term oral steroids, treated successfully. Key words: AIDS, Cryptococcus meningitis, HIV, immunosuppressive therapy

  7. Prevalence of HIV Associated Neurocognitive Deficit among HIV ...

    African Journals Online (AJOL)

    GB

    2017-01-01

    Jan 1, 2017 ... Late clinical stage of the illness (AOR= 4.2 (95% CI; ... cognitive deficit, HIV Associated Dementia, Cognitive Impairment, ..... Memory recall was assessed in the third part, and it was found that 119(50.9%) ... times more prone to develop NCD (AOR= 7.19 .... impairment in HIV-1-infected adults in Sub-.

  8. Human immunodeficiency virus (HIV)-associated polymorphic lymphoproliferative disorders.

    Science.gov (United States)

    Nador, Roland G; Chadburn, Amy; Gundappa, Girija; Cesarman, Ethel; Said, Jonathan W; Knowles, Daniel M

    2003-03-01

    The majority of AIDS-related non-Hodgkin's lymphomas are clinically aggressive monoclonal B-cell Burkitt's lymphomas, large cell lymphomas, or immunoblastic lymphomas. In contrast, the lymphoid proliferations arising in solid organ transplant recipients, collectively referred to as posttransplantation lymphoproliferative disorders (PT-LPDs), represent a clinically and histopathologically heterogeneous group of Epstein-Barr virus (EBV)-driven B-cell proliferations of variable clonal composition. During a retrospective histopathologic review of lymphoid proliferations associated with human immunodeficiency virus (HIV) infection we identified 10 cases that morphologically resemble the polymorphic PT-LPDs. They arose in lymph nodes (five), lungs (two), and the parotid gland, perineum, and skin (one each). They exhibit a diffuse growth pattern and are composed of a polymorphic lymphoid cell population exhibiting a variable degree of plasmacytic differentiation, cytologic atypia, and numbers of atypical immunoblasts. A clonal B-cell population was detected by immunoglobulin heavy and light chain gene rearrangement and/or EBV terminal repeat analysis in 8 of the 10 (80%) cases by Southern blotting. The nongermline hybridizing bands were usually faint, however, suggesting that the clonal B-cell population represented only a subpopulation within the polymorphic lesion. Strong clonal rearrangement bands were present in one case in which there was clear morphologic evidence of transformation to diffuse large cell lymphoma. This case exhibited C-MYC, BCL-6, and p53 gene mutations. One other case exhibited a p53 gene mutation. The remaining eight cases lacked C-MYC, BCL-6, RAS, and p53 gene alterations. Clonal EBV infection was detected in 4 of the 10 (40%) lesions. Like EBV-containing PT-LPDs, all four EBV-positive HIV-associated polymorphic lesions were associated with type A EBV. The Kaposi's sarcoma-associated herpesvirus was detectable in two cases by polymerase chain

  9. Cryptococcosis in captive cheetah (Acinonyx jubatus : two cases : case report

    Directory of Open Access Journals (Sweden)

    L.A. Bolton

    1999-07-01

    Full Text Available Cryptococcus neoformans is a yeast-like organism associated with pulmonary, meningoencephalitic, or systemic disease. This case report documents 2 cases of cryptococcosis with central nervous system involvement in captive cheetah (Acinonyx jubatus. In both cases the predominant post mortal lesions were pulmonary cryptococcomas and extensive meningoencephalomyelitis. Both cheetahs tested negative for feline immunodeficiency virus and feline leukaemia virus. The organism isolated in Case 2 was classified as Cryptococcus neoformans var. gattii, which is mainly associated with disease in immunocompetent hosts.

  10. Anabolic treatment with GH, IGF-I, or anabolic steroids in patients with HIV-associated wasting.

    Science.gov (United States)

    Mulligan, Kathleen; Schambelan, Morris

    2002-09-01

    Wasting, and particularly loss of metabolically active lean tissue, contributes to increased mortality, accelerated disease progression, and impairment of strength and functional status in patients with HIV infection. A variety of protein anabolic agents, including growth hormone, insulin-like growth factor-I, testosterone, nandrolone decanoate, oxandrolone, and oxymetholone, have been studied in patients with HIV-associated wasting. Overall, these studies have demonstrated that treatment with protein anabolic agents can increase lean body mass (LBM) and in some cases provide functional benefits and improvements in quality of life. Further research is needed to determine whether such treatment prolongs survival or reduces the overall health care burden of HIV infection. The advances in identification of successful treatments for HIV-associated wasting can provide a model for using these therapies in other catabolic states, including end-stage renal disease, cancer, chronic obstructive pulmonary disease, and cardiac cachexia.

  11. Tryptophan, Neurodegeneration and HIV-Associated Neurocognitive Disorder

    Directory of Open Access Journals (Sweden)

    Nicholas W.S. Davies

    2010-06-01

    Full Text Available This review presents an up-to-date assessment of the role of the tryptophan metabolic and catabolic pathways in neurodegenerative disease and HIV-associated neurocognitive disorder. The kynurenine pathway and the effects of each of its enzymes and products are reviewed. The differential expression of the kynurenine pathway in cells within the brain, including inflammatory cells, is explored given the increasing recognition of the importance of inflammation in neurodegenerative disease. An overview of common mechanisms of neurodegeneration is presented before a review and discussion of the evidence for a pathogenetic role of the kynurenine pathway in Alzheimer’s disease, HIV-associated neurocognitive disorder, Huntington’s disease, motor neurone disease, and Parkinson’s disease.

  12. Direct determination of cryptococcal antigen in transthoracic needle aspirate for diagnosis of pulmonary cryptococcosis.

    Science.gov (United States)

    Liaw, Y S; Yang, P C; Yu, C J; Chang, D B; Wang, H J; Lee, L N; Kuo, S H; Luh, K T

    1995-06-01

    Pulmonary cryptococcosis causes significant morbidity and mortality in immunocompromised patients. Definitive diagnosis of pulmonary cryptococcosis is usually difficult. The use of direct determination of cryptococcal antigen in transthoracic needle aspirate to diagnose pulmonary cryptococcosis was investigated. Over a 2-year period, we studied a total of 41 patients with respiratory symptoms and pulmonary infiltrates of unknown etiology who were suspected of having pulmonary cryptococcosis. Twenty-two patients were immunocompetent patients and 19 patients were immunocompromised. A diagnosis of pulmonary cryptococcosis was based on cytological examination, culture for Cryptococcus neoformans, histopathologic examination, and clinical response to antifungal therapy. All patients underwent chest ultrasound and ultrasound-guided percutaneous transthoracic needle aspiration to obtain specimens for cryptococcal antigen determination. The presence of cryptococcal antigen was determined by the latex agglutination system (CALAS; Meridian Diagnostics, Cincinnati, Ohio). An antigen titer equal to or greater than 1:8 was considered positive. The specimens were also sent for cytological examination, fungal culture, and/or histopathologic examination. A final diagnosis of pulmonary cryptococcosis was made in eight patients. Direct determinations of cryptococcal antigen in lung aspirate were positive in all eight patients with pulmonary cryptococcosis (100% sensitivity, 97% specificity, a positive predictive value of 89%, and negative value of 100%), and there was only one false-positive in noncryptococcosis patients. The diagnostic accuracy was 97.5%. Serum cryptococcal antigen was positive in only three patients with pulmonary cryptococcosis (sensitivity, 37.5%). This study showed that direct measurement of cryptococcal antigen in lung aspirate can be a rapid and useful test for diagnosis of pulmonary cryptococcosis.

  13. Antiretroviral treatment reverses HIV-associated anemia in rural Tanzania

    Directory of Open Access Journals (Sweden)

    Gundersen Svein G

    2011-07-01

    Full Text Available Abstract Background HIV-associated anemia is common and associated with poor prognosis. However, its response to antiretroviral treatment (ART in rural Africa is poorly understood. Methods HIV-infected adults (≥15 years who enrolled in HIV care at Haydom Lutheran Hospital in northern Tanzania were included in the study. The effect of ART (zidovudine/stavudine + lamivudine + efavirenz/nevirapine on HIV-associated anemia was studied in a subset of patients who were anemic at the time they started ART and had a follow-up hemoglobin measurement 12 months later. Pregnant women were excluded from the study, as were women who had given birth within the past 6 weeks. Anemia was defined as hemoglobin Results At enrollment, mean hemoglobin was 10.3 g/dL, and 649 of 838 patients (77.4% were anemic. Of the anemic patients, 254 (39.1% had microcytosis and hypochromia. Among 102 patients who were anemic at ART initiation and had a follow-up hemoglobin measurement after 12 months, the mean hemoglobin increased by 2.5 g/dL (P Conclusions Most patients had anemia at enrollment, of whom nearly 40% had microcytosis and hypochromia suggestive of iron deficiency. The mean hemoglobin increased significantly in patients who received ART, but one third were still anemic 12 months after ART initiation indicating that additional interventions to treat HIV-associated anemia in rural Africa might be warranted, particularly in patients with microcytosis and those treated with zidovudine.

  14. Neurological, visual, and MRI brain scan findings in 87 South African patients with HIV-associated cryptococcal meningoencephalitis.

    Science.gov (United States)

    Loyse, A; Moodley, A; Rich, P; Molloy, S F; Bicanic, T; Bishop, L; Rae, W I D; Bhigjee, A I; Loubser, N D; Michowicz, A J; Wilson, D; Harrison, T S

    2015-06-01

    HIV-associated cryptococcal meningoencephalitis (CM) is a leading cause of adult meningitis in sub-Saharan Africa. Neuroradiological data is however limited to case reports and small case series from developed countries and/or immunocompetent patients. Eighty seven patients aged ≥18 hospitalized with a first episode of CM had magnetic resonance (MRI) imaging during the first two weeks of admission. A subset of eleven patients had follow-up scans approximately one month from their initial MRI scan. All had prospectively-recorded detailed neurological and visual examinations. An abnormal finding on neurological examination was detected in 33 (39%) patients. 38 (48%) patients experienced some visual loss. Neuroradiological lesions presumed to be cryptococcosis-related, as defined by the presence of dilated Virchow Robin spaces, pseudocysts or cryptococcomas, enhancing nodules, hydrocephalus, meningitis, focal perilesional oedema and infarcts, were detected in 55 (63%) patients. MRI findings suggestive of a second diagnosis were found in 18 (21%) patients. Visual loss was associated with the presence of cryptococcal-related lesions (p = 0.02). Blindness was associated with raised intracranial pressure (ICP) (p = 0.02). Of eleven patients with paired scans, brain swelling was identified on the initial scan in only one patient. The majority of patients had MRI brain scan abnormalities presumed secondary to CM. Dilated Virchow Robin spaces were the commonest neuroradiological lesion. Visual loss was associated with the degree of cerebral involvement as reflected by the presence of MRI abnormalities. Blindness was associated with the presence of raised ICP. Initial generalised brain swelling does not appear to be common, but further studies with paired scans are needed. Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  15. Radiological features of AIDS complicated by pulmonary cryptococcosis: Literature review and a report of 10 cases

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    Xiao Yu

    2016-03-01

    Conclusion: The radiological signs featured AIDS complicated by pulmonary cryptococcosis such as singular or multiple nodules with cavity and “halo sign” can facilitate its diagnosis. But the diagnosis should be made in combination to the clinical history.

  16. Cryptococcosis in kidney transplant recipients in a Chinese university hospital and a review of published cases

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    Ya-li Yang

    2014-09-01

    Conclusions: Cryptococcosis is a serious infection among kidney transplant recipients in mainland China. It has unique characteristics, such as a relatively long time to onset after kidney transplantation, and diverse clinical manifestations. Treatment with intrathecal injection of amphotericin B is considered effective for central nervous system involvement. The findings of this study also highlight the urgent need for multicenter, prospective, and multidisciplinary clinical studies and education on cryptococcosis in kidney transplant recipients in China.

  17. Characteristics and survival for HIV-associated multicentric Castleman disease in Malawi

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    Satish Gopal

    2015-08-01

    Full Text Available Introduction: Clinical reports of multicentric Castleman disease (MCD from sub-Saharan Africa (SSA are scarce despite high prevalence of HIV and Kaposi sarcoma-associated herpesvirus (KSHV. Our objective is to describe characteristics and survival for HIV-associated MCD patients in Malawi. To our knowledge, this is the first HIV-associated MCD case series from the region. Methods: We describe HIV-positive patients with MCD in Lilongwe, and compare them to HIV-associated lymph node Kaposi sarcoma (KS and non-Hodgkin lymphoma (NHL patients treated at our centre. All patients were enrolled into a prospective longitudinal cohort study at a national teaching hospital and cancer referral centre serving half of Malawi's 16 million people. We included adult patients≥18 years of age with HIV-associated MCD (n=6, lymph node KS (n=5 or NHL (n=31 enrolled between 1 June 2013 and 31 January 2015. Results and discussion: MCD patients had a median age of 42.4 years (range 37.2–51.8. All had diffuse lymphadenopathy and five had hepatosplenomegaly. Concurrent KS was present for one MCD patient, and four had performance status ≥3. MCD patients had lower median haemoglobin (6.4 g/dL, range 3.6–9.3 than KS (11.0 g/dL, range 9.1–12.0, p=0.011 or NHL (11.2 g/dL, range 4.5–15.1, p=0.0007. Median serum albumin was also lower for MCD (2.1 g/dL, range 1.7–3.2 than KS (3.7 g/dL, range 3.2–3.9, p=0.013 or NHL (3.4 g/dL, range 1.8–4.8, p=0.003. All six MCD patients were on antiretroviral therapy (ART with median CD4 count 208 cells/µL (range 108–1146, and all with HIV RNA <400 copies/mL. Most KS and NHL patients were also on ART, although ART duration was longer for MCD (56.4 months, range 18.2–105.3 than KS (14.2 months, range 6.8–21.9, p=0.039 or NHL (13.8 months, range 0.2–98.8, p=0.017. Survival was poorer for MCD patients than lymph node KS or NHL. Conclusions: HIV-associated MCD occurs in Malawi, is diagnosed late and is associated with high

  18. Cryptococcosis in kidney transplant recipients in a Chinese university hospital and a review of published cases.

    Science.gov (United States)

    Yang, Ya-li; Chen, Min; Gu, Ju-lin; Zhu, Fan-yuan; Xu, Xiao-guang; Zhang, Chao; Chen, Jiang-han; Pan, Wei-hua; Liao, Wan-qing

    2014-09-01

    Cryptococcosis is a severe fungal infection with a high mortality rate among solid-organ transplant recipients. Today, China is among the countries performing the most kidney transplants worldwide, however data on the association of cryptococcosis with kidney transplantation in mainland China remain scarce and fragmented. We retrospectively analyzed cases of culture-confirmed cryptococcosis following kidney transplantation that have occurred at our hospital and reviewed the published cases in China over the last 30 years. Cryptococcosis in kidney transplant recipients was mainly caused by Cryptococcus neoformans var. grubii VNI strains and occurred most frequently in patients aged 41-50 years (37.9%, 11/29). The average time to infection after kidney transplantation was 5.16 ± 3.97 years. The clinical manifestations were found to be diverse, with slight to moderate headache and fever, meningeal irritation, and high cerebrospinal fluid pressure being relatively common. Physicians should be alert to these symptoms among kidney transplant recipients. Cryptococcosis is a serious infection among kidney transplant recipients in mainland China. It has unique characteristics, such as a relatively long time to onset after kidney transplantation, and diverse clinical manifestations. Treatment with intrathecal injection of amphotericin B is considered effective for central nervous system involvement. The findings of this study also highlight the urgent need for multicenter, prospective, and multidisciplinary clinical studies and education on cryptococcosis in kidney transplant recipients in China. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  19. Cryptococcosis in HIV-negative Patients with Renal Dialysis: A Retrospective Analysis of Pooled Cases.

    Science.gov (United States)

    Hong, Nan; Chen, Min; Fang, Wenjie; Al-Hatmi, Abdullah M S; Boekhout, Teun; Xu, Jianping; Zhang, Lei; Liu, Jia; Pan, Weihua; Liao, Wanqing

    2017-06-30

    Cryptococcosis is a lethal fungal infection mainly caused by Cryptococcus neoformans/C. gattii species. Currently, our understanding of cryptococcosis episodes in HIV-negative patients during renal dialysis remains scarce and fragmented. Here, we performed an analysis of pooled cases to systemically summarize the epidemiology and clinical characteristics of cryptococcosis among HIV-negative patients with renal dialysis. Using pooled data from our hospital and studies identified in four medical databases, 18 cases were identified and analyzed. The median duration time of renal dialysis for peritoneal renal dialysis and hemodialysis cases was 8 months and 36 months, respectively. Several non-neoformans/gattii species were identified among the renal dialysis recipients with cryptococcosis, particularly Cryptococcus laurentii and Cryptococcus albidus, which share similar clinical manifestations as those caused by C. neoformans and C. gattii. Our analyses suggest that physicians should consider the possibility of the occurrence of cryptococcosis among renal dialysis recipients even when cryptococcal antigen test result is negative. The timely removal of the catheter is crucial for peritoneal dialysis patients with cryptococcosis. In addition, there is a need for optimized antifungal treatment strategy in renal dialysis recipients with cryptococcal infections.

  20. Treatment of experimental cryptococcosis with SCH 39304 and fluconazole.

    Science.gov (United States)

    Negroni, R; Costa, M R; Finquelievich, J L; Iovannitti, C; Agorio, I; Tiraboschi, I N; Loebenberg, D

    1991-01-01

    The efficacy of two triazoles, SCH 39304 and fluconazole, in the treatment of disseminated cryptococcosis in Wistar rats was determined. A total of 160 rats were inoculated intracardiacally with 2 x 10(5) cells of Cryptococcus neoformans. Both drugs were administered by gavage once daily, at three doses (8, 16, and 32 mg/kg/day). Two treatment schedules were followed: (i) treatment began 1 week after infection and continued for 3 weeks and (ii) prophylaxis treatment began 3 days before infection and continued an additional 3 weeks. Evaluation was based on (i) macroscopic examination of lungs, (ii) microscopic examination of brains and lungs, (iii) histopathology of brains and lungs, and (iv) determination of number of CFU in brains. The number of CFU was the best measure of activity. SCH 39304 was more active than fluconazole in both regimens, and, prophylactically, SCH 39304 was able to achieve biological cures. PMID:1929309

  1. [A case of skin cryptococcosis in systemic lupus erythematosus].

    Science.gov (United States)

    Halweg, H; Korzeniewska-Koseła, M; Podsiadło, B; Krakówka, P

    1990-01-01

    Here is presented a case of woman treated by immunosuppressive preparations because of systemic lupus erythematosus with ski manifestations as tubercles and ulcerations on skin of trunk and extremities. On the basis of histological examination of tubercle skin specimens and mycological examinations of material obtained from skin ulcerations cryptococcosis was diagnosed. Disease was limited to skin that was an entry of infection. Patient was treated by Amphotericin B administered intravenously and Flucitosine per os. Amphotericin B was also applied topically. The results of cultures became gradually negative, up to total disappearance of fungus cells in direct specimens, prepared from examined material. After treatment continuing for 5 months only discoloured scars were observed on sick skin.

  2. Understanding and intervening in HIV-associated tuberculosis.

    Science.gov (United States)

    Rockwood, Neesha; Wilkinson, Robert John

    2015-12-01

    HIV-associated tuberculosis can present as extremes, ranging from acute life-threatening disseminated disease to occult asymptomatic infection. Both ends of this spectrum have distinct pathological correlates and require specific diagnostic and treatment approaches. Novel therapeutics, targeting both pathogen and host, are needed to augment pathogen clearance. In latent tuberculosis infection, enhancement of immune activation could be desirable. Antiretroviral therapy augments the beneficial effects of antitubercular therapy. However, in the context of high bacillary burden, antiretroviral therapy can also result in pathology (tuberculosis immune reconstitution inflammatory syndrome). In the immune reconstituting patient, modulation of immune activation controls tissue destruction. Interventions should also be appropriate and sustainable within the programmatic setting.

  3. Evidence of Cryptococcosis in cattle in Zaria Kaduna state, Nigeria

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    Emmanuella N. Akange

    2013-04-01

    Full Text Available Aim: Cryptococcosis is azoonotic infection caused by fungal of the Cryptococcus neoformans complex comprising of C. neoformans and C. gattii.The disease affects humans and animals worldwide causing morbidity and mortality. This work was carried out to determine the occurrence of cryptococcal antigens and factors associated with presence of antigens in cattle in Zaria, Nigeria. Materials and Methods: Three hundred and ninety (390 serum samples from cattle of various ages were collected from 11 farms in Zaria, Nigeria. The samples were analysed using alatex agglutination test and lateral flow assay kit which detectsthe polysaccharide capsular antigens of Cryptococcus species. Results:Out of the 390 samples tested 28 (7.17% were found to be positive using the latex agglutination test while only of these 22 (5.64% were positive using the lateral flow assay. There was a strong correlation (r=0.939, p=0.0002 between the results of the latex agglutination test and the lateral flow assay. There was no statistically significant difference (p>0.005 in positivity for cryptococcal antigens between sex, age and sex, though, there was a statistically significant difference (p<0.05 in positivity between management systems i.e. semi-intensive and intensive farming systems. Conclusions: The epidemiological value of this report lies in its demonstration that the risk of cattle and humans infection with cryptococcosis exist in farms in Zaria. The presence of this pathogen among these cattle poses an economic threat to the livestock industry due to the mastitis it causes. It also poses a significant public health threat because of its zoonotic nature and the increasing population of immunocompromised individuals. Large scale studies to determine specific risk factors and the role of the environment and experimental studies to determine what governs the transition from nasal colonisation to infection are recommended. [Vet World 2013; 6(2.000: 64-67

  4. Leptin in congenital and HIV-associated lipodystrophy.

    Science.gov (United States)

    Tsoukas, Michael A; Farr, Olivia M; Mantzoros, Christos S

    2015-01-01

    Leptin is a hormone secreted by adipocytes that regulates energy metabolism via peripheral action on glucose synthesis and utilization as well as through central regulation of food intake. Patients with decreased amounts of fat in their adipose tissue (lipoatrophy) will have low leptin levels, and hypoleptinemic states have been associated with a variety of metabolic dysfunctions. Pronounced complications of insulin resistance, dyslipidemia and fatty liver are observed in patients suffering from congenital or acquired generalized lipodystrophy while somewhat less pronounced abnormalities are associated with human immunodeficiency virus (HIV) and the use of highly active antiretroviral therapy, the so-called HIV-associated lipodystrophy. Previous uncontrolled open-label studies have demonstrated that physiological doses of leptin repletion have corrected many of the metabolic derangements observed in subjects with rare fat maldistribution syndromes such as generalized lipodystrophy. In the much more commonly encountered HIV-associated lipodystrophy, leptin replacement has been shown to decrease central fat mass and to improve insulin sensitivity, dyslipidemia, and glucose levels. The United States Food and Drug Administration has recently granted approval for recombinant leptin therapy for congenital and acquired generalized lipodystrophy, however large, well-designed, placebo-controlled studies are needed to assess long-term efficacy, safety and adverse effects of leptin replacement. In this review, we present the role of leptin in the metabolic complications of congenital and acquired lipodystrophy and discuss current and emerging clinical therapeutic uses of leptin in humans with lipodystrophy.

  5. National Institute on Drug Abuse symposium report: drugs of abuse, dopamine, and HIV-associated neurocognitive disorders/HIV-associated dementia.

    Science.gov (United States)

    Purohit, Vishnudutt; Rapaka, Rao; Frankenheim, Jerry; Avila, Albert; Sorensen, Roger; Rutter, Joni

    2013-04-01

    The National Institute on Drug Abuse organized a symposium on drugs of abuse, dopamine, and HIV-associated neurocognitive disorders (HAND)/HIV-associated dementia (HAD) in Rockville, Maryland, October 4, 2011. The purpose of this symposium was to evaluate the potential role of dopamine in the potentiation of HAND/HAD by drugs of abuse. A summary of the symposium has been presented in this report.

  6. Severe enophthalmos and lagophthalmos secondary to HIV-associated lipoatrophy.

    Science.gov (United States)

    De Niro, Jennifer Edith; Silkiss, Rona Z

    2011-08-04

    HIV-associated lipoatrophy has been closely linked to the use of the thymidine nucleoside reverse-transcriptase inhibitors stavudine and zidovudine. The lipoatrophy can have severe psychological effects and is associated with increased risk of metabolic disorders and cardiovascular disease. The authors present a case of a 45-year-old HIV-positive man who presented with severe bilateral enophthalmos (recession of the eyes) and lagophthamos (inability to fully close the eyes) from orbital fat atrophy. He had taken zidovudine for 8 years and stavudine for 13 years. Cessation of the causative drugs usually does not result in noticeable improvement of the lipoatrophy. Placement of bilateral orbital floor implants decreased our patient's orbital volume and substantially improved his eyelid function and cosmetic appearance.

  7. Metreleptin Treatment in Patients with Non-HIV Associated Lipodystrophy.

    Science.gov (United States)

    Akinci, Gulcin; Akinci, Baris

    2015-01-01

    Lipodystrophies are a heterogeneous group of disorders characterized by congenital or acquired loss of adipose tissue. Recently, metreleptin, a recombinant human leptin analog, has been approved for the treatment of patients with generalized lipodystrophy. Leptin is an adipokine which has a fundamental role in glucose and lipid homeostasis. Metreleptin treatment has been demonstrated to improve metabolic abnormalities such as hyperglycemia, hypertriglyceridemia, increased hepatic fat content and elevated liver enzymes alanine transaminase and aspartate transaminase in patients with generalized lipodystrophy, and to correct hyperphagia that likely occurs as a result of leptin deficiency. Limited data has also suggested that metreleptin treatment might be beneficial on metabolic abnormalities in patients with partial lipodystrophy. This review focuses on potential benefits of metreleptin in various forms of non-HIV associated lipodystrophy. Safety issues have been discussed. Recent patent submissions have also been reviewed.

  8. Multiple facets of HIV-associated renal disease.

    Science.gov (United States)

    da Silva, D R; Gluz, I C; Kurz, J; Thomé, G G; Zancan, R; Bringhenti, R N; Schaefer, P G; Dos Santos, M; Barros, E J G; Veronese, F V

    2016-01-01

    HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years) HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD) or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD) and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%), acute kidney injury (28%), nephrotic syndrome (23%), and chronic kidney disease (22%). Focal segmental glomerulosclerosis (28%), mainly the collapsing form (HIVAN), acute interstitial nephritis (AIN) (26%), and immune complex-mediated glomerulonephritis (ICGN) (25%) were the predominant renal histology. Baseline CD4 cell count ≥ 200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012). At last follow-up, 64% of patients with baseline CD4 ≥ 200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2)-1 compared to the other 35% of patients who presented with CD4 HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥ 200 cells/mm3 was associated with better renal function after 2 years of follow-up.

  9. Multiple facets of HIV-associated renal disease

    Directory of Open Access Journals (Sweden)

    D.R. da Silva

    2016-01-01

    Full Text Available HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%, acute kidney injury (28%, nephrotic syndrome (23%, and chronic kidney disease (22%. Focal segmental glomerulosclerosis (28%, mainly the collapsing form (HIVAN, acute interstitial nephritis (AIN (26%, and immune complex-mediated glomerulonephritis (ICGN (25% were the predominant renal histology. Baseline CD4 cell count ≥200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012. At last follow-up, 64% of patients with baseline CD4 ≥200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2-1 compared to the other 35% of patients who presented with CD4 <200 cells/mm3 (log rank=9.043, P=0.003. In conclusion, the main histological lesion of HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥200 cells/mm3 was associated with better renal function after 2 years of follow-up.

  10. Multiple facets of HIV-associated renal disease

    Science.gov (United States)

    da Silva, D.R.; Gluz, I.C.; Kurz, J.; Thomé, G.G.; Zancan, R.; Bringhenti, R.N.; Schaefer, P.G.; dos Santos, M.; Barros, E.J.G.; Veronese, F.V.

    2016-01-01

    HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years) HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD) or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD) and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%), acute kidney injury (28%), nephrotic syndrome (23%), and chronic kidney disease (22%). Focal segmental glomerulosclerosis (28%), mainly the collapsing form (HIVAN), acute interstitial nephritis (AIN) (26%), and immune complex-mediated glomerulonephritis (ICGN) (25%) were the predominant renal histology. Baseline CD4 cell count ≥200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012). At last follow-up, 64% of patients with baseline CD4 ≥200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2)-1 compared to the other 35% of patients who presented with CD4 <200 cells/mm3 (log rank=9.043, P=0.003). In conclusion, the main histological lesion of HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥200 cells/mm3 was associated with better renal function after 2 years of follow-up. PMID:27007656

  11. Cryptococcosis-the impact of delay to diagnosis.

    Science.gov (United States)

    Aye, C; Henderson, A; Yu, H; Norton, R

    2016-07-01

    Cryptococcosis is a mycotic disease caused by the yeast Cryptococcus sp. It is associated with significant mortality and morbidity, including long-term neurological sequelae. It is not known whether the high morbidity observed is related to a delay in diagnosis. A retrospective chart review of all cryptococcal infections that had been diagnosed in the region between 1997 and 2015 was performed. Twenty-nine cases were identified. Overall mortality rate was 10.3%, with an attributable mortality rate of 6.9%. Forty-five per cent of patients with central nervous system involvement developed long-term neurological deficits. Significant associations were noted between those with and without long-term neurological deficits and in both time from onset of symptoms to diagnosis (median of 45.5 days versus 18.5 days, respectively) and time from presentation to diagnosis (median 14.5 days versus 7 days, respectively). In addition, raised intracranial pressure (p 0.03) and female gender (p 0.02) were significantly associated with poor neurological outcomes. This highlights the importance of early diagnosis and the need to limit raised intracranial pressure to minimize long-term neurological deficits.

  12. Influenza A Virus as a Predisposing Factor for Cryptococcosis

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    Lorena V. N. Oliveira

    2017-09-01

    Full Text Available Influenza A virus (IAV infects millions of people annually and predisposes to secondary bacterial infections. Inhalation of fungi within the Cryptococcus complex causes pulmonary disease with secondary meningo-encephalitis. Underlying pulmonary disease is a strong risk factor for development of C. gattii cryptococcosis though the effect of concurrent infection with IAV has not been studied. We developed an in vivo model of Influenza A H1N1 and C. gattii co-infection. Co-infection resulted in a major increase in morbidity and mortality, with severe lung damage and a high brain fungal burden when mice were infected in the acute phase of influenza multiplication. Furthermore, IAV alters the host response to C. gattii, leading to recruitment of significantly more neutrophils and macrophages into the lungs. Moreover, IAV induced the production of type 1 interferons (IFN-α4/β and the levels of IFN-γ were significantly reduced, which can be associated with impairment of the immune response to Cryptococcus during co-infection. Phagocytosis, killing of cryptococci and production of reactive oxygen species (ROS by IAV-infected macrophages were reduced, independent of previous IFN-γ stimulation, leading to increased proliferation of the fungus within macrophages. In conclusion, IAV infection is a predisposing factor for severe disease and adverse outcomes in mice co-infected with C. gattii.

  13. Approaches to antifungal therapies and their effectiveness among patients with cryptococcosis.

    Science.gov (United States)

    Bratton, Emily W; El Husseini, Nada; Chastain, Cody A; Lee, Michael S; Poole, Charles; Stürmer, Til; Weber, David J; Juliano, Jonathan J; Perfect, John R

    2013-06-01

    The goal of this study was to determine the degree to which the persistence of cryptococcosis, overall 1-year mortality, and 1-year mortality due to cryptococcosis were influenced by initial antifungal treatment regimen in a cohort of adults with cryptococcosis treated at a tertiary care medical center. Risk factors, underlying conditions, treatment, and mortality information were obtained for 204 adults with cryptococcosis from Duke University Medical Center (DUMC) from 1996 to 2009. Adjusted risk ratios (RR) for persistence and hazard ratios (HR) for mortality were estimated for each exposure. The all-cause mortality rate among patients with nonsevere disease (20%) was similar to that in the group with disease (26%). However, the rate of cryptococcosis-attributable mortality with nonsevere disease (5%) was much lower than with severe disease (20%). Flucytosine exposure was associated with a lower overall mortality rate (HR, 0.4; 95% confidence interval [CI], 0.2 to 0.9) and attributable mortality rate (HR, 0.5; 95% CI, 0.2 to 1.2). Receiving a nonrecommended antifungal regimen was associated with a higher relative risk of persistent infection at 4 weeks (RR, 1.9; 95% CI, 0.9 to 4.3), and the rate of attributable mortality among those not receiving the recommended dose of initial therapy was higher than that of those receiving recommended dosing (HR, 2.3; 95% CI, 1.0 to 5.0). Thus, the 2010 Infectious Diseases Society of America (IDSA) guidelines are supported by this retrospective review as a best-practice protocol for cryptococcal management. Future investigations should consider highlighting the distinction between all-cause mortality and attributable mortality so as not to overestimate the true effect of cryptococcosis on patient death.

  14. Vertebro-cerebral cryptococcosis mimicking tuberculosis: A diagnostic dilemma in countries with high burden of tuberculosis

    Directory of Open Access Journals (Sweden)

    R Gupta

    2012-01-01

    Full Text Available We report a case of a 30-year-old immunocompetent man with disseminated cryptococcosis who was initially treated with antitubercular therapy due to clinical and radiological diagnosis of vertebro-cerebral tuberculosis. The diagnosis of Cryptococcus infection was made due to incidental isolation of this fungus from blood culture with negative cerebrospinal fluid culture results. Though disseminated cryptococcosis with central nervous system, skeletal, and skin involvement is an uncommon manifestation of Cryptococcus neoformans infection, a high clinical suspicion and early initiation of therapy is needed to recognise and treat such patients efficiently.

  15. Vertebro-cerebral cryptococcosis mimicking tuberculosis: a diagnostic dilemma in countries with high burden of tuberculosis.

    Science.gov (United States)

    Gupta, R; Kushwaha, S; Behera, S; Jaiswal, A; Thakur, R

    2012-01-01

    We report a case of a 30-year-old immunocompetent man with disseminated cryptococcosis who was initially treated with antitubercular therapy due to clinical and radiological diagnosis of vertebro-cerebral tuberculosis. The diagnosis of Cryptococcus infection was made due to incidental isolation of this fungus from blood culture with negative cerebrospinal fluid culture results. Though disseminated cryptococcosis with central nervous system, skeletal, and skin involvement is an uncommon manifestation of Cryptococcus neoformans infection, a high clinical suspicion and early initiation of therapy is needed to recognise and treat such patients efficiently.

  16. Combination antifungal therapies for HIV-associated cryptococcal meningitis: a randomised trial.

    NARCIS (Netherlands)

    Brouwer, A.E.; Rajanuwong, A.; Chierakul, W.; Griffin, G.E.; Larsen, R.A.; White, N.J.; Harrison, T.S.

    2004-01-01

    BACKGROUND: It frequently takes more than 2 weeks for drug treatments for cryptococcal meningitis to sterilise cerebrospinal fluid (CSF). In-vitro and animal studies lend support to the use of combinations of amphotericin B, flucytosine, and fluconazole for treatment of cryptococcosis. We compared t

  17. HIV-associated lipodystrophy: a review from a Brazilian perspective.

    Science.gov (United States)

    Alves, Marcelle D; Brites, Carlos; Sprinz, Eduardo

    2014-01-01

    The prognosis of human immunodeficiency virus (HIV)-infected individuals has dramatically improved worldwide since the introduction of highly antiretroviral therapy. Nevertheless, along with the decrease in mortality, several body modifications not initially related to HIV infection have been reported. Disorders in lipid and glucose metabolism, accompanied by body shape abnormalities and alterations in fat distribution, began to be described. A syndrome, named "HIV-associated lipodystrophy syndrome", was coined to classify these clinical spectrum aspects. This syndrome involves not only metabolic alterations but also fat redistribution, with lipoatrophy due to subcutaneous fat loss (predominantly in the face and lower limbs) and lipohypertrophy related to central fat gain. These changes in body shape are very important to be recognized, as they are associated with worse morbidity and mortality. Self-esteem difficulties related to body alterations might lead to treatment failures due to medication adherence problems. Moreover, these alterations have been associated with an increased risk of cardiovascular events. Therefore, it is extremely important to identify this syndrome early in order to provide an even better quality of life for this population, as the clinical approach is not easy. Treatment change, medications to treat dyslipidemia, and surgical intervention are instruments to be used to try to correct these abnormalities. The aim of this study is to review clinical presentation, diagnosis, and management of body shape and metabolic complications of HIV infection from a Brazilian perspective, a medium income country with a large number of patients on antiretroviral therapy.

  18. HIV-Associated Cardiovascular Disease: Role of Connexin 43.

    Science.gov (United States)

    Prevedel, Lisa; Morocho, Camilla; Bennett, Michael V L; Eugenin, Eliseo A

    2017-09-01

    Chronic HIV infection due to effective antiretroviral treatment has resulted in a broad range of clinical complications, including accelerated heart disease. Individuals with HIV infection have a 1.5 to 2 times higher incidence of cardiovascular diseases than their uninfected counterparts; however, the underlying mechanisms are poorly understood. To explore the link between HIV infection and cardiovascular diseases, we used postmortem human heart tissues obtained from HIV-infected and control uninfected individuals to examine connexin 43 (Cx43) expression and distribution and HIV-associated inflammation. Here, we demonstrate that Cx43 is dysregulated in the hearts of HIV-infected individuals. In all HIV heart samples analyzed, there were areas where Cx43 was overexpressed and found along the lateral membrane of the cardiomyocyte and in the intercalated disks. Areas of HIV tissue with anomalous Cx43 expression and localization also showed calcium overload, sarcofilamental atrophy, and accumulation of collagen. All these changes were independent of viral replication, CD4 counts, inflammation, and type of antiretroviral treatment. Overall, we propose that HIV infection increases Cx43 expression in heart, resulting in tissue damage that likely contributes to the high rates of cardiovascular disease in HIV-infected individuals. Copyright © 2017 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

  19. Fluconazole alters the polysaccharide capsule of Cryptococcus gattii and leads to distinct behaviors in murine Cryptococcosis.

    Science.gov (United States)

    Santos, Julliana Ribeiro Alves; Holanda, Rodrigo Assunção; Frases, Susana; Bravim, Mayara; Araujo, Glauber de S; Santos, Patrícia Campi; Costa, Marliete Carvalho; Ribeiro, Maira Juliana Andrade; Ferreira, Gabriella Freitas; Baltazar, Ludmila Matos; Miranda, Aline Silva; Oliveira, Danilo Bretas; Santos, Carolina Maria Araújo; Fontes, Alide Caroline Lima; Gouveia, Ludmila Ferreira; Resende-Stoianoff, Maria Aparecida; Abrahão, Jonatas Santos; Teixeira, Antônio Lúcio; Paixão, Tatiane Alves; Souza, Danielle G; Santos, Daniel Assis

    2014-01-01

    Cryptococcus gattii is an emergent human pathogen. Fluconazole is commonly used for treatment of cryptococcosis, but the emergence of less susceptible strains to this azole is a global problem and also the data regarding fluconazole-resistant cryptococcosis are scarce. We evaluate the influence of fluconazole on murine cryptococcosis and whether this azole alters the polysaccharide (PS) from cryptococcal cells. L27/01 strain of C. gattii was cultivated in high fluconazole concentrations and developed decreased drug susceptibility. This phenotype was named L27/01F, that was less virulent than L27/01 in mice. The physical, structural and electrophoretic properties of the PS capsule of L27/01F were altered by fluconazole. L27/01F presented lower antiphagocytic properties and reduced survival inside macrophages. The L27/01F did not affect the central nervous system, while the effect in brain caused by L27/01 strain began after only 12 hours. Mice infected with L27/01F presented lower production of the pro-inflammatory cytokines, with increased cellular recruitment in the lungs and severe pulmonary disease. The behavioral alterations were affected by L27/01, but no effects were detected after infection with L27/01F. Our results suggest that stress to fluconazole alters the capsule of C. gattii and influences the clinical manifestations of cryptococcosis.

  20. [Cryptococcosis of the central nervous system. A report of five cases].

    Science.gov (United States)

    Fernández-Concepción, O; Ariosa-Acuña, M C; Giroud-Benítez, J L; Pando-Cabrera, A; García-Fidalgo, J A; Mestre-Miguelez, R

    Since the 1980s, in relation to the spread of AIDS, there has been an enormous increase in cryptococcosis, a mycotic disorder which usually affects the central nervous system (CNS). This disease is caused by Cryptococcus neoformans, a microorganism acquired by inhalation of bird excrement. This germ produces a capsule which protects it from phagocytosis, can synthesize melanin which acts as an antioxidant of the cytotoxic lymphocytes and can reproduce at body temperature. Clinically it may show as chronic or subacute meningitis and/or encephalitis, as endocranial hypertension or as an intracranial space occupying lesion (crytococcoma). To establish the diagnosis, Chinese ink, culture and the latex agglutination test are useful. Treatment is with amphotericin B associated or not with fluocytokine and fluconazole, the protocol used depending on the clinical form. To review the most up-to-date literature on cryptococcosis of the CNS to study the condition in relation to five cases. We report five patients with cryptococcosis of the CNS diagnosed and treated in the Instituto Nacional de Neurología y Neurocirugia de la Habana, Cuba, showing an increase in the frequency of the occurrence of cases not related to HIV infection, great variety of clinico-humoral presentation and the characteristics of the treatment given. Cryptococcosis can be cured completely when the condition is diagnosed early; without treatment it is invariably fatal.

  1. Pharmacokinetics/pharmacodynamic correlations of fluconazole in murine model of cryptococcosis.

    Science.gov (United States)

    Santos, Julliana Ribeiro Alves; César, Isabela Costa; Costa, Marliete Carvalho; Ribeiro, Noelly Queiroz; Holanda, Rodrigo Assunção; Ramos, Lais Hott; Freitas, Gustavo José Cota; Paixão, Tatiane Alves; Pianetti, Gerson Antônio; Santos, Daniel Assis

    2016-09-20

    The emergence of fluconazole-resistant Cryptococcus gattii is a global concern, since this azole is the main antifungal used worldwide to treat patients with cryptococcosis. Although pharmacokinetic (PK) and pharmacodynamic (PD) indices are useful predictive factors for therapeutic outcomes, there is a scarcity of data regarding PK/PD analysis of antifungals in cryptococcosis caused by resistant strains. In this study, PK/PD parameters were determined in a murine model of cryptococcosis caused by resistant C. gattii. We developed and validated a suitable liquid chromatography-electrospray ionization tandem mass spectrometry method for PK studies of fluconazole in the serum, lungs, and brain of uninfected mice. Mice were infected with susceptible or resistant C. gattii, and the effects of different doses of fluconazole on the pulmonary and central nervous system fungal burden were determined. The peak levels in the serum, lungs, and brain were achieved within 0.5h. The AUC/MIC index (area under the curve/minimum inhibitory concentration) was associated with the outcome of anti-cryptococcal therapy. Interestingly, the maximum concentration of fluconazole in the brain was lower than the MIC for both strains. In addition, the treatment of mice infected with the resistant strain was ineffective even when high doses of fluconazole were used or when amphotericin B was tested, confirming the cross-resistance between these drugs. Altogether, our novel data provide the correlation of PK/PD parameters with antifungal therapy during cryptococcosis caused by resistant C. gattii.

  2. Cerebellar cryptococcosis characterized by a space-occupying lesion in an immunocompetent non-HIV patient

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    Liu BX

    2014-12-01

    Full Text Available Bi-Xia Liu,1,* Xi-Jian Dai,2,3,* Heng Liu,4,* Hong-Han Gong,3 Yi-Xiang J Wang,2 Lun-Li Zhang1 1Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 2Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; 3Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 4Department of Radiology, Affiliated Hospital of Zunyi Medical University, Guizhou, People’s Republic of China *These authors contributed equally to this work Abstract: Central nervous system (CNS cryptococcosis is an opportunistic fungal infection that typically occurs in patients with reduced immunological function, such as patients with AIDS, patients receiving organ transplants, or patients receiving corticosteroid and immunosuppressive therapy. CNS cryptococcosis rarely occurs in immunocompetent patients. CNS cryptococcosis is characterized by meningitis and encephalitis and occasionally forms isolated granulomas. Isolated cerebellar cryptococcoma is a rare condition, especially in immunocompetent patients, and the misdiagnosis rate is high. A definite diagnosis must be based on pathology. To raise awareness of this disease, the clinical data of a patient with cryptococcomas in the right side of the cerebellum are reported. Keywords: cryptococcosis, cerebellar, central nervous system, magnetic resonance imaging, immunosuppressive

  3. Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report

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    Probst Corina

    2010-08-01

    Full Text Available Abstract Background Cryptococcus neoformans is an encapsulated yeast and the most frequent cryptococcal species found in humans. Cryptococcosis is considered an opportunistic infection as it affects mainly immunosuppressed individuals. In humans, C. neoformans causes three types of infections: pulmonary cryptococcosis, cryptococcal meningitis and wound or cutaneous cryptococcosis. Case Presentation An 81-year-old woman developed severe necrotizing cellulitis on her left arm without any preceding injury. The patient had been treated with systemic corticosteroids over twenty years for rheumatoid arthritis (RA. Skin biopsies of the wound area were initially interpreted as cutaneous vasculitis of unknown etiology. However, periodic acid Schiff staining and smear analysis later revealed structures consistent with Cryptococcus neoformans, and the infection was subsequently confirmed by culture. After the initiation of therapy with fluconazole 400 mg per day the general condition and the skin ulcers improved rapidly and the patient was discharged to a rehabilitation facility. Subsequently surgical debridement and skin grafting were performed. Conclusions Opportunistic infections such as cryptococcosis can clinically and histologically mimic cutaneous vasculitis and have to be investigated rigorously as a differential diagnosis in immunosuppressed patients.

  4. Fluconazole Alters the Polysaccharide Capsule of Cryptococcus gattii and Leads to Distinct Behaviors in Murine Cryptococcosis

    Science.gov (United States)

    Santos, Julliana Ribeiro Alves; Holanda, Rodrigo Assunção; Frases, Susana; Bravim, Mayara; Araujo, Glauber de S.; Santos, Patrícia Campi; Costa, Marliete Carvalho; Ribeiro, Maira Juliana Andrade; Ferreira, Gabriella Freitas; Baltazar, Ludmila Matos; Miranda, Aline Silva; Oliveira, Danilo Bretas; Santos, Carolina Maria Araújo; Fontes, Alide Caroline Lima; Gouveia, Ludmila Ferreira; Resende-Stoianoff, Maria Aparecida; Abrahão, Jonatas Santos; Teixeira, Antônio Lúcio; Paixão, Tatiane Alves; Souza, Danielle G.; Santos, Daniel Assis

    2014-01-01

    Cryptococcus gattii is an emergent human pathogen. Fluconazole is commonly used for treatment of cryptococcosis, but the emergence of less susceptible strains to this azole is a global problem and also the data regarding fluconazole-resistant cryptococcosis are scarce. We evaluate the influence of fluconazole on murine cryptococcosis and whether this azole alters the polysaccharide (PS) from cryptococcal cells. L27/01 strain of C. gattii was cultivated in high fluconazole concentrations and developed decreased drug susceptibility. This phenotype was named L27/01F, that was less virulent than L27/01 in mice. The physical, structural and electrophoretic properties of the PS capsule of L27/01F were altered by fluconazole. L27/01F presented lower antiphagocytic properties and reduced survival inside macrophages. The L27/01F did not affect the central nervous system, while the effect in brain caused by L27/01 strain began after only 12 hours. Mice infected with L27/01F presented lower production of the pro-inflammatory cytokines, with increased cellular recruitment in the lungs and severe pulmonary disease. The behavioral alterations were affected by L27/01, but no effects were detected after infection with L27/01F. Our results suggest that stress to fluconazole alters the capsule of C. gattii and influences the clinical manifestations of cryptococcosis. PMID:25392951

  5. Characteristics of Resting-State Functional Connectivity in HIV-Associated Neurocognitive Disorder.

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    Hea Won Ann

    Full Text Available HIV-associated neurocognitive disorder (HAND can occur in patients without prior AIDS defining illness and can be debilitating. This study aimed to evaluate the difference in the patterns of intrinsic brain activity between patients with or without HAND for deepening our understanding of HAND.We evaluated 24 HIV-infected individuals, 12 with previously diagnosed HAND and 12 previously diagnosed without HAND, and 11 seronegative individuals. These individuals then underwent repeat NP testing and a functional brain MRI scan. For functional MRI analysis, seed-based analysis with bilateral precuneus cortex seed was applied.Among the 12 individuals with previously diagnosed HAND, 3 showed improvement of their neurocognitive function and 1 was excluded for worsening liver disease. Among the 12 patients who previously had normal neurocognitive function, 2 showed neurocognitive impairment. Overall, the HAND group, who had impaired cognitive function at the time of MRI scan, showed significant decrease of resting status functional connectivity between bilateral precuneus and prefrontal cortex (PFC compared with nonHAND group, those who had normal neurocognitive function (Corrected P<0.05. The functional connectivity with the right inferior frontal operculum and right superior frontal gyrus was positively correlated with memory and learning ability.This cross-sectional study found a significant difference in fMRI patterns between patients with and without HAND. Decreased functional connectivity between precuneus and PFC could be possible functional substrate for cognitive dysfunction in HIV patients, which should be characterized in a longitudinal study.

  6. Neuronal ferritin heavy chain and drug abuse affect HIV-associated cognitive dysfunction.

    Science.gov (United States)

    Pitcher, Jonathan; Abt, Anna; Myers, Jaclyn; Han, Rachel; Snyder, Melissa; Graziano, Alessandro; Festa, Lindsay; Kutzler, Michele; Garcia, Fernando; Gao, Wen-Jun; Fischer-Smith, Tracy; Rappaport, Jay; Meucci, Olimpia

    2014-02-01

    Interaction of the chemokine CXCL12 with its receptor CXCR4 promotes neuronal function and survival during embryonic development and throughout adulthood. Previous studies indicated that μ-opioid agonists specifically elevate neuronal levels of the protein ferritin heavy chain (FHC), which negatively regulates CXCR4 signaling and affects the neuroprotective function of the CXCL12/CXCR4 axis. Here, we determined that CXCL12/CXCR4 activity increased dendritic spine density, and also examined FHC expression and CXCR4 status in opiate abusers and patients with HIV-associated neurocognitive disorders (HAND), which is typically exacerbated by illicit drug use. Drug abusers and HIV patients with HAND had increased levels of FHC, which correlated with reduced CXCR4 activation, within cortical neurons. We confirmed these findings in a nonhuman primate model of SIV infection with morphine administration. Transfection of a CXCR4-expressing human cell line with an iron-deficient FHC mutant confirmed that increased FHC expression deregulated CXCR4 signaling and that this function of FHC was independent of iron binding. Furthermore, examination of morphine-treated rodents and isolated neurons expressing FHC shRNA revealed that FHC contributed to morphine-induced dendritic spine loss. Together, these data implicate FHC-dependent deregulation of CXCL12/CXCR4 as a contributing factor to cognitive dysfunction in neuroAIDS.

  7. HIV-associated lipodystrophy: a review from a Brazilian perspective

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    Alves MD

    2014-07-01

    Full Text Available Marcelle D Alves,1 Carlos Brites,2 Eduardo Sprinz1,31Infectious Disease Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; 2School of Medicine, Federal University of Bahia, Salvador, Brazil; 3School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, BrazilAbstract: The prognosis of human immunodeficiency virus (HIV-infected individuals has dramatically improved worldwide since the introduction of highly antiretroviral therapy. Nevertheless, along with the decrease in mortality, several body modifications not initially related to HIV infection have been reported. Disorders in lipid and glucose metabolism, accompanied by body shape abnormalities and alterations in fat distribution, began to be described. A syndrome, named “HIV-associated lipodystrophy syndrome”, was coined to classify these clinical spectrum aspects. This syndrome involves not only metabolic alterations but also fat redistribution, with lipoatrophy due to subcutaneous fat loss (predominantly in the face and lower limbs and lipohypertrophy related to central fat gain. These changes in body shape are very important to be recognized, as they are associated with worse morbidity and mortality. Self-esteem difficulties related to body alterations might lead to treatment failures due to medication adherence problems. Moreover, these alterations have been associated with an increased risk of cardiovascular events. Therefore, it is extremely important to identify this syndrome early in order to provide an even better quality of life for this population, as the clinical approach is not easy. Treatment change, medications to treat dyslipidemia, and surgical intervention are instruments to be used to try to correct these abnormalities. The aim of this study is to review clinical presentation, diagnosis, and management of body shape and metabolic complications of HIV infection from a Brazilian perspective, a medium income country with a large

  8. HIV-associated renal and genitourinary comorbidities in Africa.

    Science.gov (United States)

    Kalyesubula, Robert; Wearne, Nicola; Semitala, Fred C; Bowa, Kasonde

    2014-09-01

    With the recent massive scale-up of access to antiretroviral therapy (ART) in resource-limited countries, HIV has become a chronic disease with new challenges. There is mounting evidence of an increased burden of renal and genitourinary diseases among HIV-infected persons caused by direct HIV viral effects and/or indirectly through the development of opportunistic infections, ART medication-related toxicities, and other noncommunicable diseases (NCDs). We review the epidemiology of HIV-associated renal and urogenital diseases, including interactions with kidney-related NCDs such as hypertension, diabetes mellitus, and cardiovascular disease. We also examine the current evidence regarding the impact of HIV infection on the development of urogenital diseases. Highly advisable in sub-Saharan Africa are the establishment of renal disease registries, reviews of existing clinical practice including cost-effectiveness studies, and the adoption and use of HIV-related NCD management, with training for different cadres of health providers. Epidemiological research priorities include prospective studies to evaluate the true prevalence and spectrum of HIV-related renal disease and their progression. Simple diagnostics tools should be evaluated, including urinary dipsticks and point-of-care urea and creatinine tests to screen for kidney injury in primary care settings. Study of urological manifestations of HIV can help determine the extent of disease and outcomes. As patients live longer on ART, the burden of renal and genitourological complications of HIV and of ART can be expected to increase with a commensurate urgency in both discovery and evidence-based improvements in clinical management.

  9. CURRENT KNOWLEDGE ON HIV-ASSOCIATED PLASMABLASTIC LYMPHOMA

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    Michele Bibas

    2014-10-01

    Full Text Available HIV-associated PBL is an AIDS-defining cancer, classified by WHO as distinct entity of aggressive DLBCL. To date less than 250 cases have been published, of them17 are pediatric. The pathogenesis of this rare disease is related to immunodefiency, chronic immune stimulation and EBV. Clinically is a rapid growing destructive disease mainly of oral cavity, but frequently involves extraoral and extranodal sites. The diagnosis requires tissue mass or lymph node biopsy, but  core needle or fine needle biopsy is acceptable for difficult access sites. Immunophenotype is CD45, CD20, CD79a negative and CD38, CD138, MUM1 positive, EBER and KI67 is >80%. Frequently is diagnosed in patients with low CD4+ and high viral load, however is reported also in patients on effective cART and high CD4. Treatment administered is usually CHOP or CHOP-like regimens, more intensive regimens as CODOX-M/IVAC or DA-EPOCH are possible options. Intensification with ABMT in CR1 may be  considered for fit patients. Rituximab is not useful for this CD20- disease. Bortezomib and new drugs were used at case report level, with transient response. CNS prophylaxis is mandatory. Use of cART is recommended during chemotherapy, keeping in mind the possible overlapping toxicities. For refractory/relapsed patients, therapy is usually considered  palliative, however in chemosensitive disease intensification + ABMT or new drugs may be considered. Factors affecting outcome are achieving complete remission, PS, clinical stage, MYC , IPI. Reported median PFS ranges between  6-7 months and median OS ranges between 11-13 months. Long term survivor are reported but mostly in pediatric patients.  Due to the scarcity of data on this subtype of NHL we suggest that the diagnosis and the management of HIV-positive PBL patients should be performed in specialized centers.

  10. Disseminated cryptococcosis manifested as a single tumor in an immunocompetent patient, similar to the cutaneous primary forms*

    Science.gov (United States)

    do Amaral, Danielle Mechereffe; Rocha, Ritha de Cássia Capelato; Carneiro, Luiz Euribel Prestes; Vasconcelos, Dewton Moraes; de Abreu, Marilda Aparecida Milanez Morgado

    2016-01-01

    Cryptococcosis is a fungal infection caused by Cryptococcus neoformans that tends to affect immunocompromised individuals. The fungi are mostly acquired by inhalation, which leads to an initial pulmonary infection. Later, other organs - such as the central nervous system and the skin - can be affected by hematogenous spread. In addition, cutaneous contamination can occur by primary inoculation after injuries (primary cutaneous cryptococcosis), whose diagnosis is defined based on the absence of systemic involvement. The clinical presentation of cutaneous forms typically vary according to the infection mode. We report an unusual case of disseminated cryptococcosis in an immunocompetent patient with cutaneous lesions similar to those caused by primary inoculation. This clinical picture leads us to question the definition of primary cutaneous cryptococcosis established in the literature. PMID:28300886

  11. Atypical micromorphology and uncommon location of cryptococcosis: a histopathologic study using special histochemical techniques (one case report).

    Science.gov (United States)

    Gazzoni, Alexandra Flávia; Severo, Cecília Bittencourt; Barra, Marines Bizarro; Severo, Luiz Carlos

    2009-04-01

    Here we report an unusual case of disseminated cryptococcosis in a patient with AIDS. Although typical Cryptococcus neoformans micromorphology was observed in tongue biopsy, cervical lymph node examination revealed atypical histopathologic findings. These included pseudohyphae, chains of budding yeasts and structures resembling germ tubes. Cryptococcus neoformans infection in supraclavicular lymph nodes was also confirmed by culture. The importance of using special histochemical techniques-Mayer's mucicarmine stain for mucicarminophilic capsule and Grocott's silver stain-in the diagnosis of cryptococcosis is reinforced.

  12. HIV-associated dementia in the Dominican Republic: a consequence of stigma, domestic abuse and limited health literacy.

    Science.gov (United States)

    Santoso, Laura Frances; Erkkinen, Emily E; Deb, Anindita; Adon, Carlos

    2016-04-20

    A 38-year-old Dominican woman presented at an infectious disease clinic in Santo Domingo, with subacute dementia and psychomotor slowing. Based on physical findings and laboratory results, she was diagnosed with AIDS and HIV-associated dementia (HAD). She subsequently began combined antiretroviral therapy (cART). Psychiatric complications later emerged: the patient developed suicidal ideation and her partner expressed homicidal thoughts. After extensive interviewing, it was revealed that the patient had known her HIV-positive serostatus for years. However, several factors, including HIV stigma, mental illness stigma, domestic abuse and limited health literacy, had prevented her from seeking treatment and from disclosing her status to her partner. This patient's HIV was unmanaged as a consequence of social and educational circumstance, which resulted in severe sequelae, namely HAD. Compounded barriers to care can lead to the presentation of disease complications that are rarely seen today in countries with widespread access to antiretroviral therapy.

  13. Mitochondrial DNA variation and HIV-associated sensory neuropathy in CHARTER.

    Science.gov (United States)

    Holzinger, Emily R; Hulgan, Todd; Ellis, Ronald J; Samuels, David C; Ritchie, Marylyn D; Haas, David W; Kallianpur, Asha R; Bloss, Cinnamon S; Clifford, David B; Collier, Ann C; Gelman, Benjamin B; Marra, Christina M; McArthur, Justin C; McCutchan, J Allen; Morgello, Susan; Simpson, David M; Franklin, Donald R; Rosario, Debralee; Selph, Doug; Letendre, Scott; Grant, Igor

    2012-12-01

    HIV-associated sensory neuropathy remains an important complication of combination antiretroviral therapy and HIV infection. Mitochondrial DNA haplogroups and single nucleotide polymorphisms (SNPs) have previously been associated with symptomatic neuropathy in clinical trial participants. We examined associations between mitochondrial DNA variation and HIV-associated sensory neuropathy in CNS HIV Antiretroviral Therapy Effects Research (CHARTER). CHARTER is a USA-based longitudinal observational study of HIV-infected adults who underwent a structured interview and standardized examination. HIV-associated sensory neuropathy was determined by trained examiners as ≥1 sign (diminished vibratory and sharp-dull discrimination or ankle reflexes) bilaterally. Mitochondrial DNA sequencing was performed and haplogroups were assigned by published algorithms. Multivariable logistic regression of associations between mitochondrial DNA SNPs, haplogroups, and HIV-associated sensory neuropathy were performed. In analyses of associations of each mitochondrial DNA SNP with HIV-associated sensory neuropathy, the two most significant SNPs were at positions A12810G [odds ratio (95 % confidence interval) = 0.27 (0.11-0.65); p = 0.004] and T489C [odds ratio (95 % confidence interval) = 0.41 (0.21-0.80); p = 0.009]. These synonymous changes are known to define African haplogroup L1c and European haplogroup J, respectively. Both haplogroups were associated with decreased prevalence of HIV-associated sensory neuropathy compared with all other haplogroups [odds ratio (95 % confidence interval) = 0.29 (0.12-0.71); p = 0.007 and odds ratio (95 % confidence interval) = 0.42 (0.18-1.0); p = 0.05, respectively]. In conclusion, in this cohort of mostly combination antiretroviral therapy-treated subjects, two common mitochondrial DNA SNPs and their corresponding haplogroups were associated with a markedly decreased prevalence of HIV-associated sensory neuropathy.

  14. Intramedullary abscess resulting from disseminated cryptococcosis despite immune restoration in a patient with AIDS.

    Science.gov (United States)

    Rambeloarisoa, J; Batisse, D; Thiebaut, J-B; Mikol, J; Mrejen, S; Karmochkine, M; Kazatchkine, M D; Weiss, L; Piketty, C

    2002-04-01

    We report on a case of cryptococcal intramedullary abscess, which occurred three years after a disseminated cryptococcosis and two years after a lymph node cryptococcal recurrence in a HIV-infected patient who exhibited a long-standing immune restoration. At the time of diagnosis, CD4(+) lymphocyte-count was 640x10(6)/l and HIV viral load was undetectable. Spinal involvement is rare during cryptococcosis of the central nervous system. As far as we are aware, there is only one case of proven intramedullary cryptococcal abscess reported in the literature and this case is then the second one. The significant and sustained increase in CD4 count following effective antiretroviral therapy was probably associated with only a partial immune restitution that did not allow to avoid the occurrence of the cryptococcal medullar abscess. Finally, this case raises the question of when to stop secondary prophylaxis of cryptococcal disease after increase in CD4 cell count under antiretroviral therapy.

  15. Peripheral blood lymphocyte HIV DNA levels correlate with HIV associated neurocognitive disorders in Nigeria.

    Science.gov (United States)

    Jumare, Jibreel; Sunshine, Sara; Ahmed, Hayat; El-Kamary, Samer S; Magder, Laurence; Hungerford, Laura; Burdo, Tricia; Eyzaguirre, Lindsay M; Umlauf, Anya; Cherner, Mariana; Abimiku, Alash'le; Charurat, Man; Li, Jonathan Z; Blattner, William A; Royal, Walter

    2017-02-27

    Mononuclear cells play key roles in the pathogenic mechanisms leading to HIV-associated neurocognitive disorders (HANDs). We examined the association between HIV DNA within peripheral blood mononuclear cell (PBMC) subsets and HAND in Nigeria. PBMCs were collected at baseline from 36 antiretroviral naive participants. CD14+ cells and T&B lymphocyte fractions were isolated by, respectively, positive and negative magnetic bead separation. Total HIV DNA within CD14+ and T&B cells were separately quantified using real-time PCR assay targeting HIV LTR-gag and cell input numbers determined by CCR5 copies/sample. Utilizing demographically adjusted T scores obtained from a 7-domain neuropsychological test battery, cognitive status was determined by the global deficit score (GDS) approach, with a GDS of ≥0.5 indicating cognitive impairment. In a linear regression adjusting for plasma HIV RNA, CD4 and lymphocyte count, Beck's depression score, and years of education, there was 0.04 lower log10 HIV DNA copies within T&B lymphocytes per unit increase in global T score (p = 0.02). Adjusting for the same variables in a logistic regression, the odds of cognitive impairment were 6.2 times greater per log10 increase in HIV DNA within T&B lymphocytes (p = 0.048). The association between cognitive impairment and HIV DNA within CD14+ monocytes did not reach statistical significance. In this pretreatment cohort with mild cognitive dysfunction, we found a strong association between levels of HIV DNA within the lymphocyte subset and HAND independent of plasma HIV RNA. These findings likely reflect the neurologic impact of a larger HIV reservoir and active viral replication.

  16. Primary pulmonary cryptococcosis: evaluation of CT characteristics in 26 immunocompetent Chinese patients

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    Qu, Yanjuan; Liu, Guobing; Ghimire, Prasanna; Liao, Meiyan; Xu, Liying [Dept. of Radiology, Zhongnan Hospital of Wuhan Univ., Wuhan (China)], E-mail: leometeor123@gmail.com; Shi, Heshui [Dept. of Radiology, Union Hospital affiliated to Tongji Medical College of Huazhong Univ. of Science and Technology, Wuhan (China); Yang, Guifang [Dept. of Pathology, Zhongnan Hospital of Wuhan Univ., Wuhan (China); Wang, Guanliang [Dept. of Radiology, Taizhou Hospital of Zhejiang Province, Taizhou (China)

    2012-07-15

    Background. Discrepancies still exist in the diagnosis of primary pulmonary cryptococcosis in immunocompetent patients. Purpose. To describe and evaluate radiological manifestations of pulmonary cryptococcosis in immunocompetent patients. Material and Methods. Twenty-six histopathologically confirmed cases of pulmonary cryptococcosis were analyzed for clinical, pathological, and CT characteristics. Necessary statistical tests for differences in CT presentations and correlation analysis between clinical and CT characteristics were performed. Results. The patients' ages ranged from 24 to 79 years, with 20 men and six women. Eighteen patients were symptomatic, with cough as the most common symptom (n = 14, 53.8%). Nodules (n = 21, 80.8%) were the most common CT findings. Eight cases presented with solitary and nine with multiple nodules, while 13 cases presented with irregular and 19 with ill-defined nodules. The halo sign was demonstrated, encompassing nodules in 14 of the 21 patients. Lesions were mainly localized in the lower lobes of the lungs (n = 15, 57.7%) with peripheral distribution (n = 18, 69.2%). Ground-glass opacities (GGOs) were more easily detected in older patients (66.7%, P <0.01). No significant differences in CT abnormalities were found between male and female patients. Conclusion. Primary pulmonary cryptococcosis in immunocompetent patients exhibits certain CT characteristics. The typical presentation includes multiple nodules with the halo sign scattered in the peripheral field in the lower lobes of the bilateral lungs. This could contribute to diagnosis of the disease entity. However, vigilance should be exercised when facing GGOs, with or without nodules, in older patients.

  17. Paracoccidioidomycosis and cryptococcosis with localized skin manifestations: report of two cases in the elderly*

    Science.gov (United States)

    de Oliveira, Ederson Valei Lopes; de Almeida, Margarete Teresa Gottardo; Turatti, Aline; Gomes, Ciro Martins; Roselino, Ana Maria

    2016-01-01

    Distinct cases of Paracoccidioidomycosis and Cryptococcosis with atypical and localized skin manifestation on the upper limbs of two elderly patients are reported. In the 2nd one, he presented asymptomatic pulmonary cancer; the blood tests for fungal infection were negative, and the etiologic agents were seen in skin biopsy samples. This report emphasizes the importance of the differential diagnosis of infectious diseases in elderly patients. PMID:27192530

  18. Disseminated cryptococcosis and fluconazole resistant oral candidiasis in a patient with acquired immunodeficiency syndrome (AIDS).

    Science.gov (United States)

    Kothavade, Rajendra J; Oberai, Chetan M; Valand, Arvind G; Panthaki, Mehroo H

    2010-10-28

    Disseminated cryptococcosis and recurrent oral candidiasis was presented in a-heterosexual AIDS patient. Candida tropicalis (C.tropicalis) was isolated from the oral pseudomembranous plaques and Cryptococcus neoformans (C. neoformans) was isolated from maculopapular lesions on body parts (face, hands and chest) and body fluids (urine, expectorated sputum, and cerebrospinal fluid). In vitro drug susceptibility testing on the yeast isolates demonstrated resistance to fluconazole acquired by C. tropicalis which was a suggestive possible root cause of recurrent oral candidiasis in this patient.

  19. [Basic principles in the formulation of a postmortem diagnosis in HIV-associated infections].

    Science.gov (United States)

    Parkhomenko, Iu G; Ziuzia, Iu R

    2013-01-01

    If a patient dies from HIV-associated disease, after the heading "Underlying disease" the postmortem diagnosis should contain the heading "Secondary diseases" wherein HIV-associated infection is given with the form, site, extent, and activity of the process being indicated. While comparing clinical and postmortem diagnoses in HIV infection, the discrepancy should be specified in view of a secondary disease. If there are a few HIV-associated infections, they all are indicated in the heading "Secondary diseases", one of them, the complications of which are of crucial importance in tanatogenesis, is better chosen to be encoded in the medical death certificate. In some situations, HIV infection can be mixed, competitive, background, or concomitant regardless of its stage.

  20. Clinical and epidemiological features of 123 cases of cryptococcosis in Mato Grosso do Sul, Brazil.

    Science.gov (United States)

    Lindenberg, Andrea de Siqueira Campos; Chang, Marilene Rodrigues; Paniago, Anamaria Melo Miranda; Lazéra, Márcia dos Santos; Moncada, Paula Maria Frank; Bonfim, Gisele Facholi; Nogueira, Susie Andries; Wanke, Bodo

    2008-01-01

    To identify the clinical and epidemiological profile of cryptococcosis diagnosed at the University Hospital of the Federal University of Mato Grosso do Sul, Brazil, medical records of 123 patients admitted from January 1995 to December 2005 were analyzed. One hundred and four cases (84.5%) had HIV infection, six (4.9%) had other predisposing conditions and 13 (10.6%) were immunocompetent. Male patients predominated (68.3%) and their age ranged from 19 to 69 years (mean: 35.9). Most patients (73.2%) were born and lived lifelong in the state of Mato Grosso do Sul. Involvement of the central nervous system occurred in 103 patients (83.7%) and headache and vomiting were the most frequent symptoms. In 77 cases it was possible to identify the Cryptococcus species: 69 (89.6%) C. neoformans and eight (10.4%) C. gattii. Amphotericin B was the drug of choice for treatment (106/123), followed by fluconazole in 60% of cases. The overall lethality rate was 49.6%, being 51% among the HIV infected patients and 41.2% among the non-HIV infected (p > 0.05). Although cryptococcosis exhibited in our region a similar behavior to that described in the literature, the detection of an important rate of immunocompetent individuals and five C. gattii cryptococcosis in HIV-infected patients is noteworthy.

  1. Limited Activity of Miltefosine in Murine Models of Cryptococcal Meningoencephalitis and Disseminated Cryptococcosis

    Science.gov (United States)

    Najvar, Laura K.; Bocanegra, Rosie; Kirkpatrick, William R.; Sorrell, Tania C.; Patterson, Thomas F.

    2013-01-01

    Miltefosine is an alkyl phosphocholine with good oral bioavailability and in vitro activity against Cryptococcus species that has gained interest as an additional agent for cryptococcal infections. Our objective was to further evaluate the in vivo efficacy of miltefosine in experimental in vivo models of cryptococcal meningoencephalitis and disseminated cryptococcosis. Mice were infected intracranially or intravenously with either C. neoformans USC1597 or H99. Miltefosine treatment (1.8 to 45 mg/kg of body weight orally once daily) began at either 1 h or 1 day postinoculation. Fluconazole (10 mg/kg orally twice daily) or amphotericin B deoxycholate (3 mg/kg intraperitoneally once daily) served as positive controls. In our standard models, miltefosine did not result in significant improvements in survival or reductions in fungal burden against either C. neoformans isolate. There was a trend toward improved survival with miltefosine at 7.2 mg/kg against disseminated cryptococcosis with the H99 strain but only at a low infecting inoculum. In contrast, both fluconazole and amphotericin B significantly improved survival in mice with cryptococcal meningoencephalitis and disseminated cryptococcosis due to USC1597. Amphotericin B also improved survival against both cryptococcal infections caused by H99. Combination therapy with miltefosine demonstrated neither synergy nor antagonism in both models. These results demonstrate limited efficacy of miltefosine and suggest caution with the potential use of this agent for the treatment of C. neoformans infections. PMID:23165465

  2. The epidemiology of cryptococcosis and the characterization of Cryptococcus neoformans isolated in a Brazilian University Hospital

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    Paula Augusta Dias Fogaça de Aguiar

    Full Text Available ABSTRACT Cryptococcosis, a systemic disease caused by the fungus Cryptococcus neoformans/ Cryptococcus gattii is more severe in immunocompromised individuals. This study aimed to analyze the epidemiology of the disease, the molecular characteristics and the antifungal susceptibility of C. neoformans isolated from patients treated in a Brazilian university hospital. This retrospective study was conducted in the Clinical Hospital, Federal University of Uberlândia, and evaluated cases of cryptococcosis and strains of C. neoformans isolated from 2004 to 2013. We evaluated 41 patients, 85% of whom were diagnosed with AIDS. The fungus was isolated from the cerebrospinal fluid (CSF of 21 patients (51%; 19.5% had fungemia and in 24% the agent was isolated from the CSF and blood, concurrently. Meningoencephalitis was the most frequent (75% manifestation of infection. Despite adequate treatment, the mortality of the disease was 58.5%. Most isolates (97.5% presented the VNI genotype (serotype A, var. grubii and one isolate was genotyped as C. gattii (VGI; all the isolates were determined as mating type MATa and showed susceptibility to the tested antifungals (fluconazole, voriconazole, amphotericin B and 5-flucytosine. Although AIDS detection rates remain stable, opportunistic infections such as cryptococcosis remain as major causes of morbidity and mortality in these patients.

  3. Research progress of HIV-associated central nervous system infections and neurosyphilis in China

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    Ying PENG

    2016-08-01

    Full Text Available Currently, acquired immunodeficiency syndrome (AIDS and syphilis are widely epidemic all over the world, which has seriously jeopardized public health security. In China, studies on human immunodeficiency virus (HIV-associated central nervous system (CNS damage and neurosyphilis are increasing. This paper reviews related literatures on HIV-associated CNS infection and neurosyphilis, and summarizes the epidemiological characteristics, pathogenesis, clinical features, diagnosis and treatment strategies, so as to provide new clues for further exploration into clinical diagnosis and treatment. DOI: 10.3969/j.issn.1672-6731.2016.07.003

  4. Safe interruption of maintenance therapy against previous infection with four common HIV-associated opportunistic pathogens during potent antiretroviral therapy

    DEFF Research Database (Denmark)

    Kirk, Ole; Reiss, Peter; Uberti-Foppa, Caterina;

    2002-01-01

    maintenance therapy for cytomegalovirus (CMV) end-organ disease, disseminated Mycobacterium avium complex (MAC) infection, cerebral toxoplasmosis, and extrapulmonary cryptococcosis in patients receiving antiretroviral therapy. DESIGN: Observational study. SETTING: Seven European HIV cohorts. PATIENTS: 358...... identified: 162 for CMV disease, 103 for MAC infection, 75 for toxoplasmosis, and 39 for cryptococcosis. During 781 person-years of follow-up, five patients had relapse. Two relapses (one of CMV disease and one of MAC infection) were diagnosed after maintenance therapy was interrupted when the CD4 lymphocyte....... One relapse (toxoplasmosis) was diagnosed after maintenance therapy interruption at a CD4 lymphocyte count greater than 200 x 10(6) cells/L for 15 months. The overall incidences of recurrent CMV disease, MAC infection, toxoplasmosis, and cryptococcosis were 0.54 per 100 person-years (95% CI, 0.07 to 1...

  5. Complications of antiretroviral therapy initiation in hospitalised patients with HIV-associated tuberculosis.

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    Helen van der Plas

    Full Text Available BACKGROUND: HIV-associated tuberculosis is a common coinfection in Sub-Saharan Africa, which causes high morbidity and mortality. A sub-set of HIV-associated tuberculosis patients require prolonged hospital admission, during which antiretroviral therapy initiation may be required. The aim of this study was to document the causes of clinical deterioration of hospitalised patients with HIV-associated tuberculosis starting antiretroviral therapy in order to inform healthcare practice in low- to middle-income countries. METHODS: Prospective, observational cohort study of adult inpatients with HIV-associated tuberculosis starting antiretroviral therapy in a dedicated tuberculosis hospital in Cape Town, South Africa. Causes of clinical deterioration and outcome were recorded in the first 12 weeks of antiretroviral therapy. Patients with rifampicin-resistant tuberculosis were excluded. RESULTS: Between May 2009 and November 2010, 112 patients (60% female, with a median age of 32 years were enrolled. At baseline the median CD4 count was 55 cells/mm3 (IQR 31-106 and HIV viral load 5.6 log copies/mL. All patients had significant comorbidity: 82% were bed-bound, 65% had disseminated tuberculosis and 27% had central nervous system tuberculosis. Seventy six patients (68% developed 144 clinical events after starting antiretroviral therapy. TB-IRIS, hospital-acquired infections and significant drug toxicities occurred in 42%, 20.5% and 15% of patients respectively. A new opportunistic disease occurred in 15% of patients and a thromboembolic event in 8%. Mortality during the 12 week period was 10.6%. CONCLUSIONS: High rates of TB-IRIS, hospital-acquired infections and drug toxicities complicate the course of patients with HIV-associated tuberculosis starting antiretroviral therapy in hospital. Despite the high morbidity, mortality was relatively low. Careful clinical management and adequate resources are needed in hospitalised HIV-TB patients in the 1(st three

  6. HIV-Associated Tuberculosis in the Newborn and Young Infant

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    M. Adhikari

    2011-01-01

    Full Text Available Each year, approximately 250 000 women die during pregnancy, delivery, or postpartum. Maternal mortality rates due to tuberculosis (TB and HIV in Sub-Saharan Africa now supersede obstetric-related causes of mortality. The majority of cases occur in population-dense regions of Africa and Asia where TB is endemic. The vertical transmission rate of tuberculosis is 15%, the overall vertical transmission rate of HIV in resource-limited settings with mono- or dual-ARV therapy varies from 1.9% to 10.7%. If the millennium development goals are to be achieved, both HIV and TB must be prevented. The essential aspect of TB prevention and detection in the newborn is the maternal history and a positive HIV status in the mother. Perinatal outcomes are guarded even with treatment of both diseases. Exclusive breast feeding is recommended. The community and social impact are crippling. The social issues aggravate the prognosis of these two diseases.

  7. The influence of HLA on HIV-associated neurocognitive impairment in Anhui, China.

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    Rachel D Schrier

    Full Text Available BACKGROUND: HLA-DR*04 was identified as a predictor of HIV-Associated neurocognitive disorder (HAND, low CD4 T-cell responses to HIV, and low plasma HIV RNA levels in a U.S. cohort. We hypothesized that low CD4 T-cell activation leads to poor immune control of HIV in the CNS, predisposing to HAND, but also provided fewer target (activated CD4 T-cells for HIV replication. To assess the consistency of these HLA Class II associations in a new cohort and extend analysis to HLA Class I, HLA types, neurocognitive, and virologic status were examined in a cohort of former plasma donors in China. METHODS: 178 HIV infected individuals in Anhui China, were HLA typed and underwent neurocognitive evaluations (using locally standardized norms, neuromedical, treatment and virologic assessments at baseline and at 12 months. RESULTS: HLA DR*04 was associated with a higher rate of baseline neurocognitive impairment (p = 0.04, neurocognitive decline (p = 0.04, and lower levels of HIV RNA in plasma (p = 0.05. HLA Class I alleles (B*27,57,58,A*03,33 that specify a CD8 T-cell response to conserved HIV sequences were neuroprotective, associated with less impairment at baseline (p = 0.037, at month 012 (p = 0.013 and less neurocognitive decline (p = 0.023 in the interval. Consistent with the theory that effective CD8 T-cell responses require CD4 T-cell support, the HLA DR*04 allele reduced the neuroprotective effect of the Class I alleles. The presence of HLA-DR*04 and the Alzheimer associated allele ApoE4 in the same individual had a synergistic negative effect on cognition (p = 0.003. CONCLUSIONS: Despite major background differences between U.S. and Anhui China cohorts, HLA DR*04 predicted neurocognitive impairment and lower plasma HIV RNA levels in both populations. HLA Class I alleles associated with CD8 T-cell control of HIV were associated with protection from HAND, but protection was reduced in the presence of HLA-DR*04.

  8. The use of ventriculoperitoneal shunts for uncontrollable intracranial hypertension in patients with HIV-associated cryptococcal meningitis with or without hydrocephalus.

    Science.gov (United States)

    Liu, Li; Zhang, Renfang; Tang, Yang; Lu, Hongzhou

    2014-12-01

    Extremely elevated intracranial pressure (ICP) in patients with HIV and cryptococcal meningitis is a poor prognostic predictor of death during initial therapy. The risks associated with implanting a cerebrospinal fluid (CSF) shunt into immunocompromised patients with ongoing CSF infection have historically discouraged surgeons from implanting CSF shunts in patients with HIV and cryptococcal meningitis. An unanswered question is whether ventriculoperitoneal (VP) shunts can effectively provide long-term treatment for patients with intracranial hypertension and HIV-associated cryptococcal meningitis in China. Outcomes for 9 patients with HIV-associated cryptococcal meningitis who were given VP shunts for increased ICP were retrospectively analyzed. Each patient's age, sex, clinical manifestations, CD4+ lymphocyte count, HIV viral load, neurological status, CSF features, image findings, anad other opportunistic infections were recorded for analysis. All patients had signs and symptoms of increased ICP, including headaches, nausea, and vomiting. Seven patients (77.78%) had visual loss due to persistent papilledema. The median time from diagnosis of cryptococcal meningitis to VP shunting in the 9 patients was 5 months (range 0.5-12.5 months). Seven patients (77.78%) had good outcomes, with recovery from 1 month to 48 months. Two patients had poor outcomes; one died six months after shunting due to severe adverse reactions to antiretroviral drugs, and the other died two weeks after surgery. Patients with intracranial hypertension and HIV-associated cryptococcal meningitis who cannot tolerate cessation of external lumbar CSF drainage or frequent lumbar punctures may be eligible for VP shunt placement, despite severe immunosuppression and persistent CSF cryptococcal infection.

  9. FATAL DISSEMINATED CRYPTOCOCCOSIS WITH RENAL INVOLVEMENT IN AN HIV-INFECTED PATIENT

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    Elizabeth De Francesco DAHER

    2015-08-01

    Full Text Available SUMMARY Introduction: We present a fatal case of disseminated cryptococcosis in a young man whose diagnosis of HIV infection was made at the time of admission to the emergency room. Case report: The patient was a twenty-three-year-old man, with a history of daily fever during one month associated with diarrhea, weight loss, headache, vomiting and generalized seizures. He also had a history of diabetes mellitus, alcoholism and drug addiction. Upon physical examination the patient was pale, disoriented and had periods of agitation. White blood cells count was 3,440/mm3 (5% lymphocytes, hemoglobin was 10g/dL, platelets were 83,000/ mm3. Creatinine was 0.7 mg/dL; urea 19 mg/dL; Na, K, and liver enzymes were within normal limits. Lactic dehydrogenase was 494 IU/L. Cerebrospinal fluid (CSF analysis revealed 10 white blood cells/mm3 (58% neutrophils, 31% lymphocytes, 11% monocytes and 2 red blood cells/mm3. India ink test revealed six Cryptococcus yeasts/mm3. CSF glucose was 122 mg/dL and protein was 36 mg/ dL. VDRL test was negative and anti-HIV test was positive. Intravenous hydration, insulin, phenytoin, fluconazole, pyrimethamine, sulfadiazine, folinic acid, and amphotericin B were started. The patient did not improve and became obtunded and hypotensive. He was intubated and put on mechanical respiration. He received vasoactive drugs and died less than 24 hours after admission. A postmortem examination was performed and revealed disseminated cryptococcosis, with severe involvement of the kidneys. Conclusion: Cryptococcosis, as a rule, is a systemic disease that affects mostly immunocompromised individuals, especially patients with AIDS. When diagnosed late in its course it has a very high mortality.

  10. Ketoconazole in the treatment of cryptococcosis of the central nervous system

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    P. C. Trevisol-Bittencourt

    1991-06-01

    Full Text Available Two patients with cryptococcosis of the CNS were treated with ketoconazole (KTZ, an imidazole derivative with fungistatic properties; they had either failed standard therapy (Amphotericin-B + 5-Flurocytosine or suffred intolerable side-effects to it. Both patients were administered KTZ 800 mg/day as monotherapy for six months without interruption and both responded. One month after KTZ therapy was withdrawn, however, a relapse of the infection was seen in one case. Side-effects were minimal during the trial of treatment. KTZ could be a useful drug in some cases of neurocryptococcosis.

  11. Disseminated cryptococcosis in a patient with HIV/AIDS at a teaching hospital in Ghana

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    KP Akakpo

    2015-01-01

    Full Text Available Objective: To raise awareness of the existence of cryptococcal infections in HIV/AIDS patients in Ghana. Method: Detailed postmortem gross and histopathological analysis of an HIV/AIDS patient suspected to have cryptococcal meningitis was carried out and histopathological findings correlated with clinical findings. Results: showed disseminated Cryptococcosis in an HIV/AIDS patient which was confirmed with special stains. Conclusion: cryptococcal infection occurs in HIV /AIDS patients in Ghanaian and when clinically suspected the diagnosis should be pursued vigorously.

  12. Comparison of Fungizone, Amphotec, AmBisome, and Abelcet for Treatment of Systemic Murine Cryptococcosis

    OpenAIRE

    Clemons, Karl V.; Stevens, David A.

    1998-01-01

    Three lipid-based formulations of amphotericin B have been approved for use in various countries. The aim of this study was to compare Amphotec (ABCD; Sequus), AmBisome (AmBi; Nexstar), Abelcet (ABLC; The Liposome Co.), and conventional deoxycholate amphotericin B (Fungizone; Bristol Meyers Squibb) for the treatment of experimental systemic cryptococcosis. A model was established in 10-week-old female CD-1 mice by intravenous (i.v.) injection of 6.25 × 105 viable Cryptococcus neoformans yeast...

  13. HIV-associated opportunistic CNS infections: pathophysiology, diagnosis and treatment.

    Science.gov (United States)

    Bowen, Lauren N; Smith, Bryan; Reich, Daniel; Quezado, Martha; Nath, Avindra

    2016-10-27

    Nearly 30 years after the advent of antiretroviral therapy (ART), CNS opportunistic infections remain a major cause of morbidity and mortality in HIV-positive individuals. Unknown HIV-positive disease status, antiretroviral drug resistance, poor drug compliance, and recreational drug abuse are factors that continue to influence the morbidity and mortality of infections. The clinical and radiographic pattern of CNS opportunistic infections is unique in the setting of HIV infection: opportunistic infections in HIV-positive patients often have characteristic clinical and radiological presentations that can differ from the presentation of opportunistic infections in immunocompetent patients and are often sufficient to establish the diagnosis. ART in the setting of these opportunistic infections can lead to a paradoxical worsening caused by an immune reconstitution inflammatory syndrome (IRIS). In this Review, we discuss several of the most common CNS opportunistic infections: cerebral toxoplasmosis, progressive multifocal leukoencephalopathy (PML), tuberculous meningitis, cryptococcal meningitis and cytomegalovirus infection, with an emphasis on clinical pearls, pathological findings, MRI findings and treatment. Moreover, we discuss the risk factors, pathophysiology and management of IRIS. We also summarize the challenges that remain in management of CNS opportunistic infections, which includes the lack of phase II and III clinical trials, absence of antimicrobials for infections such as PML, and controversy regarding the use of corticosteroids for treatment of IRIS.

  14. Evaluation and Diagnosis of HIV-Associated Lung Disease.

    Science.gov (United States)

    Maximous, Stephanie; Huang, Laurence; Morris, Alison

    2016-04-01

    There are myriad pulmonary conditions associated with HIV, ranging from acute infections to chronic noncommunicable diseases. The epidemiology of these diseases has changed significantly in the era of widespread antiretroviral therapy. Evaluation of the HIV-infected patient involves assessment of the severity of illness and a thorough yet efficient pursuit of definitive diagnosis, which may involve multiple etiologies simultaneously. Important clues to a diagnosis include medical and social history, demographic details such as travel and geography of residence, substance use, sexual practices, and domiciliary and incarceration status. CD4 cell count is a tremendously useful measure of immune function and risk for HIV-related diseases, and helps narrow down the differential. Careful history of current symptoms and physical examination with particular attention to extrapulmonary signs are crucial early steps. Many adjunctive laboratory studies can suggest or rule out particular diagnoses. Pulmonary function testing (PFT) may aid in characterization of several chronic noninfectious illnesses accelerated by HIV. Chest radiograph and computed tomography (CT) scan allow for classification of diseases by pathognomonic imaging patterns, although many infectious conditions present atypically, particularly with lower CD4 counts. Ultimately, definitive diagnosis with sputum, bronchoscopy with bronchoalveolar lavage, or lung tissue is often needed. It is of utmost importance to maintain a high degree of suspicion for HIV in otherwise undiagnosed patients, as the first presentation of HIV may be via an acute pulmonary illness.

  15. Cutaneous HIV-associated Kaposi sarcoma: a potential setting for management by clinical observation.

    Science.gov (United States)

    Beatrous, Surget V; Grisoli, Stratton B; Riahi, Ryan R; Cohen, Philip R

    2017-06-15

    Kaposi sarcoma (KS) is a malignancy of viral etiology whose course ranges from cutaneous limited lesions to fulminant disease with multi-organ involvement. Four clinical variants of the disease exist: classic, endemic, iatrogenic, and epidemic. Iatrogenic and epidemic variants of Kaposi sarcoma develop in the setting of immune suppression. Transplant recipients who develop iatrogenic KS typically demonstrate improvement of lesions following de-escalation of immunosuppressive therapy. Similarly, HIV-infected patients who begin highly active antiretroviral therapy (HAART) experience immune reconstitution, which can induce KS regression. We describe two patients with varying clinical outcomes of cutaneous-limited HIV-associated KS after immune reconstitution with HAART. We propose that immune reconstitution with HAART, followed by clinical and radiographic surveillance for disease progression, may be an appropriate initial management strategy for limited cutaneous HIV-associated KS. In patients with more extensive disease at presentation or failure of HAART alone, antineoplastic therapy should be instituted.

  16. Are MMSE and HDS-R neuropsychological tests adequate for screening HIV-associated neurocognitive disorders?

    Science.gov (United States)

    Nakazato, Ai; Tominaga, Daisuke; Tasato, Daisuke; Miyagi, Kyoko; Nakamura, Hideta; Haranaga, Shusaku; Higa, Futoshi; Tateyama, Masao; Fujita, Jiro

    2014-03-01

    HIV-associated neurocognitive disorders (HAND) are one of major comorbidities in patients with HIV-1 infection. There are currently no standardized tests for screening HAND in such patients. The sensitivity of the cognitive function tests routinely used in clinical practice, such as the Mini-Mental State Examination and the Revised Hasegawa's Dementia Scale, is inadequate to rule out HAND, even in patients with clear abnormal behavior. We report a 41-year-old man with HIV-associated dementia, the most severe form of HAND, in whom the simplified methods did not show abnormal results, and a comprehensive battery of neuropsychological tests which covering several cognitive domains was needed to detect cognitive impairment.

  17. An initial screening for HIV-associated neurocognitive disorders of HIV-1 infected patients in China

    OpenAIRE

    Zhang, Yulin; Qiao, Luxin; Ding, Wei; Wei, Feili; Zhao, Qingxia; WANG, XICHENG; Shi, Ying; Li, Ning; Smith, Davey; Chen, Dexi

    2012-01-01

    HIV-associated neurocognitive disorders (HAND), characterized by cognitive, motor, and behavioral abnormalities, are common among people living with HIV and AIDS. In combined antiretroviral therapy era in Western countries, nearly 40% of HIV-infected patients continue to suffer from HAND, mainly with mild or asymptomatic cognitive impairment. However, the prevalence and the clinical features of HAND in China are still not well known. In this study, a multi-center cross-sectional study was per...

  18. Capítulo 3: criptococose pulmonar Chapter 3: pulmonary cryptococcosis

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    Cecília Bittencourt Severo

    2009-11-01

    Full Text Available Criptococose é uma micose sistêmica causada por duas espécies do basidiomiceto encapsulado, Cryptococcus neoformans e C. gattii, que, respectivamente, causam infecção em indivíduos imunocomprometidos e em hospedeiros imunocompetentes, respectivamente. Pacientes com deficiência em células T são mais suscetíveis. A infecção se inicia por lesões pulmonares assintomáticas e a doença disseminada frequentemente cursa com meningoencefalite. A importância médica da criptococose aumentou significativamente em consequência da epidemia da AIDS e dos transplantes de órgãos.Cryptococcosis is a systemic mycosis caused by two species of the encapsulated basidiomycetes, Cryptococcus neoformans and C. gattii, which, respectively, cause infection in immunocompromised individuals and in immunologically normal hosts. Patients with T-cell deficiencies are more susceptible to this infection. The spectrum of the disease ranges from asymptomatic pulmonary lesions to disseminated infection with meningoencephalitis. The medical relevance of cryptococcosis increased dramatically as a consequence of the AIDS epidemic and organ transplants.

  19. The Case for Adopting the “Species Complex” Nomenclature for the Etiologic Agents of Cryptococcosis

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    Kyung J. Kwon-Chung

    2017-01-01

    Full Text Available Cryptococcosis is a potentially lethal disease of humans/animals caused by Cryptococcus neoformans and Cryptococcus gattii. Distinction between the two species is based on phenotypic and genotypic characteristics. Recently, it was proposed that C. neoformans be divided into two species and C. gattii into five species based on a phylogenetic analysis of 115 isolates. While this proposal adds to the knowledge about the genetic diversity and population structure of cryptococcosis agents, the published genotypes of 2,606 strains have already revealed more genetic diversity than is encompassed by seven species. Naming every clade as a separate species at this juncture will lead to continuing nomenclatural instability. In the absence of biological differences between clades and no consensus about how DNA sequence alone can delineate a species, we recommend using “Cryptococcus neoformans species complex” and “C. gattii species complex” as a practical intermediate step, rather than creating more species. This strategy recognizes genetic diversity without creating confusion.

  20. Flucytosine + fluconazole association in the treatment of a murine experimental model of cryptococcosis

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    A. J. Bava

    1994-12-01

    Full Text Available The efficacy of flucytosine (5-FC and fluconazole (FLU association in the treatment of a murine experimental model of cryptococcosis, was evaluated. Seven groups of 10 Balb C mice each, were intraperitoneally inoculated with 10(7 cells of Cryptococcus neoformans. Six groups were allocated to receive 5-FC (300 mg/kg and FLU (16 mg/ kg, either combined and individually, by daily gavage beginning 5 days after the infection, for 2 and 4 weeks. One group received distilled water and was used as control. The evaluation of treatments was based on: survival time; macroscopic examination of brain, lungs, liver and spleen at autopsy; presence of capsulated yeasts in microscopic examination of wet preparations of these organs and cultures of brain homogenate. 5-FC and FLU, individually or combined, significantly prolonged the survival time of the treated animals with respect to the control group (p<0.01. Animals treated for 4 weeks survived significantly longer than those treated for 2 weeks (p<0.01. No significant differences between the animals treated with 5-FC and FLU combined or separately were observed in the survival time and morphological parameters. The association of 5-FC and FLU does not seem to be more effective than 5-FC or FLU alone, in the treatment of this experimental model of cryptococcosis.

  1. The Case for Adopting the “Species Complex” Nomenclature for the Etiologic Agents of Cryptococcosis

    Science.gov (United States)

    Bennett, John E.; Wickes, Brian L.; Meyer, Wieland; Wollenburg, Kurt R.; Bicanic, Tihana A.; Castañeda, Elizabeth; Chang, Yun C.; Chen, Jianghan; Cogliati, Massimo; Dromer, Françoise; Ellis, David; Filler, Scott G.; Harrison, Thomas S.; Holland, Steven M.; Kohno, Shigeru; Kronstad, James W.; Lazera, Marcia; Levitz, Stuart M.; Lionakis, Michail S.; Ngamskulrongroj, Popchai; Pappas, Peter G.; Perfect, John R.; Rickerts, Volker; Sorrell, Tania C.; Walsh, Thomas J.; Williamson, Peter R.; Zelazny, Adrian M.; Casadevall, Arturo

    2017-01-01

    ABSTRACT Cryptococcosis is a potentially lethal disease of humans/animals caused by Cryptococcus neoformans and Cryptococcus gattii. Distinction between the two species is based on phenotypic and genotypic characteristics. Recently, it was proposed that C. neoformans be divided into two species and C. gattii into five species based on a phylogenetic analysis of 115 isolates. While this proposal adds to the knowledge about the genetic diversity and population structure of cryptococcosis agents, the published genotypes of 2,606 strains have already revealed more genetic diversity than is encompassed by seven species. Naming every clade as a separate species at this juncture will lead to continuing nomenclatural instability. In the absence of biological differences between clades and no consensus about how DNA sequence alone can delineate a species, we recommend using “Cryptococcus neoformans species complex” and “C. gattii species complex” as a practical intermediate step, rather than creating more species. This strategy recognizes genetic diversity without creating confusion. PMID:28101535

  2. Clinical Features, Treatment, and Outcome of HIV-Associated Immune Thrombocytopenia in the HAART Era

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    Kimberley L. S. Ambler

    2012-01-01

    Full Text Available The characteristics of HIV-associated ITP were documented prior to the HAART era, and the optimal treatment beyond HAART is unknown. We performed a review of patients with HIV-associated ITP and at least one platelet count <20 × 109/L since January 1996. Of 5290 patients in the BC Centre for Excellence in HIV/AIDS database, 31 (0.6% had an ITP diagnosis and platelet count <20 × 109/L. Initial ITP treatment included IVIG, n=12; steroids, n=10; anti-RhD, n=8; HAART, n=3. Sixteen patients achieved response and nine patients achieved complete response according to the International Working Group criteria. Median time to response was 14 days. Platelet response was not significantly associated with treatment received, but complete response was lower in patients with a history of injection drug use. Complications of ITP treatment occurred in two patients and there were four unrelated deaths. At a median followup of 48 months, 22 patients (71% required secondary ITP treatment. This is to our knowledge the largest series of severe HIV-associated ITP reported in the HAART era. Although most patients achieved a safe platelet count with primary ITP treatment, nearly all required retreatment for ITP recurrence. New approaches to the treatment of severe ITP in this population are needed.

  3. HIV-associated TB in An Giang Province, Vietnam, 2001-2004: epidemiology and TB treatment outcomes.

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    Trinh Thanh Thuy

    Full Text Available BACKGROUND: Mortality is high in HIV-infected TB patients, but few studies from Southeast Asia have documented the benefits of interventions, such as co-trimoxazole (CTX, in reducing mortality during TB treatment. To help guide policy in Vietnam, we studied the epidemiology of HIV-associated TB in one province and examined factors associated with outcomes, including the impact of CTX use. METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively abstracted data for all HIV-infected persons diagnosed with TB from 2001-2004 in An Giang, a province in southern Vietnam in which TB patients receive HIV counseling and testing. We used standard WHO definitions to classify TB treatment outcomes. We conducted multivariate analysis to identify risk factors for the composite outcome of death, default, or treatment failure during TB treatment. From 2001-2004, 637 HIV-infected TB patients were diagnosed in An Giang. Of these, 501 (79% were male, 321 (50% were aged 25-34 years, and the most common self-reported HIV risk factor was sex with a commercial sex worker in 221 (35%. TB was classified as smear-positive in 531 (83%. During TB treatment, 167 (26% patients died, 9 (1% defaulted, and 6 (1% failed treatment. Of 454 patients who took CTX, 116 (26% had an unsuccessful outcome compared with 33 (70% of 47 patients who did not take CTX (relative risk, 0.4; 95% confidence interval [CI], 0.3-0.5. Adjusting for male sex, rural residence, TB smear status and disease location, and the occurrence of adverse events during TB treatment in multivariate analysis, the benefit of CTX persisted (adjusted odds ratio for unsuccessful outcome 0.1; CI, 0.1-0.3. CONCLUSIONS/SIGNIFICANCE: In An Giang, Vietnam, HIV-associated TB was associated with poor TB treatment outcomes. Outcomes were significantly better in those taking CTX. This finding suggests that Vietnam should consider applying WHO recommendations to prescribe CTX to all HIV-infected TB patients.

  4. Major role for amphotericin B-flucytosine combination in severe cryptococcosis.

    Directory of Open Access Journals (Sweden)

    Françoise Dromer

    Full Text Available BACKGROUND: The Infectious Diseases Society of America published in 2000 practical guidelines for the management of cryptococcosis. However, treatment strategies have not been fully validated in the various clinical settings due to exclusion criteria during therapeutic trials. We assessed here the optimal therapeutic strategies for severe cryptococcosis using the observational prospective CryptoA/D study after analyzing routine clinical care of cryptococcosis in university or tertiary care hospitals. METHODOLOGY/PRINCIPAL FINDINGS: Patients were enrolled if at least one culture grew positive with Cryptococcus neoformans. Control of sterilization was warranted 2 weeks (Wk2 and 3 months (Mo3 after antifungal therapy onset. 208 HIV-positive or -negative adult patients were analyzed. Treatment failure (death or mycological failure at Wk2 and Mo3 was the main outcome measured. Combination of amphotericin B+flucytosine (AMB+5FC was the best regimen for induction therapy in patients with meningoencephalitis and in all patients with high fungal burden and abnormal neurology. In those patients, treatment failure at Wk2 was 26% in the AMB+5FC group vs. 56% with any other treatments (p<0.001. In patients treated with AMB+5FC, factors independently associated with Wk2 mycological failure were high serum antigen titer (OR [95%CI] = 4.43[1.21-16.23], p = 0.025 and abnormal brain imaging (OR = 3.89[1.23-12.31], p = 0.021 at baseline. Haematological malignancy (OR = 4.02[1.32-12.25], p = 0.015, abnormal neurology at baseline (OR = 2.71[1.10-6.69], p = 0.030 and prescription of 5FC for less than 14 days (OR = 3.30[1.12-9.70], p = 0.030 were independently associated with treatment failure at Mo3. CONCLUSION/SIGNIFICANCE: Our results support the conclusion that induction therapy with AMB+5FC for at least 14 days should be prescribed rather than any other induction treatments in all patients with high fungal burden at baseline regardless of their HIV serostatus and

  5. Asymptomatic pulmonary cryptococcosis in solid organ transplantation: report of four cases and review of the literature.

    Science.gov (United States)

    Mueller, N J; Fishman, J A

    2003-09-01

    Cryptococcus neoformans is the third most common cause of invasive fungal infections in solid organ transplantation. The infection generally presents as disseminated disease, involving multiple sites including the central nervous system, lungs, and skin. An increase in the incidence of primary pulmonary cryptococcal infections has been reported recently in solid organ recipients; these infections were generally symptomatic with an accelerated clinical course. We report four cases of asymptomatic pulmonary cryptococcosis in solid organ recipients (kidney, n=2, heart, n=2). In each case, an incidental finding on a routine chest radiograph led to the microbiological or histopathological diagnosis of invasive pulmonary C. neoformans infection. In these patients, cryptococcosis occurred a median of 25 months (range 7-36 months) after organ transplantation. All patients had a calcineurin inhibitor, prednisone, and azathioprine or mycophenolate mofetil as part of their immunosuppressive therapy at the time of diagnosis. Serum cryptococcal antigen was available and positive in the three patients studied; assessment of cerebrospinal fluid (CSF) of all four patients revealed no organisms by smear or culture. Therapy consisted of oral fluconazole in all cases, with flucytosine in one case, combined with resection of lung tissue in two individuals. All patients have remained free of cryptococcal disease (follow-up median 42 months, from 18 to 88 months). Cryptococcal disease in solid organ recipients may present as asymptomatic, localized pulmonary disease. The natural history of such infections is unknown. New pulmonary radiographic findings should prompt an aggressive diagnostic evaluation including serum and CSF cryptococcal antigen assays, and a biopsy of pulmonary lesions. Prolonged therapy may be used to reduce the risk of progression and dissemination during periods of intensified immune suppression.

  6. Some pharmacokinetic indices of oral fluconazole administration to koalas (Phascolarctos cinereus) infected with cryptococcosis.

    Science.gov (United States)

    Govendir, M; Black, L A; Jobbins, S E; Kimble, B; Malik, R; Krockenberger, M B

    2016-08-01

    Three asymptomatic koalas serologically positive for cryptococcosis and two symptomatic koalas were treated with 10 mg/kg fluconazole orally, twice daily for at least 2 weeks. The median plasma Cmax and AUC0-8 h for asymptomatic animals were 0.9 μg/mL and 4.9 μg/mL·h, respectively; and for symptomatic animals 3.2 μg/mL and 17.3 μg/mL·h, respectively. An additional symptomatic koala was treated with fluconazole (10 mg/kg twice daily) and a subcutaneous amphotericin B infusion twice weekly. After 2 weeks the fluconazole Cmax was 3.7 μg/mL and the AUC0-8 h was 25.8 μg/mL*h. An additional three koalas were treated with fluconazole 15 mg/kg twice daily for at least 2 weeks, with the same subcutaneous amphotericin protocol co-administered to two of these koalas (Cmax : 5.0 μg/mL; mean AUC0-8 h : 18.1 μg/mL*h). For all koalas, the fluconazole plasma Cmax failed to reach the MIC90 (16 μg/mL) to inhibit C. gattii. Fluconazole administered orally at either 10 or 15 mg/kg twice daily in conjunction with amphotericin is unlikely to attain therapeutic plasma concentrations. Suggestions to improve treatment of systemic cryptococcosis include testing pathogen susceptibility to fluconazole, monitoring plasma fluconazole concentrations, and administration of 20-25 mg/kg fluconazole orally, twice daily, with an amphotericin subcutaneous infusion twice weekly.

  7. HIV-associated neurocognitive disorder: rate of referral for neurorehabilitation and psychiatric co-morbidity.

    LENUS (Irish Health Repository)

    Herlihy, D

    2012-04-01

    Despite advances in antiretroviral therapy, HIV-infected patients continue to present with HIV-associated neurocognitive disorder (HAND) which may be associated with significant psychiatric co-morbidity. We audited our patients with HAND referred for psychiatric assessment against the National Service Framework guidelines that they should receive neurorehabilitation. We found that despite these patients posing a risk to themselves and others due to poor insight and medication adherence, high rates of psychiatric co-morbidity and severely challenging behaviour, few were referred for neurorehabilitation. We recommend that clear referral pathways for psychiatric intervention and neurorehabilitation are established in HIV treatment centres.

  8. Factors associated with early mycological clearance in HIV-associated cryptococcal meningitis

    Science.gov (United States)

    Concha-Velasco, Fátima; González-Lagos, Elsa; Seas, Carlos; Bustamante, Beatriz

    2017-01-01

    Introduction The first-line combination therapy for HIV-associated cryptococcal meningitis (CM), a condition of high mortality particularly in the first two weeks of treatment, consists of amphotericin B plus flucytosine (5-FC). Given that 5-FC remains unavailable in many countries, the knowledge of factors influencing mycological clearance in patients treated with second-line therapy could contribute to effective management. Objectives To determine the factors associated with the clearance of Cryptococcus sp. from the cerebrospinal fluid by the second week of effective antifungal therapy (early mycological clearance) in HIV-associated CM. Methods Retrospective cohort study based on secondary data corresponding to HIV-associated CM cases hospitalized at a tertiary health care center in Lima, Peru where 5-FC remains unavailable. Risk factors associated with early mycological clearance were analyzed by generalized linear regression models. Results From January 2000 to December 2013, 234 individuals were discharged with a diagnosis of HIV-associated CM; in 215 we retrieved the required data. The inpatient mortality was 20% (43/215), 15 of them in the first two weeks of treatment. In the final model (157 cases), adjusted for age, previous episode of CM, ART use, type of antifungal treatment, raised intracranial pressure, frequency of therapeutic lumbar punctures, baseline fungal burden and treatment period, the factors associated with early mycological clearance were: Amphotericin B deoxycholate plus fluconazole as combination therapy (RR, 1.56; 95% CI, 1.14–2.14); severe baseline intracranial pressure (≥35 cm H2O) (RR, 0.57; 95% CI, 0.33–0.99); and baseline fungal burden over 4.5 log10 CFU/mL (RR, 0.61 95% CI: 0.39–0.95). Conclusions In a setting without access to first-line therapy for CM, the combination therapy with amphotericin B deoxycholate plus fluconazole was positively associated with early mycological clearance, while high fungal burden and severe

  9. HIV-associated adipose redistribution syndrome (HARS: etiology and pathophysiological mechanisms

    Directory of Open Access Journals (Sweden)

    Sekhar Rajagopal

    2007-06-01

    Full Text Available Abstract Human immunodeficiency virus (HIV-associated adipose redistribution syndrome (HARS is a fat accumulation disorder characterized by increases in visceral adipose tissue. Patients with HARS may also present with excess truncal fat and accumulation of dorsocervical fat ("buffalo hump". The pathophysiology of HARS appears multifactorial and is not fully understood at present. Key pathophysiological influences include adipocyte dysfunction and an excessive free fatty acid release by adipocyte lipolysis. The contributory roles of free fatty acids, cytokines, hormones including cortisol, insulin and the growth hormone-adipocyte axis are significant. Other potential humoral, paracrine, endocrine, and neural influences are also discussed.

  10. In vitro antifungal susceptibility profiles of Cryptococcus species isolated from HIV-associated cryptococcal meningitis patients in Zimbabwe.

    Science.gov (United States)

    Nyazika, Tinashe K; Herkert, Patricia F; Hagen, Ferry; Mateveke, Kudzanai; Robertson, Valerie J; Meis, Jacques F

    2016-11-01

    Cryptococcus neoformans is the leading cause of cryptococcosis in HIV-infected subjects worldwide. Treatment of cryptococcosis is based on amphotericin B, flucytosine, and fluconazole. In Zimbabwe, little is known about antifungal susceptibility of Cryptococcus. Sixty-eight genotyped Cryptococcus isolates were tested for antifungal profiles. Amphotericin B, isavuconazole, and voriconazole showed higher activity than other triazoles. Fluconazole and flucytosine were less effective, with geometric mean MICs of 2.24 and 2.67mg/L for C. neoformans AFLP1/VNI, 1.38 and 1.53mg/L for C. neoformans AFLP1A/VNB/VNII and AFLP1B/VNII, and 1.85 and 0.68mg/L for Cryptococcus tetragattii, respectively. A significant difference between flucytosine geometric mean MICs of C. neoformans and C. tetragattii was observed (P=0.0002). The majority of isolates (n=66/68; 97.1%) had a wild-type MIC phenotype of all antifungal agents. This study demonstrates a favorable situation with respect to the tested antifungals agents. Continued surveillance of antifungal susceptibility profiles is important due to the high burden of cryptococcosis in Africa.

  11. Adrenal cryptococcosis in an immunosuppressed patient showing intensely increased metabolic activity on (18)F-FDG PET/CT.

    Science.gov (United States)

    Papadakis, Georgios Z; Holland, Steven M; Quezado, Martha; Patronas, Nicholas J

    2016-12-01

    Disseminated cryptococcosis most commonly occurs in immunosuppressed patients and can rarely affect the adrenal glands. We report on a patient with biopsy proven bilateral adrenal cryptococcosis resulting in primary adrenal insufficiency, which was evaluated with whole-body positron emission tomography/computed tomography scan using (18)F-FDG. Both enlarged adrenal glands presented intensely increased (18)F-FDG activity in the periphery, while central necrotic regions were photopenic. Although diagnosis was established by adrenal gland biopsy, (18)F-FDG positron emission tomography/computed tomography scan can significantly contribute to the assessment of disease activity and monitoring of treatment response. Furthermore, fungal infections should always be considered when encountering hypermetabolic adrenal masses, especially in the setting of immunodeficient patients.

  12. HIV-associated cutaneous Kaposi`s sarcoma - palliative local treatment by radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Saran, F.H. [Dept. of Radiotherapy and Oncology, Univ. Hospital, Frankfurt Univ. (Germany); Adamietz, I.A. [Dept. of Radiotherapy and Oncology, Univ. Hospital, Frankfurt Univ. (Germany); Thilmann, C. [Dept. of Radiotherapy and Oncology, Univ. Hospital, Frankfurt Univ. (Germany); Mose, S. [Dept. of Radiotherapy and Oncology, Univ. Hospital, Frankfurt Univ. (Germany); Boettcher, H.D. [Dept. of Radiotherapy and Oncology, Univ. Hospital, Frankfurt Univ. (Germany)

    1997-07-01

    The increasing number of HIV-infected patients makes palliative treatment of HIV-associated Kaposi`s sarcoma more common. We retrospectively evaluated a reduced fractionated radiotherapy with 20 Gy in respect to response rates and acute side-effects. From January 1992 to January 1995, 52 patients with HIV-associated Kaposi`s sarcoma were treated with 133 single portals. Six weeks after the end of radiotherapy 42 patients with 124 portals were evaluable with respect to response rates and side-effects. Of the treated portals 32% were judged as complete responses (CR), 55% as partial responses (PR) and 12% as no change (NC). Skin reactions RTOG, grade 1 were seen in 74% of the patients. Compared with literature data the reduced overall dose of 20 Gy in 10 fractions led to a reduction of CRs by approximately 50% while the overall response rate remained equal. The success of radiotherapy for the nodular component of Kaposi`s sarcoma can be improved, if a dose exceeding 20 Gy in 10 fractions is applied but at the cost of increasing side-effects in case that non-conventional fractionation schemes are used. (orig.).

  13. HIV-Associated Hodgkin's Lymphoma: Prognosis and Therapy in the Era of cART

    Directory of Open Access Journals (Sweden)

    Caron A. Jacobson

    2012-01-01

    Full Text Available Patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS are at increased risk for developing Hodgkin's lymphoma (HL, a risk that has not decreased despite the success of combination antiretroviral therapy (cART in the modern era. HIV-associated HL (HIV-HL differs from HL in non-HIV-infected patients in that it is nearly always associated with Epstein-Barr virus (EBV and more often presents with high-risk features of advanced disease, systemic “B” symptoms, and extranodal involvement. Before the introduction of cART, patients with HIV-HL had lower response rates and worse outcomes than non-HIV-infected HL patients treated with conventional chemotherapy. The introduction of cART, however, has allowed for the delivery of full-dose and dose-intensive chemotherapy regimens with improved outcomes that approach those seen in non-HIV infected patients. Despite these significant advances, HIV-HL patients remain at increased risk for treatment-related toxicities and drug-drug interactions which require careful attention and supportive care to insure the safe administration of therapy. This paper will address the modern diagnosis, risk stratification, and therapy of HIV-associated HL.

  14. The Causes of HIV-Associated Cardiomyopathy: A Tale of Two Worlds

    Directory of Open Access Journals (Sweden)

    Rebecca H. Lumsden

    2016-01-01

    Full Text Available Antiretroviral therapy (ART has transformed the clinical profile of human immunodeficiency virus (HIV from an acute infection with a high mortality into a treatable, chronic disease. As a result, the clinical sequelae of HIV infection are changing as patients live longer. HIV-associated cardiomyopathy (HIVAC is a stage IV, HIV-defining illness and remains a significant cause of morbidity and mortality among HIV-infected individuals despite ART. Causes and clinical manifestations of HIVAC depend on the degree of host immunosuppression. Myocarditis from direct HIV toxicity, opportunistic infections, and nutritional deficiencies are implicated in causing HIVAC when HIV viral replication is unchecked, whereas cardiac autoimmunity, chronic inflammation, and ART cardiotoxicity contribute to HIVAC in individuals with suppressed viral loads. The initiation of ART has dramatically changed the clinical manifestation of HIVAC in high income countries from one of severe, left ventricular systolic dysfunction to a pattern of subclinical cardiac dysfunction characterized by abnormal diastolic function and strain. In low and middle income countries, however, HIVAC is the most common HIV-associated cardiovascular disease. Clear diagnostic and treatment guidelines for HIVAC are currently lacking but should be prioritized given the global burden of HIVAC.

  15. Household Everyday Functioning in the Internet Age: Online Shopping and Banking Skills Are Affected in HIV-Associated Neurocognitive Disorders.

    Science.gov (United States)

    Woods, Steven Paul; Iudicello, Jennifer E; Morgan, Erin E; Verduzco, Marizela; Smith, Tyler V; Cushman, Clint

    2017-08-01

    The Internet is a fundamental tool for completing many different instrumental activities of daily living (IADL), including shopping and banking. Persons with HIV-associated Neurocognitive Disorders (HAND) are at heightened risk for IADL problems, but the extent to which HAND interferes with the performance of Internet-based household IADLs is not known. Ninety-three individuals with HIV disease, 43 of whom were diagnosed with HAND, and 42 HIV- comparison participants completed Internet-based tests of shopping and banking. Participants used mock credentials to log in to an experimenter-controlled Web site and independently performed a series of typical online shopping (e.g., purchasing household goods) and banking (e.g., transferring funds between accounts) tasks. Individuals with HAND were significantly more likely to fail the online shopping task than neurocognitively normal HIV+ and HIV- participants. HAND was also associated with poorer overall performance versus HIV+ normals on the online banking task. In the HAND group, Internet-based task scores were correlated with episodic memory, executive functions, motor skills, and numeracy. In the HIV+ sample as a whole, lower Internet-based task scores were uniquely associated with poorer performance-based functional capacity and self-reported declines in shopping and financial management in daily life, but not with global manifest functional status. Findings indicate that HAND is associated with difficulties in using the Internet to complete important household everyday functioning tasks. The development and validation of effective Internet training and compensatory strategies may help to improve the household management of persons with HAND. (JINS, 2017, 23, 605-615).

  16. Comparison and temporal trends of three groups with cryptococcosis: HIV-infected, solid organ transplant, and HIV-negative/non-transplant.

    Directory of Open Access Journals (Sweden)

    Emily W Bratton

    Full Text Available BACKGROUND: The Infectious Disease Society of America (IDSA 2010 Clinical Practice Guidelines for the management of cryptococcosis outlined three key populations at risk of disease: (1 HIV-infected, (2 transplant recipient, and (3 HIV-negative/non-transplant. However, direct comparisons of management, severity and outcomes of these groups have not been conducted. METHODOLOGY/PRINCIPAL FINDINGS: Annual changes in frequency of cryptococcosis diagnoses, cryptococcosis-attributable mortality and mortality were captured. Differences examined between severe and non-severe disease within the context of the three groups included: demographics, symptoms, microbiology, clinical management and treatment. An average of nearly 15 patients per year presented at Duke University Medical Center (DUMC with cryptococcosis. Out of 207 study patients, 86 (42% were HIV-positive, 42 (20% were transplant recipients, and 79 (38% were HIV-negative/non-transplant. HIV-infected individuals had profound CD4 lymphocytopenia and a majority had elevated intracranial pressure. Transplant recipients commonly (38% had renal dysfunction. Nearly one-quarter (24% had their immunosuppressive regimens stopped or changed. The HIV-negative/non-transplant population reported longer duration of symptoms than HIV-positive or transplant recipients and 28% (22/79 had liver insufficiency or underlying hematological malignancies. HIV-positive and HIV-negative/non-transplant patients accounted for 89% of severe disease cryptococcosis-attributable deaths and 86% of all-cause mortality. CONCLUSIONS/SIGNIFICANCE: In this single-center study, the frequency of cryptococcosis did not change in the last two decades, although the underlying case mix shifted (fewer HIV-positive cases, stable transplant cases, more cases with neither. Cryptococcosis had a relatively uniform and informed treatment strategy, but disease-attributable mortality was still common.

  17. The impact of HIV-associated lipodystrophy on healthcare utilization and costs

    Directory of Open Access Journals (Sweden)

    Lee Daniel

    2008-07-01

    Full Text Available Abstract Background HIV disease itself is associated with increased healthcare utilization and healthcare expenditures. HIV-infected persons with lipodystrophy have been shown to have poor self-perceptions of health. We evaluated whether lipodystrophy in the HIV-infected population was associated with increased utilization of healthcare services and increased healthcare costs. Objective To examine utilization of healthcare services and associated costs with respect to presence of lipodystrophy among HIV-infected patients. Methods Healthcare utilization and cost of healthcare services were collected from computerized accounting records for participants in a body image study among HIV-infected patients treated at a tertiary care medical center. Lipodystrophy was assessed by physical examination, and effects of lipodystrophy were assessed via body image surveys. Demographic and clinical characteristics were also ascertained. Analysis of healthcare utilization and cost outcomes was performed via between-group analyses. Multivariate modeling was used to determine predictors of healthcare utilization and associated costs. Results Of the 181 HIV-infected participants evaluated in the study, 92 (51% had clinical evidence of HIV-associated lipodystrophy according to physician examination. Total healthcare utilization, as measured by the number of medical center visits over the study period, was notably increased among HIV-infected subjects with lipodystrophy as compared to HIV-infected subjects without lipodystrophy. Similarly, total healthcare expenditures over the study period were $1,718 more for HIV-infected subjects with lipodystrophy than for HIV-infected subjects without lipodystrophy. Multivariate modeling demonstrated strong associations between healthcare utilization and associated costs, and lipodystrophy score as assessed by a clinician. Healthcare utilization and associated costs were not related to body image survey scores among HIV

  18. Common invasive fungal diseases: an overview of invasive candidiasis, aspergillosis, cryptococcosis, and Pneumocystis pneumonia.

    Science.gov (United States)

    Schmiedel, Yvonne; Zimmerli, Stephan

    2016-01-01

    Every year, Candida, Aspergillus, Cryptococcus and Pneumocystis infect an estimated two million individuals worldwide. Most are immunocompromised or critically ill. Candida is the most common fungal pathogen of the critically ill and of recipients of transplanted abdominal organs. In high-risk haemato-oncological patients, in contrast, the introduction of antifungal prophylaxis with fluconazole and later with mould-active posaconazole has led to a remarkable reduction of invasive candidiasis and is likely to have a similar effect on invasive aspergillosis. Invasive aspergillosis remains the dominant invasive fungal disease (IFD) of haemato-oncological patients and solid-organ transplant recipients and is increasingly found in individuals with exacerbated chronic obstructive pulmonary disease on corticosteroids. In the developed world, owing to antiretroviral therapy Pneumocystis pneumonia and cryptococcosis have become rare in patients with human immunodeficiency virus (HIV) and are mainly found in solid-organ transplant recipients or immunocompromised patients. In the developing world, cryptococcosis remains a common and highly lethal disease of HIV positive individuals. With invasive candidiasis and invasive aspergillosis, timely diagnosis is the principal challenge. The clinical presentation is nonspecific and current diagnostic tests lack sensitivity and specificity. The combination of several tests improves sensitivity, but not specificity. Standardised polymerase chain-reaction-based assays may be promising tools for more rapid and specific diagnosis of candidiasis and invasive aspergillosis. Nevertheless, initiation of treatment is often based solely on clinical suspicion. Empirical therapy, however, may lead to over-treatment of patients without IFD or it may miss its target in the case of resistance. Despite the success of antifungal prophylaxis in reducing the incidence of IFDs in haemato-oncological patients, there are a considerable number of

  19. Prognosis of HIV-associated non-Hodgkin lymphoma in patients starting combination antiretroviral therapy

    DEFF Research Database (Denmark)

    Bohlius, Julia; Schmidlin, Kurt; Costagliola, Dominique

    2009-01-01

    OBJECTIVE: We examined survival and prognostic factors of patients who developed HIV-associated non-Hodgkin lymphoma (NHL) in the era of combination antiretroviral therapy (cART). DESIGN AND SETTING: Multicohort collaboration of 33 European cohorts. METHODS: We included all cART-naive patients...... enrolled in cohorts participating in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) who were aged 16 years or older, started cART at some point after 1 January 1998 and developed NHL after 1 January 1998. Patients had to have a CD4 cell count after 1 January 1998 and one....... Patients developing NHL on cART had an increased risk of death compared with patients who were cART naive at diagnosis. CONCLUSION: In the era of cART two-thirds of patients diagnosed with HIV-related systemic NHL survive for longer than 1 year after diagnosis. Survival is poorer in patients diagnosed...

  20. Depression and Apathy Among People Living with HIV: Implications for Treatment of HIV Associated Neurocognitive Disorders

    Science.gov (United States)

    Whitehead, Nicole E.; Burrell, Larry E.; Dotson, Vonetta M.; Cook, Robert L.; Malloy, Paul; Devlin, Kathryn; Cohen, Ronald A.

    2015-01-01

    Depression and apathy are common among people living with HIV (PLWH). However, in PLWH, it is unclear whether depression and apathy are distinct conditions, which contribute to different patterns of disruption to cognitive processing and brain systems. Understanding these conditions may enable the development of prognostic indicators for HIV associated neurocognitive disorders (HAND). The present study examined substance use behavior and cognitive deficits, associated with depression and apathy, in 120 PLWH, using hierarchical regression analyses. Higher levels of depression were associated with a history of alcohol dependence and greater deficits in processing speed, motor and global cognitive functioning. Higher levels of apathy were associated with a history of cocaine dependence. It is recommended that PLWH get screened appropriately for apathy and depression, in order to receive the appropriate treatment, considering the comorbidities associated with each condition. Future research should examine the neurological correlates of apathy and depression in PLWH. PMID:25533921

  1. Script generation of activities of daily living in HIV-associated neurocognitive disorders.

    Science.gov (United States)

    Scott, J Cobb; Woods, Steven Paul; Vigil, Ofilio; Heaton, Robert K; Grant, Igor; Ellis, Ronald J; Marcotte, Thomas D

    2011-07-01

    Script generation describes one's ability to produce complex, sequential action plans derived from mental representations of everyday activities. The aim of this study was to assess the effect of human immunodeficiency virus (HIV) infection on script generation performance. Sixty HIV+ individuals (48% of whom had HIV-associated neurocognitive disorders [HAND]) and 26 demographically comparable HIV- participants were administered a novel, standardized test of script generation, which required participants to verbally generate and organize the necessary steps for completing six daily activities. HAND participants evidenced significantly more total errors, intrusions, and script boundary errors compared to the HIV- sample, indicating difficulties inhibiting irrelevant actions and staying within the prescribed boundaries of scripts, but had adequate knowledge of the relevant actions required for each script. These findings are generally consistent with the executive dysfunction and slowing common in HAND and suggest that script generation may play a role in everyday functioning problems in HIV.

  2. Detecting altered connectivity patterns in HIV associated neurocognitive impairment using mutual connectivity analysis

    Science.gov (United States)

    Abidin, Anas Zainul; D'Souza, Adora M.; Nagarajan, Mahesh B.; Wismüller, Axel

    2016-03-01

    The use of functional Magnetic Resonance Imaging (fMRI) has provided interesting insights into our understanding of the brain. In clinical setups these scans have been used to detect and study changes in the brain network properties in various neurological disorders. A large percentage of subjects infected with HIV present cognitive deficits, which are known as HIV associated neurocognitive disorder (HAND). In this study we propose to use our novel technique named Mutual Connectivity Analysis (MCA) to detect differences in brain networks in subjects with and without HIV infection. Resting state functional MRI scans acquired from 10 subjects (5 HIV+ and 5 HIV-) were subject to standard preprocessing routines. Subsequently, the average time-series for each brain region of the Automated Anatomic Labeling (AAL) atlas are extracted and used with the MCA framework to obtain a graph characterizing the interactions between them. The network graphs obtained for different subjects are then compared using Network-Based Statistics (NBS), which is an approach to detect differences between graphs edges while controlling for the family-wise error rate when mass univariate testing is performed. Applying this approach on the graphs obtained yields a single network encompassing 42 nodes and 65 edges, which is significantly different between the two subject groups. Specifically connections to the regions in and around the basal ganglia are significantly decreased. Also some nodes corresponding to the posterior cingulate cortex are affected. These results are inline with our current understanding of pathophysiological mechanisms of HIV associated neurocognitive disease (HAND) and other HIV based fMRI connectivity studies. Hence, we illustrate the applicability of our novel approach with network-based statistics in a clinical case-control study to detect differences connectivity patterns.

  3. Clinical and microbiological features of HIV-associated tuberculous meningitis in Vietnamese adults.

    Directory of Open Access Journals (Sweden)

    M Estee Torok

    Full Text Available METHODS: The aim of this prospective, observational cohort study was to determine the clinical and microbiological features, outcome, and baseline variables predictive of death, in Vietnamese adults with HIV-associated tuberculous meningitis (TBM. 58 patients were admitted to the Hospital for Tropical Diseases in Ho Chi Minh City and underwent routine clinical and laboratory assessments. Treatment was with standard antituberculous therapy and adjunctive dexamethasone; antiretroviral therapy was not routinely available. Patients were followed up until the end of TB treatment or death. RESULTS: The median symptom duration was 11 days (range 2-90 days, 21.8% had a past history of TB, and 41.4% had severe (grade 3 TBM. The median CD4 count was 32 cells/mm(3. CSF findings were as follows: median leucocyte count 438 x 10(9cells/l (63% neutrophils, 69% smear positive and 87.9% culture positive. TB drug resistance rates were high (13% mono-resistance 32.6% poly-resistance 8.7% multidrug resistance. 17% patients developed further AIDS-defining illnesses. 67.2% died (median time to death 20 days. Three baseline variables were predictive of death by multivariate analysis: increased TBM grade [adjusted hazard ratio (AHR 1.73, 95% CI 1.08-2.76, p = 0.02], lower serum sodium (AHR 0.93, 95% CI 0.89 to 0.98, p = 0.002 and decreased CSF lymphocyte percentage (AHR 0.98, 95% CI 0.97 to 0.99, p = 0.003. CONCLUSIONS: HIV-associated TBM is devastating disease with a dismal prognosis. CSF findings included CSF neutrophil predominance, high rates of smear and culture positivity, and high rates of antituberculous drug resistance. Three baseline variables were independently associated with death: increased TBM grade; low serum sodium and decreased CSF lymphocyte percentage.

  4. Immunocytochemical and virological characteristics of HIV-associated inflammatory myopathies: similarities with seronegative polymyositis.

    Science.gov (United States)

    Illa, I; Nath, A; Dalakas, M

    1991-05-01

    We performed an immunoperoxidase study on muscle biopsy specimens from 19 patients with polymyositis who were seropositive for human immunodeficiency virus (HIV) (21 specimens) and 5 HIV-seronegative patients with polymyositis and compared the findings. A quantitative analysis of T cells and T-cell subsets, B cells, natural killer cells, interleukin-2 receptor-positive cells, and macrophages was performed on serial sections from all the specimens. Localization of major histocompatibility complex (MHC)-I and -II antigens, alpha and gamma interferon, and HIV antigens (p24, gp120, and gp41) was performed using specific antisera. In specimens from HIV-positive and seronegative patients, the predominant cell population was CD8+ cells and macrophages invading or surrounding healthy muscle fibers that expressed MHC-I antigen on their surface. The endomysial infiltrates in specimens from HIV-positive patients differed from those seen in specimens from the seronegative patients only by a significant reduction of the CD4+ cells (12.6 +/- 3.2% versus 21.1 +/- 4.2%). HIV antigens were seen in occasional interstitial mononuclear cells (but not in muscle fibers) in 6 of the 21 specimens from HIV-positive patients. Interferon was not localized. We conclude that the development of HIV-associated polymyositis does not appear to be related to direct infection of the muscle fibers by HIV but rather is due to a T-cell-mediated and MHC-I-restricted cytotoxic process, perhaps triggered by HIV. Because this immunopathological mechanism is common in both HIV-associated polymyositis and polymyositis alone, it is suggested that viruses may also be responsible in triggering polymyositis.

  5. Role of neurotrophic factor alterations in the neurodegenerative process in HIV associated neurocognitive disorders.

    Science.gov (United States)

    Fields, Jerel; Dumaop, Wilmar; Langford, T D; Rockenstein, Edward; Masliah, E

    2014-03-01

    Migration of HIV infected cells into the CNS is associated with a spectrum of neurological disorders, ranging from milder forms of HIV-associated neurocognitive disorders (HAND) to HIV-associated dementia (HAD). These neuro-psychiatric syndromes are related to the neurodegenerative pathology triggered by the release of HIV proteins and cytokine/chemokines from monocytes/macrophages into the CNS -a condition known as HIV encephalitis (HIVE). As a result of more effective combined anti-retroviral therapy patients with HIV are living longer and thus the frequency of HAND has increased considerably, resulting in an overlap between the neurodegenerative pathology associated with HIV and that related to aging. In fact, HIV infection is believed to hasten the aging process. The mechanisms through which HIV and aging lead to neurodegeneration include: abnormal calcium flux, excitotoxicity, signaling abnormalities, oxidative stress and autophagy defects. Moreover, recent studies have shown that defects in the processing and transport of neurotrophic factors such as fibroblast growth factors (FGFs), neural growth factor (NGF) and brain-derived growth factor (BDNF) might also play a role. Recent evidence implicates alterations in neurotrophins in the pathogenesis of neurodegeneration associated with HAND in the context of aging. Here, we report FGF overexpression curtails gp120-induced neurotoxicity in a double transgenic mouse model. Furthermore, our data show disparities in brain neurotrophic factor levels may be exacerbated in HIV patients over 50 years of age. In this review, we discuss the most recent findings on neurotrophins and HAND in the context of developing new therapies to combat HIV infection in the aging population.

  6. Assessing the impact of defining a global priority research agenda to address HIV-associated tuberculosis.

    Science.gov (United States)

    Odone, Anna; Matteelli, Alberto; Chiesa, Valentina; Cella, Paola; Ferrari, Antonio; Pezzetti, Federica; Signorelli, Carlo; Getahun, Haileyesus

    2016-11-01

    In 2010, the WHO issued 77 priority research questions (PRQs) to address HIV-associated TB. Objective of the this study was to assess the impact of defining the research agenda in stimulating and directing research around priority research questions. We used number and type of scientific publications as a proxy to quantitatively assess the impact of research agenda setting. We conducted 77 single systematic reviews - one for every PRQ - building 77 different search strategies using PRQs' keywords. Multivariate logistic regression models were applied to assess the quantity and quality of research produced over time and accounting for selected covariates. In 2009-2015, PRQs were addressed by 1631 publications (median: 11 studies published per PRQ, range 1-96). The most published area was 'Intensified TB case finding' (median: 23 studies/PRQ, range: 2-74). The majority (62.1%, n = 1013) were published as original studies, and more than half (58%, n = 585) were conducted in the African region. Original studies' publication increased over the study period (P trend = <0.001). They focused more on the 'Intensified TB case finding' (OR = 2.17, 95% CI: 1.56-2.93) and 'Drug-resistant TB and HIV infection' (OR = 2.12, 95% CI: 1.47-3.06) areas than non-original studies. Original studies were published in journals of lower impact factor and received a smaller number of citations than non-original studies (OR = 0.54, 95% CI: 0.42-0.69). The generation of evidence to address PRQs has increased over time particularly in selected fields. Setting a priority research agenda for HIV-associated TB might have positively influenced the direction and the conduct of research and contributed to the global response to such a major threat to health. © 2016 John Wiley & Sons Ltd.

  7. [Non-neuromeningeal cryptococcosis in patients with AIDS in Bamako, Mali: 2 case reports].

    Science.gov (United States)

    Minta, D K; Traoré, A M; Coulibaly, I; Diallo, K; Soukho-Kaya, A; Dolo, A; Kamaté, B; Ouologuem, D S; Dembélé, M; Traoré, H A; Chabasse, D; Pichard, E

    2014-06-01

    Non-neuromeningeal cryptococcosis forms resulting from disseminated infection are rarely reported in African literature and are non-documented in Malian medical ward. We report two clinical observations. Case 1: a 26-year-old patient, carrying the HIV-1 infection, in which the clinical examination revealed skin lesions simulating molluscum contagiosum and functional impairment of the lower limbs. Radiography of the lumbar spine showed vertebral osteolysis on L4-L5. Cryptococcal research remained negative in the CSF but positive at histological examination of the skin lesions and in pathological products of lumbosacral drainage. The treatment with fluconazole and ARV led to a favorable outcome. Case 2: a 42-year-old patient, admitted for fever cough, known for his non-compliance to ARVs and in which the examination found a syndrome of pleural condensation and a painful swelling of the outer third of the right clavicle (around the acromio-clavicular joint). Paraclinical investigations concluded in osteolysis of the acromial end of the right clavicle and an image of the right lung with abundant effusion. Cryptococcal research was positive in the pleural effusion and in the product of aspiration of acromio-clavicular tumefaction, negative in CSF. It seems important to think of a cryptococcal etiology even in the absence of clinical meningeal signs in front of any cutaneous sign and any fluctuating swelling in HIV+ patient. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  8. Comparison of Fungizone, Amphotec, AmBisome, and Abelcet for Treatment of Systemic Murine Cryptococcosis

    Science.gov (United States)

    Clemons, Karl V.; Stevens, David A.

    1998-01-01

    Three lipid-based formulations of amphotericin B have been approved for use in various countries. The aim of this study was to compare Amphotec (ABCD; Sequus), AmBisome (AmBi; Nexstar), Abelcet (ABLC; The Liposome Co.), and conventional deoxycholate amphotericin B (Fungizone; Bristol Meyers Squibb) for the treatment of experimental systemic cryptococcosis. A model was established in 10-week-old female CD-1 mice by intravenous (i.v.) injection of 6.25 × 105 viable Cryptococcus neoformans yeast cells. Therapy began 4 days later, with i.v. administration three times per week for 2 weeks. Mice received either no treatment, 1 mg of Fungizone per kg of body weight, or 1, 5, or 10 mg of ABCD, AmBi, or ABLC per kg. Ninety percent of control mice died between days 15 and 34. All treatment regimens except ABLC at 1 mg/kg prolonged survival compared with no treatment (P ABLC ≫ Fungizone. This is the first study that compared all four amphotericin B formulations. PMID:9559804

  9. Comparison of fungizone, Amphotec, AmBisome, and Abelcet for treatment of systemic murine cryptococcosis.

    Science.gov (United States)

    Clemons, K V; Stevens, D A

    1998-04-01

    Three lipid-based formulations of amphotericin B have been approved for use in various countries. The aim of this study was to compare Amphotec (ABCD; Sequus), AmBisome (AmBi; Nexstar), Abelcet (ABLC; The Liposome Co.), and conventional deoxycholate amphotericin B (Fungizone; Bristol Meyers Squibb) for the treatment of experimental systemic cryptococcosis. A model was established in 10-week-old female CD-1 mice by intravenous (i.v.) injection of 6.25 x 10(5) viable Cryptococcus neoformans yeast cells. Therapy began 4 days later, with i.v. administration three times per week for 2 weeks. Mice received either no treatment, 1 mg of Fungizone per kg of body weight, or 1, 5, or 10 mg of ABCD, AmBi, or ABLC per kg. Ninety percent of control mice died between days 15 and 34. All treatment regimens except ABLC at 1 mg/kg prolonged survival compared with no treatment (P ABLC > Fungizone. This is the first study that compared all four amphotericin B formulations.

  10. HIV-Associated Neuroretinal Disorder in Patients With Well-Suppressed HIV-Infection : A Comparative Cohort Study

    NARCIS (Netherlands)

    Demirkaya, Nazli; Wit, Ferdinand W N M; van Den Berg, Thomas J T P; Kooij, Katherine W; Prins, Maria; Schlingemann, Reinier O; Abramoff, Michael D; Reiss, Peter; Verbraak, Frank D

    2016-01-01

    PURPOSE: Loss of neuroretinal structure and function, ascribed to a 'HIV-associated Neuroretinal Disorder' (HIV-NRD), in the absence of ocular opportunistic infections, has been reported in HIV-infected individuals treated with combination antiretroviral therapy (cART). Whether HIV-infected individu

  11. Antibody Response is More Likely to Pneumococcal Proteins Than to Polysaccharide After HIV-associated Invasive Pneumococcal Disease

    DEFF Research Database (Denmark)

    Kantsø, Bjørn; Green, Nicola; Goldblatt, David;

    2015-01-01

    BACKGROUND: Human immunodeficiency virus (HIV)-infected individuals are at increased risk of invasive pneumococcal disease (IPD). In order to assess the immunogenicity of pneumococcal proteins and polysaccharide, we investigated protein and serotype-specific antibody responses after HIV-associate...

  12. Prevalence of HIV-associated cryptococcal meningitis and utility of microbiological determinants for its diagnosis in a tertiary care center

    Directory of Open Access Journals (Sweden)

    Thakur Rajeev

    2008-04-01

    Full Text Available Context: Human immunodeficiency virus (HIV infection continues to be the most important risk factor for the development of central nervous system (CNS cryptococcosis, which in turn is an important contributor to morbidity and mortality in HIV-infected patients. Early diagnosis of such patients is the key to their therapeutic success. Aims: This study was undertaken to find out the prevalence of CNS cryptococcosis and to assess the role of microbiological parameters for its specific diagnosis in HIV-reactive hospitalized patients admitted with meningeal signs in a tertiary care setting. Materials and Methods: A total of 104 patients suspected to be suffering from meningitis/meningoencephalitis were subjected to cerebrospinal fluid (CSF analysis (including India ink preparation, culture by conventional methods and Bactec MGIT 960 system, antigen detection and tests for HIV antibodies by standard laboratory operating procedures. Results: The prevalence of HIV infection in our study group was 12.5% (13/104, while the prevalence of cryptococcal CNS infection in HIV-reactive cohort was 46% (6/13. Additionally, 15.3% (2/13 of the patients from this cohort were positive for Mycobacterium tuberculosis. Conclusions: High prevalence of cryptococcal CNS infections in HIV-infected patients underscores the importance of precise and early microbiological diagnosis for better management of such patients

  13. Neuromeningeal cryptococcosis in sub-Saharan Africa: Killer disease with sparse data

    Directory of Open Access Journals (Sweden)

    Komi Assogba

    2015-01-01

    Full Text Available Introduction: The extent of neuromeningeal cryptococcosis (NMC has increased since the advent of HIV/AIDS. It has non-specific clinical signs but marked by high mortality. Objective: To analyze the characteristics of the NMC in sub-Saharan Africa. Materials and Methods: We have conducted a literature reviewed on the NMC in sub-Saharan Africa from the publications available on the basis of national and international data with keywords such as "Cryptococcus, Epidemiology, Symptoms, Outcomes and Mortality" and their equivalent in French in July 2011. All publications from 1990 to 2010 with 202 references were analyzed. The following results are the means of different studied variables. Results: We selected in final 43 publications dealing with the NMC which 24 involved 17 countries in Africa. The average age was 36 years old. The average prevalence was 3.41% and the average incidence was 10.48% (range 6.90% to 12%. The most common signs were fever (75%, headaches (62.50% and impaired consciousness. Meningeal signs were present in 49% of cases. The mean CD4 count was 44.8cells/mm 3 . The India ink and latex agglutination tests were the most sensitive. The average time before the consultation and the hospital stay was almost identical to 27.71 days. The average death rate was 45.90%. Fluconazole has been the most commonly used molecule. Conclusion: The epidemiological indicators of NMC varied more depending on the region of sub-Saharan Africa. Early and effective taking care of patients to reduce diagnostic delay and heavy mortality remains the challenges.

  14. Criptococose canina: relato de caso Canine ocular cryptococcosis: a case report

    Directory of Open Access Journals (Sweden)

    C.E. Larsson

    2003-10-01

    Full Text Available Descreve-se, pela primeira vez no Brasil, um caso de criptococose canina com acometimento oftalmo e dermatopático, com diagnóstico intra-vitam, em animal da raça Pastor Alemão, fêmea, com 24 meses de vida, criado em São Paulo, em contacto com outros cinco cães assintomáticos, que havia se infectado pelo contato com dejetos de pombos (Columba livia. Evoluia há 90 dias, com quadro tegumentar e ósseo, sintomas e lesões características, sendo, ainda, detectada forma assintomática de coriorretinite, de início unilateral. O diagnóstico foi estabelecido pelos dados da anamnese, dos exames físico, dermatológico e complementares (radiográfico, cultivo micológico, histopatologia de pele tendo-se evidenciado e isolado cepa de Criptococcus neoformans var. neoformans. Após nove meses de terapia com itraconazol (9mg/kg/SID/VO houve involução total do quadro, sem qualquer efeito adverso à droga.A case of cryptococcosis with ocular and cutaneous involvement is reported by the first time in Brazil in a dog. A two-year-old female German Shepherd living in a hold house with other five healthy dogs was infected through the contact with pigeon (Columba livia feces. The illness started 90 days previously with cutaneous and bone involvement resulting in characteristic clinical signs and lesions, in addition to a initially unilateral asymptomatic chorioretinitis. The diagnosis was established based on anamnesis, physical and dermatologic examinations and complementary exams (radiographs, skin biopsy and histopathology and the isolation of a Cryptococcus neoformans var. neoformans strain was accomplished. There was a complete resolution of the disease after nine months of therapy using itraconazole (9mg/kg, q24h, PO and no side effect was observed.

  15. Neuropathogenesis of HIV: from initial neuroinvasion to HIV-associated neurocognitive disorder (HAND).

    Science.gov (United States)

    Zayyad, Zaina; Spudich, Serena

    2015-03-01

    Early in the HIV epidemic, the central nervous system (CNS) was recognized as a target of infection and injury in the advanced stages of disease. Though the most severe forms of HIV-associated neurocognitive disorder (HAND) related to severe immunosuppression are rare in the current era of widespread combination antiretroviral therapy (cART), evidence now supports pathological involvement of the CNS throughout the course of infection. Recent work suggests that the stage for HIV neuropathogenesis may be set with initial viral entry into the CNS, followed by initiation of pathogenetic processes including neuroinflammation and neurotoxicity, and establishment of local, compartmentalized HIV replication that may reflect a tissue reservoir for HIV. Key questions still exist as to when HIV establishes local infection in the CNS, which CNS cells are the primary targets of HIV, and what mechanistic processes underlie the injury to neurons that produce clinical symptoms of HAND. Advances in these areas will provide opportunities for improved treatment of patients with established HAND, prevention of neurological disease in those with early stage infection, and understanding of HIV tissue reservoirs that will aid efforts at HIV eradication.

  16. HIV-associated disruption of mucosal epithelium facilitates paracellular penetration by human papillomavirus.

    Science.gov (United States)

    Tugizov, Sharof M; Herrera, Rossana; Chin-Hong, Peter; Veluppillai, Piri; Greenspan, Deborah; Michael Berry, J; Pilcher, Christopher D; Shiboski, Caroline H; Jay, Naomi; Rubin, Mary; Chein, Aung; Palefsky, Joel M

    2013-11-01

    The incidence of human papillomavirus (HPV)-associated epithelial lesions is substantially higher in human immunodeficiency virus (HIV)-infected individuals than in HIV-uninfected individuals. The molecular mechanisms underlying the increased risk of HPV infection in HIV-infected individuals are poorly understood. We found that HIV proteins tat and gp120 were expressed within the oral and anal mucosal epithelial microenvironment of HIV-infected individuals. Expression of HIV proteins in the mucosal epithelium was correlated with the disruption of epithelial tight junctions (TJ). Treatment of polarized oral, cervical and anal epithelial cells, and oral tissue explants with tat and gp120 led to disruption of epithelial TJ and increased HPV pseudovirion (PsV) paracellular penetration in to the epithelium. PsV entry was observed in the basal/parabasal cells, the cells in which the HPV life cycle is initiated. Our data suggest that HIV-associated TJ disruption of mucosal epithelia may potentiate HPV infection and subsequent development of HPV-associated neoplasia.

  17. HIV-Associated Distal Neuropathic Pain is Associated with Smaller Total Cerebral Cortical Gray Matter

    Science.gov (United States)

    Keltner, John R.; Fennema-Notestine, Christine; Vaida, Florin; Wang, Dongzhe; Franklin, Donald R.; Dworkin, Robert H.; Sanders, Chelsea; McCutchan, J. Allen; Archibald, Sarah L.; Miller, David J.; Kesidis, George; Cushman, Clint; Kim, Sung Min; Abramson, Ian; Taylor, Michael J.; Theilmann, Rebecca J.; Julaton, Michelle D.; Notestine, Randy J.; Corkran, Stephanie; Cherner, Mariana; Duarte, Nichole A.; Alexander, Terry; Robinson-Papp, Jessica; Gelman, Benjamin B.; Simpson, David M.; Collier, Ann C.; Marra, Christina M.; Morgello, Susan; Brown, Greg; Grant, Igor; Atkinson, J. Hampton; Jernigan, Terry L.; Ellis, Ronald J.

    2014-01-01

    Despite modern antiretroviral therapy, HIV-associated sensory neuropathy affects over 50% of HIV patients. The clinical expression of HIV neuropathy is highly variable: many individuals report few symptoms, but about half report distal neuropathic pain (DNP), making it one of the most prevalent, disabling and treatment-resistant complications of HIV disease. The presence and intensity of pain is not fully explained by the degree of peripheral nerve damage, making it unclear why some patients do, and others do not, report pain. To better understand central nervous system contributions to HIV DNP, we performed a cross-sectional analysis of structural magnetic resonance imaging (MRI) volumes in 241 HIV-infected participants from an observational multi-site cohort study at five US sites (CNS HIV Antiretroviral Treatment Effects Research Study, CHARTER). The association between DNP and the structural imaging outcomes was investigated using both linear and nonlinear (Gaussian Kernel support vector) multivariable regression, controlling for key demographic and clinical variables. Severity of DNP symptoms was correlated with smaller total cerebral cortical gray matter volume (R = −0.24; p = 0.004). Understanding the mechanisms for this association between smaller total cortical volumes and DNP may provide insight into HIV DNP chronicity and treatment-resistance. PMID:24549970

  18. Role of the retinoic acid receptor-α in HIV-associated nephropathy.

    Science.gov (United States)

    Ratnam, Krishna K; Feng, Xiaobei; Chuang, Peter Y; Verma, Vikram; Lu, Ting-Chi; Wang, Jinshan; Jin, Yuanmeng; Farias, Eduardo F; Napoli, Joseph L; Chen, Nan; Kaufman, Lewis; Takano, Tomoko; D'Agati, Vivette D; Klotman, Paul E; He, John C

    2011-03-01

    All-trans retinoic acid protects against the development of HIV-associated nephropathy (HIVAN) in HIV-1 transgenic mice (Tg26). In vitro, all-trans retinoic acid inhibits HIV-induced podocyte proliferation and restores podocyte differentiation markers by activating its receptor-α (RARα). Here, we report that Am580, a water-soluble RARα-specific agonist, attenuated proteinuria, glomerosclerosis, and podocyte proliferation, and restored podocyte differentiation markers in kidneys of Tg26 mice. Furthermore, RARα-/- Tg26 mice developed more severe kidney and podocyte injury than did RARα+/- Tg26 mice. Am580 failed to ameliorate kidney injury in RARα-/- Tg26 mice, confirming our hypothesis that Am580 acts through RARα. Although the expression of RARα-target genes was suppressed in the kidneys of Tg26 mice and of patients with HIVAN, the expression of RARα in the kidney was not different between patients with HIVAN and minimal change disease. However, the tissue levels of retinoic acid were reduced in the kidney cortex and isolated glomeruli of Tg26 mice. Consistent with this, the expression of two key enzymes in the retinoic acid synthetic pathway, retinol dehydrogenase type 1 and 9, and the overall enzymatic activity for retinoic acid synthesis were significantly reduced in the glomeruli of Tg26 mice. Thus, a defect in the endogenous synthesis of retinoic acid contributes to loss of the protection by retinoic acid in HIVAN. Hence, RARα agonists may be potential agents for the treatment of HIVAN.

  19. The evolution of our knowledge of HIV-associated kidney disease in Africa.

    Science.gov (United States)

    Swanepoel, Charles R; Wearne, Nicola; Duffield, Maureen S; Okpechi, Ikechi G

    2012-10-01

    Human immunodeficiency virus (HIV) infection started in Africa circa 1930. South Africa has the highest prevalence rate in the world. Although reports of HIV-associated nephropathy (HIVAN) appeared in the early 1980s, the earliest report from sub-Saharan Africa (SSA) came in 1994. Geographical, socioeconomic, political, and ethical factors have worked in concert to shape the character of HIV disease as it is seen in SSA. Political leaders within SSA have, through their actions, significantly contributed to the incidence of HIV infection. Black females, who often face cultural suppression and disadvantage, have a higher prevalence of HIV than males. Too few studies and outcomes data have bedeviled the statistics in SSA in relation to HIVAN prevalence and its management. Much of what is written is approximation and anecdotal. The largest reliable biopsy series comes from the University of Cape Town, where a workable classification of HIVAN has been developed to enable standardization of terminology. Histologic and clinical prognostic indicators with outcomes have been evaluated using this classification. Patients with HIV who present with acute kidney injury appear to have mainly acute tubular necrosis due to sepsis, dehydration, and nephrotoxic drugs. Since the rollout of combination antiretroviral therapy, the extent of HIV infection and kidney disease continues to be modified and possibly retarded.

  20. Delineating HIV-associated neurocognitive disorders using transgenic models: the neuropathogenic actions of Vpr.

    Science.gov (United States)

    Power, Christopher; Hui, Elizabeth; Vivithanaporn, Pornpun; Acharjee, Shaona; Polyak, Maria

    2012-06-01

    HIV-associated neurocognitive disorders (HAND) represent a constellation of neurological disabilities defined by neuropsychological impairments, neurobehavioral abnormalities and motor deficits. To gain insights into the mechanisms underlying the development of these disabilities, several transgenic models have been developed over the past two decades, which have provided important information regarding the cellular and molecular factors contributing to the neuropathogenesis of HAND. Herein, we concentrate on the neuropathogenic effects of HIV-1 Vpr expressed under the control of c-fms, resulting transgene expression in myeloid cells in both the central and peripheral nervous systems. Vpr's actions, possibly through its impact on cell cycle machinery, in brain culminate in neuronal and astrocyte injury and death through apoptosis involving activation of caspases-3, -6 and -9 depending on the individual target cell type. Indeed, these outcomes are also induced by soluble Vpr implying Vpr's effects stem from direct interaction with target cells. Remarkably, in vivo transgenic Vpr expression induces a neurodegenerative phenotype defined by neurobehavioral deficits and neuronal loss in the absence of frank inflammation. Implantation of another viral protein, hepatitis C virus (HCV) core, into Vpr transgenic animals' brains stimulated neuroinflammation and amplified the neurodegenerative disease phenotype, thereby recapitulating HCV's putative neuropathogenic actions. The availability of different transgenic models to study HIV neuropathogenesis represents exciting and innovative approaches to understanding disease mechanisms and perhaps developing new therapeutic strategies in the future.

  1. HIV-associated distal neuropathic pain is associated with smaller total cerebral cortical gray matter.

    Science.gov (United States)

    Keltner, John R; Fennema-Notestine, Christine; Vaida, Florin; Wang, Dongzhe; Franklin, Donald R; Dworkin, Robert H; Sanders, Chelsea; McCutchan, J Allen; Archibald, Sarah L; Miller, David J; Kesidis, George; Cushman, Clint; Kim, Sung Min; Abramson, Ian; Taylor, Michael J; Theilmann, Rebecca J; Julaton, Michelle D; Notestine, Randy J; Corkran, Stephanie; Cherner, Mariana; Duarte, Nichole A; Alexander, Terry; Robinson-Papp, Jessica; Gelman, Benjamin B; Simpson, David M; Collier, Ann C; Marra, Christina M; Morgello, Susan; Brown, Greg; Grant, Igor; Atkinson, J Hampton; Jernigan, Terry L; Ellis, Ronald J

    2014-06-01

    Despite modern antiretroviral therapy, HIV-associated sensory neuropathy affects over 50 % of HIV patients. The clinical expression of HIV neuropathy is highly variable: many individuals report few symptoms, but about half report distal neuropathic pain (DNP), making it one of the most prevalent, disabling, and treatment-resistant complications of HIV disease. The presence and intensity of pain is not fully explained by the degree of peripheral nerve damage, making it unclear why some patients do, and others do not, report pain. To better understand central nervous system contributions to HIV DNP, we performed a cross-sectional analysis of structural magnetic resonance imaging volumes in 241 HIV-infected participants from an observational multi-site cohort study at five US sites (CNS HIV Anti-Retroviral Treatment Effects Research Study, CHARTER). The association between DNP and the structural imaging outcomes was investigated using both linear and nonlinear (Gaussian Kernel support vector) multivariable regression, controlling for key demographic and clinical variables. Severity of DNP symptoms was correlated with smaller total cerebral cortical gray matter volume (r = -0.24; p = 0.004). Understanding the mechanisms for this association between smaller total cortical volumes and DNP may provide insight into HIV DNP chronicity and treatment-resistance.

  2. HIV-Associated Oral Mucosal Melanin Hyperpigmentation: A Clinical Study in a South African Population Sample

    Directory of Open Access Journals (Sweden)

    R. Chandran

    2016-01-01

    Full Text Available Objective. The aim of the study was to determine the prevalence of HIV-associated oral mucosal melanin hyperpigmentation (HIV-OMH in a specific population of HIV-seropositive South Africans and to analyse the associations between HIV-OMH clinical features and the demographic and immunological characteristics of the study cohort. Material and Methods. This cross-sectional study included 200 HIV-seropositive Black subjects. The collected data comprised age, gender, CD4+ T cell count, viral load, systemic disease, medications, oral site affected by HIV-OMH, extent (localized or generalized, intensity of the pigmentation (dark or light, and smoking and snuff use. Results. Overall, 18.5% of the study cohort had HIV-OMH. Twenty-two and a half percent had OMH that could not with confidence be attributed to HIV infection, and 59% did not have any OMH. There was a significant but weak association between smoking and the presence of HIV-OMH. Conclusions. The prevalence of HIV-OMH in the study population was 18.5%, the gingiva being the most commonly affected site. It appears that the CD4+ T cell count does not play any role in the biopathology of HIV-OMH.

  3. Modeling the Mechanisms by Which HIV-Associated Immunosuppression Influences HPV Persistence at the Oral Mucosa

    Science.gov (United States)

    Abedi, Vida; Hontecillas, Raquel; Hoops, Stefan; Leber, Andrew; Bassaganya-Riera, Josep; Ciupe, Stanca M.

    2017-01-01

    Human immunodeficiency virus (HIV)-infected patients are at an increased risk of co-infection with human papilloma virus (HPV), and subsequent malignancies such as oral cancer. To determine the role of HIV-associated immune suppression on HPV persistence and pathogenesis, and to investigate the mechanisms underlying the modulation of HPV infection and oral cancer by HIV, we developed a mathematical model of HIV/HPV co-infection. Our model captures known immunological and molecular features such as impaired HPV-specific effector T helper 1 (Th1) cell responses, and enhanced HPV infection due to HIV. We used the model to determine HPV prognosis in the presence of HIV infection, and identified conditions under which HIV infection alters HPV persistence in the oral mucosa system. The model predicts that conditions leading to HPV persistence during HIV/HPV co-infection are the permissive immune environment created by HIV and molecular interactions between the two viruses. The model also determines when HPV infection continues to persist in the short run in a co-infected patient undergoing antiretroviral therapy. Lastly, the model predicts that, under efficacious antiretroviral treatment, HPV infections will decrease in the long run due to the restoration of CD4+ T cell numbers and protective immune responses. PMID:28060843

  4. Interactive Effects of Morphine on HIV Infection: Role in HIV-Associated Neurocognitive Disorder.

    Science.gov (United States)

    Reddy, Pichili Vijaya Bhaskar; Pilakka-Kanthikeel, Sudheesh; Saxena, Shailendra K; Saiyed, Zainulabedin; Nair, Madhavan P N

    2012-01-01

    HIV epidemic continues to be a severe public health problem and concern within USA and across the globe with about 33 million people infected with HIV. The frequency of drug abuse among HIV infected patients is rapidly increasing and is another major issue since injection drug users are at a greater risk of developing HIV associated neurocognitive dysfunctions compared to non-drug users infected with HIV. Brain is a major target for many of the recreational drugs and HIV. Evidences suggest that opiate drug abuse is a risk factor in HIV infection, neural dysfunction and progression to AIDS. The information available on the role of morphine as a cofactor in the neuropathogenesis of HIV is scanty. This review summarizes the results that help in understanding the role of morphine use in HIV infection and neural dysfunction. Studies show that morphine enhances HIV-1 infection by suppressing IL-8, downregulating chemokines with reciprocal upregulation of HIV coreceptors. Morphine also activates MAPK signaling and downregulates cAMP response element-binding protein (CREB). Better understanding on the role of morphine in HIV infection and mechanisms through which morphine mediates its effects may help in devising novel therapeutic strategies against HIV-1 infection in opiate using HIV-infected population.

  5. Interactive Effects of Morphine on HIV Infection: Role in HIV-Associated Neurocognitive Disorder

    Directory of Open Access Journals (Sweden)

    Pichili Vijaya Bhaskar Reddy

    2012-01-01

    Full Text Available HIV epidemic continues to be a severe public health problem and concern within USA and across the globe with about 33 million people infected with HIV. The frequency of drug abuse among HIV infected patients is rapidly increasing and is another major issue since injection drug users are at a greater risk of developing HIV associated neurocognitive dysfunctions compared to non-drug users infected with HIV. Brain is a major target for many of the recreational drugs and HIV. Evidences suggest that opiate drug abuse is a risk factor in HIV infection, neural dysfunction and progression to AIDS. The information available on the role of morphine as a cofactor in the neuropathogenesis of HIV is scanty. This review summarizes the results that help in understanding the role of morphine use in HIV infection and neural dysfunction. Studies show that morphine enhances HIV-1 infection by suppressing IL-8, downregulating chemokines with reciprocal upregulation of HIV coreceptors. Morphine also activates MAPK signaling and downregulates cAMP response element-binding protein (CREB. Better understanding on the role of morphine in HIV infection and mechanisms through which morphine mediates its effects may help in devising novel therapeutic strategies against HIV-1 infection in opiate using HIV-infected population.

  6. Altered Oligodendrocyte Maturation and Myelin Maintenance: The Role of Antiretrovirals in HIV-Associated Neurocognitive Disorders.

    Science.gov (United States)

    Jensen, Brigid K; Monnerie, Hubert; Mannell, Maggie V; Gannon, Patrick J; Espinoza, Cagla Akay; Erickson, Michelle A; Bruce-Keller, Annadora J; Gelman, Benjamin B; Briand, Lisa A; Pierce, R Christopher; Jordan-Sciutto, Kelly L; Grinspan, Judith B

    2015-11-01

    Despite effective viral suppression through combined antiretroviral therapy (cART), approximately half of HIV-positive individuals have HIV-associated neurocognitive disorders (HAND). Studies of antiretroviral-treated patients have revealed persistent white matter abnormalities including diffuse myelin pallor, diminished white matter tracts, and decreased myelin protein mRNAs. Loss of myelin can contribute to neurocognitive dysfunction because the myelin membrane generated by oligodendrocytes is essential for rapid signal transduction and axonal maintenance. We hypothesized that myelin changes in HAND are partly due to effects of antiretroviral drugs on oligodendrocyte survival and/or maturation. We showed that primary mouse oligodendrocyte precursor cell cultures treated with therapeutic concentrations of HIV protease inhibitors ritonavir or lopinavir displayed dose-dependent decreases in oligodendrocyte maturation; however, this effect was rapidly reversed after drug removal. Conversely, nucleoside reverse transcriptase inhibitor zidovudine had no effect. Furthermore, in vivo ritonavir administration to adult mice reduced frontal cortex myelin protein levels. Finally, prefrontal cortex tissue from HIV-positive individuals with HAND on cART showed a significant decrease in myelin basic protein compared with untreated HIV-positive individuals with HAND or HIV-negative controls. These findings demonstrate that antiretrovirals can impact myelin integrity and have implications for myelination in juvenile HIV patients and myelin maintenance in adults on lifelong therapy.

  7. HIV alters neuronal mitochondrial fission/fusion in the brain during HIV-associated neurocognitive disorders.

    Science.gov (United States)

    Fields, Jerel Adam; Serger, Elisabeth; Campos, Sofia; Divakaruni, Ajit S; Kim, Changyoun; Smith, Kendall; Trejo, Margarita; Adame, Anthony; Spencer, Brian; Rockenstein, Edward; Murphy, Anne N; Ellis, Ronald J; Letendre, Scott; Grant, Igor; Masliah, Eliezer

    2016-02-01

    HIV-associated neurocognitive disorders (HAND) still occur in approximately 50% of HIV patients, and therapies to combat HAND progression are urgently needed. HIV proteins are released from infected cells and cause neuronal damage, possibly through mitochondrial abnormalities. Altered mitochondrial fission and fusion is implicated in several neurodegenerative disorders. Here, we hypothesized that mitochondrial fission/fusion may be dysregulated in neurons during HAND. We have identified decreased mitochondrial fission protein (dynamin 1-like; DNM1L) in frontal cortex tissues of HAND donors, along with enlarged and elongated mitochondria localized to the soma of damaged neurons. Similar pathology was observed in the brains of GFAP-gp120 tg mice. In vitro, recombinant gp120 decreased total and active DNM1L levels, reduced the level of Mitotracker staining, and increased extracellular acidification rate (ECAR) in primary neurons. DNM1L knockdown enhanced the effects of gp120 as measured by reduced Mitotracker signal in the treated cells. Interestingly, overexpression of DNM1L increased the level of Mitotracker staining in primary rat neurons and reduced neuroinflammation and neurodegeneration in the GFAP-gp120-tg mice. These data suggest that mitochondrial biogenesis dynamics are shifted towards mitochondrial fusion in brains of HAND patients and this may be due to gp120-induced reduction in DNM1L activity. Promoting mitochondrial fission during HIV infection of the CNS may restore mitochondrial biogenesis and prevent neurodegeneration.

  8. Lymphocyte proliferation to mycobacterial antigens is detectable across a spectrum of HIV-associated tuberculosis

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    Bakari Muhammad

    2009-02-01

    Full Text Available Abstract Background Identifying novel TB diagnostics is a major public health priority. We explored the diagnostic characteristics of antimycobacterial lymphocyte proliferation assays (LPA in HIV-infected subjects with latent or active TB. Methods HIV-infected subjects with bacille Calmette Guérin (BCG scars and CD4 counts ≥ 200 cells/mm3 entering a TB booster vaccine trial in Tanzania had baseline in vivo and in vitro immune tests performed: tuberculin skin tests (TST, LPA and five day assays of interferon gamma (IFN-γ release. Assay antigens were early secreted antigenic target 6 (ESAT-6, antigen 85 (Ag85, and Mycobacterium tuberculosis whole cell lysate (WCL. Subjects were screened for active TB at enrollment by history, exam, sputum smear and culture. We compared antimycobacterial immune responses between subjects with and without latent or active TB at enrollment. Results Among 1885 subjects screened, 635 had latent TB and 13 had active TB. Subjects with latent TB were more likely than subjects without TB to have LPA responses to ESAT-6 (13.2% vs. 5.5%, P Conclusion Lymphoproliferative responses to mycobacteria are detectable during HIV-associated active TB, and are less sensitive but more specific than TST. Trial registration ClinicalTrials.gov Identifier NCT00052195.

  9. An Unusual Case of Anti-GBM Antibody Elevation in HIV-Associated Nephropathy

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    Vinay Minocha

    2014-01-01

    Full Text Available Introduction. The most commonly seen glomerular disease in HIV infected patients is HIV-associated nephropathy (HIVAN; however, a multitude of other nephropathies can occur in HIV infection with an almost equal cumulative frequency. We report an unusual case of a patient with clinical and histological evidence of HIVAN in which the diagnosis was initially confounded by the finding of an elevated serum anti-glomerular basement membrane (anti-GBM antibody. Case Presentation. We present a case of a 27-year-old African American female with a history of schizophrenia, cocaine abuse, and HIV infection who upon admission to our hospital was found to have severe acute kidney injury requiring hemodialysis. Urine studies revealed nephrotic range proteinuria and a serological workup was positive for anti-GBM antibody elevation with a value of 91 units (normal: 0–20 units. A renal biopsy revealed HIVAN with no evidence of crescentic glomerulonephritis or anti-GBM disease. Conclusion. This case highlights the need for careful interpretation of anti-GBM antibody tests in HIV infected patients with kidney disease and, in particular, the need for biopsy confirmation of the diagnosis prior to starting therapy. More research is needed to study the prognostic correlation between the degree of anti-GBM antibody elevation in HIVAN and disease severity.

  10. Development of normative neuropsychological performance in Thailand for the assessment of HIV-associated neurocognitive disorders.

    Science.gov (United States)

    Heaps, Jodi; Valcour, Victor; Chalermchai, Thep; Paul, Robert; Rattanamanee, Somprartthana; Siangphoe, Umaporn; Sithinamsuwan, Pasiri; Chairangsaris, Parnsiri; Nidhinandana, Samart; Tipsuk, Somporn; Suttichom, Duanghathai; Fletcher, James; Shikuma, Cecilia; Ananworanich, Jintanat

    2013-01-01

    International studies of HIV-associated neurocognitive disorder (HAND) are needed to determine the viral and host factors associated with cognitive impairment particularly as more than 80% of HIV+ subjects reside in resource-limited settings. Recent diagnostic nomenclature of HAND requires comparison of cognitive performance specifically to local normative data. To evaluate this need for local norms, we compared normative data obtained locally in Thailand to Western norms. The current study examined cognitive performance in 477 seronegative Thai participants (male = 211, female = 266) who completed a battery of tests sensitive to cognitive changes in HIV. The cohort was divided into three age brackets (20-34; 35-49; 50-65 years) and four educational levels (no education or primary education, less than secondary certificate, high-school/associates degree, bachelor's degree or greater). The Thai cohort was compared (using analysis of covariance, ANCOVA) on a number of measures to a seronegative US cohort (n = 236; male = 198, female = 38) to examine cultural differences in performance. Normative data are provided with age and education stratification. The Thai and US groups performed significantly differently on all neuropsychological measures with the exception of verbal fluency. The Thai group performed better on measures of verbal learning (p normative data within local populations. The use of Western norms as a comparison group could lead to inaccurate identification of HAND in culturally distinct groups.

  11. PET brain imaging in HIV-associated neurocognitive disorders (HAND) in the era of combination antiretroviral therapy

    Energy Technology Data Exchange (ETDEWEB)

    Vera, Jaime H. [Brighton and Sussex Medical School, Department of Infection and Global Health, Brighton (United Kingdom); Brighton and Sussex University Hospitals NHS Trust, HIV Department, Brighton (United Kingdom); Ridha, Basil [Brighton and Sussex University Hospitals NHS Trust, Neurology Department, Brighton (United Kingdom); Gilleece, Yvonne; Amlani, Aliza [Brighton and Sussex University Hospitals NHS Trust, HIV Department, Brighton (United Kingdom); Thorburn, Patrick; Dizdarevic, Sabina [Brighton and Sussex University Hospitals NHS Trust, Imaging and Nuclear Medicine Department, Brighton (United Kingdom); Brighton and Sussex Medical School, Clinical Imaging Science Centre, Brighton (United Kingdom)

    2017-05-15

    Effective combination antiretroviral therapy (cART) has lead to a significant reduction in the prevalence and incidence of central nervous system (CNS) HIV-associated brain disease, particularly CNS opportunistic infections and HIV encephalitis. Despite this, cognitive deficits in people living with HIV, also known as HIV-associated neurocognitive disorders (HAND) have become more prevalent in recent years. The pathogenesis of HAND is likely to be multifactorial, however recent evidence suggests that brain microglial activation is the most likely pathogenic mechanism. Recent developments in positron emission tomography (PET) brain neuroimaging using novel brain radioligands targeting a variety of physiological changes in the brains of HIV-positive individuals have improved our understanding of the mechanisms associated with the development of HAND. This review will highlight recent PET brain neuroimaging studies in the cART era, focusing on physiological and neurochemical changes associated with HAND in people living with HIV. (orig.)

  12. Genotypes of Cryptococcus neoformans and Cryptococcus gattii as agents of endemic cryptococcosis in Teresina, Piauí (northeastern Brazil

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    Liline Maria Soares Martins

    2011-09-01

    Full Text Available Throughout Brazil, Cryptococcus neoformans is the cause of cryptococcosis, whereas Cryptococcus gattii is endemic to the northern and northeastern states. In this study, the molecular types of 63 cryptococcal isolates recovered from the cerebrospinal fluid of meningitis patients diagnosed between 2008-2010 in Teresina, Piauí, Brazil, were analysed. Out of the 63 patients, 37 (58.7% were human immunodeficiency virus (HIV-positive and 26 (41.3% were HIV-negative. URA5-restriction fragment length polymorphism analysis identified 37/63 (58.7% isolates as the C. neoformans VNI genotype, predominantly in HIV-positive patients (32/37, 86.5%, and 24/63 (38.1% as the C. gattii VGII genotype, mostly in HIV-negative patients (21/26, 80.8%. The occurrence of C. gattii VGII in six apparently healthy children and in seven adolescents/young adults in this region reaffirms the endemic occurrence of C. gattii VGII-induced primary cryptococcosis and early cryptococcal infection. Lethality occurred in 18/37 (48.6% of the HIV-positive subjects and in 13/26 (50% of the HIV-negative patients. Our results provide new information on the molecular epidemiology of C. neoformans and C. gattii in Brazilian endemic areas.

  13. Presentation, pathology, and outcome of HIV associated renal disease in a specialist centre for HIV/AIDS

    OpenAIRE

    1998-01-01

    OBJECTIVES: To describe the presentation, pathology, and outcome of biopsy proved renal disease in HIV infected patients at a central London HIV unit from 1992 to 1996. METHODS: Retrospective review of a computerised database and case notes to identify patients with renal disease confirmed by antemortem percutaneous renal biopsy or necropsy. RESULTS: 17 patients were identified, 13 had biopsy and four necropsy confirmed renal disease. Abnormalities included HIV associated nephropathy (H...

  14. Epidemiology, Diagnosis, and Treatment of HIV-Associated Non-Hodgkin Lymphoma in Resource-Limited Settings

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    Matthew Ulrickson

    2012-01-01

    Full Text Available Lymphoma was a common complication of HIV infection in the pre-antiretroviral era, and the incidence of HIV-associated lymphoma has dropped dramatically since the introduction of combination antiretroviral therapy (cART in resource-rich regions. Conversely, lymphoma is an increasingly common complication of HIV infection in resource-limited settings where the prevalence of HIV infection is high. Relatively little is known, however, about the true incidence and optimal treatment regimens for HIV-associated lymphoma in resource-poor regions. We review the epidemiology, diagnosis, and treatment of HIV-associated non-Hodgkin lymphoma in developing nations and highlight areas for further research that may benefit care in both settings. Examples include risk modification and dose modification of chemotherapy based on HIV risk factors, improving our understanding of the current burden of disease through national cancer registries, and developing cost-effective hematopathological diagnostic strategies to optimize care delivery and maximize use of available chemotherapy.

  15. [Successful treatment of HIV-associated chronic inflammatory demyelinating polyneuropathy by early initiation of highly active anti-retroviral therapy].

    Science.gov (United States)

    Kume, Kodai; Ikeda, Kazuyo; Kamada, Masaki; Touge, Tetsuo; Deguchi, Kazushi; Masaki, Tsutomu

    2013-01-01

    A 47-year-old man with HIV infection presented with lower leg dominant dysesthesia, muscle weakness and sensory ataxia of 3 month's duration. Nerve conduction studies (NCS) showed demyelination change in the median and tibial nerves and sensory nerve action potential (SNAP) in the sural nerve was not evoked. Somatosensory evoked potential (SEP) showed the delayed N9 latency. Diagnose of HIV-associated chronic inflammatory demyelinating polyneuropathy (CIDP) was made. Although the CD4 lymphocyte counts were relatively preserved (466/μl), highly active anti-retroviral therapy (HAART) was started according to a new guideline for the use of antiretroviral agents in HIV-1-infected adults and adolescents recommending early initiation of treatment. After six months, HIV1-RNA was not detected and the CD4 lymphocyte counts showed a recovering trend (585/μl). His symptoms had disappeared, except for dysesthesia in the tip of a toe. Repeated NCS demonstrated full recovery from the demyelination and appearance of SNAP in the sural nerve. The improvement of his symptoms and NCS findings has been maintained for two years. Although effectiveness of immunotherapies such as oral prednisone, high-dose immunoglobulins and plasmapheresis have been reported in HIV-associated CIDP, early initiation of HAART may be also important for favorable prognosis in HIV-associated CIDP.

  16. Intra-individual Neurocognitive Variability Confers Risk of Dependence in Activities of Daily Living among HIV-Seropositive Individuals without HIV-Associated Neurocognitive Disorders

    Science.gov (United States)

    Morgan, Erin E.; Woods, Steven Paul; Grant, Igor

    2012-01-01

    Although HIV-associated neurocognitive disorders (HAND) are the strong predictors of everyday functioning difficulties, approximately half of all functionally impaired individuals are labeled “neurocognitively normal” according to the standard neuropsychological measures, suggesting that novel predictors of functional problems in this prevalent subgroup are needed. The present study hypothesized that increased neurocognitive intra-individual variability as indexed by dispersion would be associated with poor daily functioning among 82 persons with HIV infection who did not meet research criteria for HAND. An intra-individual standard deviation was calculated across the demographically adjusted T-scores of 13 standard neuropsychological tests to represent dispersion, and functional outcomes included self-reported declines in basic and instrumental activities of daily functioning (basic activity of daily living [BADL] and instrumental activity of daily living [IADL], respectively) and medication management. Dispersion was a significant predictor of medication adherence and dependence in both BADL and IADL, even when other known predictors of functional status (i.e., age, affective distress, and indices of disease severity) were included in the models. As a significant and unique predictor of a performance on the range of daily functioning activities, neurocognitive dispersion may be indicative of deficient cognitive control expressed as inefficient regulation of neurocognitive resources in the context of competing functional demands. As such, dispersion may have clinical utility in detecting risk for functional problems among HIV-infected individuals without HAND. PMID:22337933

  17. Phase II Study of Bevacizumab in Patients With HIV-Associated Kaposi's Sarcoma Receiving Antiretroviral Therapy

    Science.gov (United States)

    Uldrick, Thomas S.; Wyvill, Kathleen M.; Kumar, Pallavi; O'Mahony, Deirdre; Bernstein, Wendy; Aleman, Karen; Polizzotto, Mark N.; Steinberg, Seth M.; Pittaluga, Stefania; Marshall, Vickie; Whitby, Denise; Little, Richard F.; Yarchoan, Robert

    2012-01-01

    Purpose Alternatives to cytotoxic agents are desirable for patients with HIV-associated Kaposi's sarcoma (KS). Vascular endothelial growth factor-A (VEGF-A) contributes to KS pathogenesis. We evaluated the humanized anti–VEGF-A monoclonal antibody, bevacizumab, in patients with HIV-KS. Patients and Methods Patients with HIV-KS who either experienced progression while receiving highly active antiretroviral therapy (HAART) for at least 1 month or did not regress despite HAART for at least 4 months were administered bevacizumab 15 mg/kg intravenously on days 1 and 8 and then every 3 weeks. The primary objective was assessment of antitumor activity using modified AIDS Clinical Trial Group (ACTG) criteria for HIV-KS. HIV-uninfected patients were also eligible and observed separately. Results Seventeen HIV-infected patients were enrolled. Fourteen patients had been receiving effective HAART for at least 6 months (median, 1 year). Thirteen patients had advanced disease (ACTG T1), 13 patients had received prior chemotherapy for KS, and seven patients had CD4 count less than 200 cells/μL. Median number of cycles was 10 (range, 1 to 37 cycles); median follow-up was 8.3 months (range, 3 to 36 months). Of 16 assessable patients, best tumor responses observed were complete response (CR) in three patients (19%), partial response (PR) in two patients (12%), stable disease in nine patients (56%), and progressive disease in two patients (12%). Overall response rate (CR + PR) was 31% (95% CI, 11% to 58.7%). Four of five responders had received prior chemotherapy for KS. Over 202 cycles, grade 3 to 4 adverse events at least possibly attributed to therapy included hypertension (n = 7), neutropenia (n = 5), cellulitis (n = 3), and headache (n = 2). Conclusion Bevacizumab is tolerated in patients with HIV-KS and has activity in a subset of patients. PMID:22430271

  18. Randomized Trial of Central Nervous System–Targeted Antiretrovirals for HIV-Associated Neurocognitive Disorder

    Science.gov (United States)

    Ellis, Ronald J.; Letendre, Scott; Vaida, Florin; Haubrich, Richard; Heaton, Robert K.; Sacktor, Ned; Clifford, David B.; Best, Brookie M.; May, Susanne; Umlauf, Anya; Cherner, Mariana; Sanders, Chelsea; Ballard, Craig; Simpson, David M.; Jay, Cheryl; McCutchan, J. Allen

    2014-01-01

    Background. Antiretroviral (ARV) medications differentially penetrate across the blood-brain barrier into central nervous system (CNS) tissues, potentially influencing their effectiveness in treating brain infection. Methods. This randomized controlled clinical trial (RCT) called for 120 participants at 5 study sites to be randomized 1:1 to CNS-targeted (CNS-T) or non–CNS-T ART. Entry clinical factors such as ARV experience were balanced across arms using an adaptive randomization approach. The primary outcome, change in neurocognitive performance, was measured as the difference in global deficit score (GDS) from baseline to week 16. Results. The study was terminated early on the recommendation of its data safety monitoring board on the basis of slow accrual and a low likelihood of detecting a difference in the primary outcome. No safety concerns were identified. Of 326 participants screened, 59 met entry criteria and were randomized. The primary intent-to-treat analysis included 49 participants who completed week 16. These comprised 39 men and 10 women with a mean age of 44 years (SD, 10 years), and median nadir and current CD4+ T-cell counts of 175 cells/µL and 242 cells/µL, respectively. The proportional improvement in GDS from baseline was nonsignificantly larger (7%; 95% confidence interval [CI], −31% to 62%) in the CNS-T arm than in the non-CNS-T arm, representing a treatment effect size of 0.09 (95% CI, −.48 to .65). Prespecified secondary analysis showed a trend interaction (P = .087), indicating that participants who had baseline plasma virologic suppression may have benefited from CNS-T. Conclusions. This study found no evidence of neurocognitive benefit for a CNS-T strategy in HIV-associated neurocognitive disorders. A benefit for a subgroup or small overall benefits could not be excluded. Clinical Trials Registration NCT00624195. PMID:24352352

  19. Complement and HIV-I infection/HIV-associated neurocognitive disorders.

    Science.gov (United States)

    Liu, Fengming; Dai, Shen; Gordon, Jennifer; Qin, Xuebin

    2014-04-01

    The various neurological complications associated with HIV-1 infection, specifically HIV-associated neurocognitive disorders (HAND) persist as a major public health burden worldwide. Despite the widespread use of anti-retroviral therapy, the prevalence of HAND is significantly high. HAND results from the direct effects of an HIV-1 infection as well as secondary effects of HIV-1-induced immune reaction and inflammatory response. Complement, a critical mediator of innate and acquired immunity, plays important roles in defeating many viral infections by the formation of a lytic pore or indirectly by opsonization and recruitment of phagocytes. While the role of complement in the pathogenesis of HIV-1 infection and HAND has been previously recognized for over 15 years, it has been largely underestimated thus far. Complement can be activated through HIV-1 envelope proteins, mannose-binding lectins (MBL), and anti-HIV-1 antibodies. Complement not only fights against HIV-1 infection but also enhances HIV-1 infection. In addition, HIV-1 can hijack complement regulators such as CD59 and CD55 and can utilize these regulators and factor H to escape from complement attack. Normally, complement levels in brain are much lower than plasma levels and there is no or little complement deposition in brain cells. Interestingly, local production and deposition of complement are dramatically increased in HIV-1-infected brain, indicating that complement may contribute to the pathogenesis of HAND. Here, we review the current understanding of the role of complement in HIV-1 infection and HAND, as well as potential therapeutic approaches targeting the complement system for the treatment and eradications of HIV-1 infection.

  20. Perceived HIV-associated stigma among HIV-seropositive men: psychometric study of HIV stigma scale

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    Adrian eValle

    2015-07-01

    Full Text Available Objectives: To assess the internal consistency and factor structure of the abridged Spanish version of the Berger HIV Stigma Scale (HSS-21, provide evidence for its convergent and discriminant validity, and describe perceived stigma in an urban population from northeast Mexico. Methods: Seventy five HIV-positive men who have sex with men (MSM were recruited. Participants answered the Spanish versions of three Likert-type scales: HSS-21, Robsenberg’s self-esteem scale, and the abbreviated version of the Zung’s Depression Scale.Results: HSS-21 showed high reliability and validity; its factor structure included four components: concern with public attitudes; negative self-image; disclosure concerns; and enacted stigma. The level of stigma was high in 27 out of 75 (36% participants; nevertheless, the score found in the component related to disclosure concerns indicated high level of stigma in 68% of participants. The score of HSS-21 was positively correlated with the score of depression and negatively correlated with the score of self-esteem. Conclusion: Results demonstrated high reliability for the HSS-21; correlations with other scales supported its validity. This scale demonstrated to be a practical tool for assessing stigma among Mexican HIV-positive MSM. High level of stigma was found only in the factor related to disclosure concerns. Policy Implications: Identifying HIV-associated stigma through a short, reliable and validated instrument will allow the development of interventions that cope and manage stigma in HIV-positive MSM. HSS-21 distinguishes between different dimensions of stigma and will contribute to a better understanding of this phenomenon.

  1. Perceived HIV-Associated Stigma among HIV-Seropositive Men: Psychometric Study of HIV Stigma Scale.

    Science.gov (United States)

    Valle, Adrian; Treviño, Ana Cecilia; Zambrano, Farith Francisco; Urriola, Karla Elizabeth; Sánchez, Luis Antonio; Elizondo, Jesus Eduardo

    2015-01-01

    To assess the internal consistency and factor structure of the abridged Spanish version of the Berger HIV Stigma Scale (HSS-21), to provide evidence for its convergent and discriminant validity, and to describe perceived stigma in an urban population from northeast Mexico. Seventy-five HIV-positive men who have sex with men (MSM) were recruited. Participants answered the Spanish versions of three Likert-type scales: HSS-21, Robsenberg's self-esteem scale, and the abbreviated version of the Zung's Depression Scale. HSS-21 showed high reliability and validity; its factor structure included four components: concern with public attitudes; negative self-image; disclosure concerns; and enacted stigma. The level of stigma was high in 27 out of 75 (36%) participants; nevertheless, the score found in the component related to disclosure concerns indicated high level of stigma in 68% of participants. The score of HSS-21 was positively correlated with the score of depression and negatively correlated with the score of self-esteem. Results demonstrated high reliability for the HSS-21; correlations with other scales supported its validity. This scale demonstrated to be a practical tool for assessing stigma among Mexican HIV-positive MSM. High level of stigma was found only in the factor related to disclosure concerns. Identifying HIV-associated stigma through a short, reliable, and validated instrument will allow the development of interventions that cope and manage stigma in HIV-positive MSM. HSS-21 distinguishes between different dimensions of stigma and will contribute to a better understanding of this phenomenon.

  2. Asymptomatic HIV-associated neurocognitive impairment increases risk for symptomatic decline

    Science.gov (United States)

    Franklin, Donald R.; Deutsch, Reena; Woods, Steven P.; Vaida, Florin; Ellis, Ronald J.; Letendre, Scott L.; Marcotte, Thomas D.; Atkinson, J.H.; Collier, Ann C.; Marra, Christina M.; Clifford, David B.; Gelman, Benjamin B.; McArthur, Justin C.; Morgello, Susan; Simpson, David M.; McCutchan, John A.; Abramson, Ian; Gamst, Anthony; Fennema-Notestine, Christine; Smith, Davey M.; Heaton, Robert K.

    2014-01-01

    Objective: While HIV-associated neurocognitive disorders (HAND) remain prevalent despite combination antiretroviral therapy (CART), the clinical relevance of asymptomatic neurocognitive impairment (ANI), the most common HAND diagnosis, remains unclear. We investigated whether HIV-infected persons with ANI were more likely than those who were neurocognitively normal (NCN) to experience a decline in everyday functioning (symptomatic decline). Methods: A total of 347 human participants from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) cohort were NCN (n = 226) or had ANI (n = 121) at baseline. Neurocognitive assessments occurred approximately every 6 months, with median (interquartile range) follow-up of 45.2 (28.7–63.7) months. Symptomatic decline was based on self-report (SR) or objective, performance-based (PB) problems in everyday functioning. Proportional hazards modeling was used to generate risk ratios for progression to symptomatic HAND after adjusting for baseline and time-dependent covariates, including CD4+ T-lymphocyte count (CD4), virologic suppression, CART, and mood. Results: The ANI group had a shorter time to symptomatic HAND than the NCN after adjusting for baseline predictors: adjusted risk ratios for symptomatic HAND were 2.0 (confidence interval [CI] 1.1–3.6; p = 0.02) for SR, 5.8 (CI 3.2–10.7; p < 0.0001) for PB, and 3.2 (CI 2.0–5.0; p < 0.0001) for either SR or PB. Current CD4 and depression were significant time-dependent covariates, but antiretroviral regimen, virologic suppression, and substance abuse or dependence were not. Conclusions: This longitudinal study demonstrates that ANI conveys a 2-fold to 6-fold increase in risk for earlier development of symptomatic HAND, supporting the prognostic value of the ANI diagnosis in clinical settings. Identifying those at highest risk for symptomatic decline may offer an opportunity to modify treatment to delay progression. PMID:24814848

  3. 免疫健全与免疫缺损宿主肺隐球菌病临床对比分析%Clinical findings of pulmonary cryptococcosis in immunocompetent and immunocompromised patients

    Institute of Scientific and Technical Information of China (English)

    李宁; 李敏; 万欢英

    2013-01-01

    Objective To analyze the clinical manifestations, radiology, diagnosis and treatment of pulmonary cryptococcosis in patients under different immune states. Methods Retrospective analysis was performed about the clinical data of 39 patients confirmed by pathological examinations at Ruijin Hospital, Shanghai Jiaotcng University School of Medicine from August 2002 to August 2012. Results Of the patients, 20 were immunocompetent and 19 were immunocompromised. All of the patients were non-Acquired Immune Deficiency Syndrome. The early symptoms were cough, phlegm and fever. Thirteen patients (33. 3%) remained asymptomatic. CD3 T cells percentage were significantly decreased (P = 0.048) and diffuse mixed imaging was significantly increased (P = 0.022) in the immunocompromised patients as compared with the immunocompetent patients. There were no significant differences in other testing results between the two groups (P>0. 05). Surgical resection was performed in 11 cases, surgical treatment combined with antifungal drug therapy in 3, antifungal drug therapy in 22 cases, fluconazole combined with antitumor drug therapy in 1. Two cases were discharged without treatment. There were 27 patients with complete clinical data during follow up and the symptoms and the lesions were lessened in some extent. Conclusion Immunocompetent patients can suffer from pulmonary cryptococcosis. There are no specific clinical manifestations and image findings for pulmonary cryptococcosis. The disease is related to the immune status of patients. The diagnosis mainly relies on histopathological examination. More reasonable treatments should be adopted according to patients' immune status to achieve better prognosis.%目的 探讨不同免疫状态患者肺隐球菌病的临床特点.方法 回顾性分析上海交通大学医学院附属瑞金医院2002年8月-2012年8月经病理学检查确诊为肺隐球菌病患者的临床资料.结果 39例患者中,入选免疫健全组20

  4. Insights into the mechanisms of protective immunity against Cryptococcus neoformans infection using a mouse model of pulmonary cryptococcosis.

    Directory of Open Access Journals (Sweden)

    Karen L Wozniak

    Full Text Available Cryptococcus neoformans is an opportunistic fungal pathogen that causes life-threatening pneumonia and meningoencephalitis in immune compromised individuals. Previous studies have shown that immunization of BALB/c mice with an IFN-gamma-producing C. neoformans strain, H99gamma, results in complete protection against a second pulmonary challenge with an otherwise lethal cryptococcal strain. The current study evaluated local anamnestic cell-mediated immune responses against pulmonary cryptococcosis in mice immunized with C. neoformans strain H99gamma compared to mice immunized with heat-killed C. neoformans (HKC.n.. Mice immunized with C. neoformans strain H99gamma had significantly reduced pulmonary fungal burden post-secondary challenge compared to mice immunized with HKC.n. Protection against pulmonary cryptococcosis was associated with increased pulmonary granulomatous formation and leukocyte infiltration followed by a rapid resolution of pulmonary inflammation, which protected the lungs from severe allergic bronchopulmonary mycosis (ABPM-pathology that developed in the lungs of mice immunized with HKC.n. Pulmonary challenge of interleukin (IL-4 receptor, IL-12p40, IL-12p35, IFN-gamma, T cell and B cell deficient mice with C. neoformans strain H99gamma demonstrated a requirement for Th1-type T cell-mediated immunity, but not B cell-mediated immunity, for the induction of H99gamma-mediated protective immune responses against pulmonary C. neoformans infection. CD4(+ T cells, CD11c(+ cells, and Gr-1(+ cells were increased in both proportion and absolute number in protected mice. In addition, significantly increased production of Th1-type/pro-inflammatory cytokines and chemokines, and conversely, reduced Th2-type cytokine production was observed in the lungs of protected mice. Interestingly, protection was not associated with increased production of cytokines IFN-gamma or TNF-alpha in lungs of protected mice. In conclusion, immunization with C

  5. Insights into the mechanisms of protective immunity against Cryptococcus neoformans infection using a mouse model of pulmonary cryptococcosis.

    Science.gov (United States)

    Wozniak, Karen L; Ravi, Sailatha; Macias, Sandra; Young, Mattie L; Olszewski, Michal A; Steele, Chad; Wormley, Floyd L

    2009-09-03

    Cryptococcus neoformans is an opportunistic fungal pathogen that causes life-threatening pneumonia and meningoencephalitis in immune compromised individuals. Previous studies have shown that immunization of BALB/c mice with an IFN-gamma-producing C. neoformans strain, H99gamma, results in complete protection against a second pulmonary challenge with an otherwise lethal cryptococcal strain. The current study evaluated local anamnestic cell-mediated immune responses against pulmonary cryptococcosis in mice immunized with C. neoformans strain H99gamma compared to mice immunized with heat-killed C. neoformans (HKC.n.). Mice immunized with C. neoformans strain H99gamma had significantly reduced pulmonary fungal burden post-secondary challenge compared to mice immunized with HKC.n. Protection against pulmonary cryptococcosis was associated with increased pulmonary granulomatous formation and leukocyte infiltration followed by a rapid resolution of pulmonary inflammation, which protected the lungs from severe allergic bronchopulmonary mycosis (ABPM)-pathology that developed in the lungs of mice immunized with HKC.n. Pulmonary challenge of interleukin (IL)-4 receptor, IL-12p40, IL-12p35, IFN-gamma, T cell and B cell deficient mice with C. neoformans strain H99gamma demonstrated a requirement for Th1-type T cell-mediated immunity, but not B cell-mediated immunity, for the induction of H99gamma-mediated protective immune responses against pulmonary C. neoformans infection. CD4(+) T cells, CD11c(+) cells, and Gr-1(+) cells were increased in both proportion and absolute number in protected mice. In addition, significantly increased production of Th1-type/pro-inflammatory cytokines and chemokines, and conversely, reduced Th2-type cytokine production was observed in the lungs of protected mice. Interestingly, protection was not associated with increased production of cytokines IFN-gamma or TNF-alpha in lungs of protected mice. In conclusion, immunization with C. neoformans

  6. Inhibition of renin activity slows down the progression of HIV-associated nephropathy.

    Science.gov (United States)

    Kumar, Dileep; Plagov, Andrei; Yadav, Iti; Torri, Deepti D; Sayeneni, Swapna; Sagar, Ankita; Rai, Partab; Adabala, Madhuri; Lederman, Rivka; Chandel, Nirupama; Ding, Guohua; Malhotra, Ashwani; Singhal, Pravin C

    2012-09-01

    In the present study, we evaluated the effect of inhibition of renin activity (aliskiren) on the progression of renal lesions in two different mouse models (Vpr and Tg26) of human immunodeficiency virus (HIV)-associated nephropathy (HIVAN). In protocol A, Vpr mice were fed either water (C-VprA) or doxycycline [Doxy (D-VprA)] in their drinking water for 6 wk. In protocols B and C, Vpr mice received either normal saline (C-VprB/C), Doxy + normal saline (D-VprB/C), or Doxy + aliskiren (AD-VprB/C) for 6 wk (protocol B) or 12 wk (protocol C). In protocols D and E, Vpr mice were fed Doxy for 6 wk followed by kidney biopsy. Subsequently, half of the mice were administered either normal saline (D-VprD/E) or aliskiren (AD-VprD/E) for 4 wk (protocol D) or 8 (protocol E) wk. All D-VprA mice showed renal lesions in the form of focal segmental glomerular sclerosis and dilatation of tubules. In protocols B and C, aliskiren diminished both progression of renal lesions and proteinuria. In protocol C, aliskiren also diminished (P Doxy-treated mice displayed increased serum ANG I levels (the product of plasma renin activity); on the other hand, all aliskiren-treated mice displayed diminished serum ANG I levels. Renal tissues of D-VprC displayed increased ANG II content; however, aliskiren attenuated renal tissue ANG II production in AD-VprC. In protocol D, AD-VprD showed a 24.2% increase in the number of sclerosed glomeruli compared with 139.2% increase in sclerosed glomeruli in D-VprD (P < 0.01) from their baseline. The attenuating effect of aliskiren on the progression of renal lesions continued in AD-VprE. Aliskiren also diminished blood pressure, proteinuria, and progression of renal lesions in Tg26 mice. These findings indicate that inhibition of renin activity has a potential to slow down the progression of HIVAN.

  7. Mendelian randomization: potential use of genetics to enable causal inferences regarding HIV-associated biomarkers and outcomes.

    Science.gov (United States)

    He, Weijing; Castiblanco, John; Walter, Elizabeth A; Okulicz, Jason F; Ahuja, Sunil K

    2010-11-01

    It is unknown whether biomarkers simply correlate with or are causal for HIV-associated outcomes. Mendelian randomization is a genetic epidemiologic approach used to disentangle causation from association. Here, we discuss the potential use of Mendelian randomization for differentiating whether biomarkers are correlating with or causal for HIV-associated outcomes. Mendelian randomization refers to the random allocation of alleles at the time of gamete formation. In observational epidemiology, this refers to the use of genetic variants to estimate a causal effect between a modifiable risk factor and an outcome of interest. A formal Mendelian randomization study using a genetic marker as a proxy for the biomarker has not been conducted in the HIV field. However, in the postgenomic era, this approach is being used increasingly. Examples are evidence for the causal role of BMI in blood pressure and noncausal role of C-reactive protein in coronary heart disease. We discuss the conceptual framework, uses, and limitations of Mendelian randomization in the context of HIV infection as well as specific biomarkers (IL-6, C-reactive protein) and genetic determinants (e.g., in CCR5, chemokine, and DARC genes) that associate with HIV-related outcomes. Making the distinction between correlation and causality has particular relevance when a biomarker (e.g., IL-6) is potentially modifiable, in which case a biomarker-guided targeted treatment strategy may be feasible. Although the tenets of Mendelian randomization rest on strong assumptions, and conducting a Mendelian randomization study in HIV infection presents many challenges, it may offer the potential to identify causal biomarkers for HIV-associated outcomes.

  8. Randomised pharmacokinetic trial of rifabutin with lopinavir/ritonavir-antiretroviral therapy in patients with HIV-associated tuberculosis in Vietnam.

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    Nguyen Thi Ngoc Lan

    Full Text Available BACKGROUND: Rifampicin and protease inhibitors are difficult to use concomitantly in patients with HIV-associated tuberculosis because of drug-drug interactions. Rifabutin has been proposed as an alternative rifamycin, but there is concern that the current recommended dose is suboptimal. The principal aim of this study was to compare bioavailability of two doses of rifabutin (150 mg three times per week and 150 mg daily in patients with HIV-associated tuberculosis who initiated lopinavir/ritonavir-based antiretroviral therapy in Vietnam. Concentrations of lopinavir/ritonavir were also measured. METHODS: This was a randomized, open-label, multi-dose, two-arm, cross-over trial, conducted in Vietnamese adults with HIV-associated tuberculosis in Ho Chi Minh City (Clinical trial registry number NCT00651066. Rifabutin pharmacokinetics were evaluated before and after the introduction of lopinavir/ritonavir -based antiretroviral therapy using patient randomization lists. Serial rifabutin and 25-O-desacetyl rifabutin concentrations were measured during a dose interval after 2 weeks of rifabutin 300 mg daily, after 3 weeks of rifabutin 150 mg daily with lopinavir/ritonavir and after 3 weeks of rifabutin 150 mg three times per week with lopinavir/ritonavir. RESULTS: Sixteen and seventeen patients were respectively randomized to the two arms, and pharmacokinetic analysis carried out in 12 and 13 respectively. Rifabutin 150 mg daily with lopinavir/ritonavir was associated with a 32% mean increase in rifabutin average steady state concentration compared with rifabutin 300 mg alone. In contrast, the rifabutin average steady state concentration decreased by 44% when rifabutin was given at 150 mg three times per week with lopinavir/ritonavir. With both dosing regimens, 2 - 5 fold increases of the 25-O-desacetyl- rifabutin metabolite were observed when rifabutin was given with lopinavir/ritonavir compared with rifabutin alone. The different doses of rifabutin had

  9. Practical Management of HIV-Associated Anemia in Resource-Limited Settings: Prospective Observational Evaluation of a New Mozambican Guideline.

    Science.gov (United States)

    Brentlinger, Paula E; Silva, Wilson P; Vermund, Sten H; Valverde, Emilio; Buene, Manuel; Moon, Troy D

    2016-01-01

    Mozambique's updated guideline for management of HIV-associated anemia prompts clinicians to consider opportunistic conditions, adverse drug reactions, and untreated immunosuppression in addition to iron deficiency, intestinal helminthes, and malaria. We prospectively evaluated this guideline in rural Zambézia Province. Likely cause(s) of anemia were determined through prespecified history, physical examination, and laboratory testing. Diagnoses were "etiologic" if laboratory confirmed (sputum microscopy, blood culture, Plasmodium falciparum malaria rapid test) or "syndromic" if not. To assess hemoglobin response, we used serial point-of-care measurements. We studied 324 ambulatory, anemic (hemoglobin Mozambique's guideline revision.

  10. The burden of HIV-associated neurocognitive disorder (HAND) in post-HAART era: a multidisciplinary review of the literature.

    Science.gov (United States)

    Caruana, G; Vidili, G; Serra, P A; Bagella, P; Spanu, A; Fiore, V; Calvisi, D F; Manetti, R; Rocchitta, G; Nuvoli, S; Babudieri, S; Simile, M M; Madeddu, G

    2017-05-01

    The purpose of the present multidisciplinary review is to give an updated insight into the most recent findings regarding the pathophysiology, diagnosis and therapeutics of HIV-associated neurocognitive disorder (HAND). We performed a comprehensive search, through electronic databases (Pubmed - MEDLINE) and search engines (Google Scholar), of peer-reviewed publications (articles and reviews) and conferences proceedings on HAND pathophysiology, diagnosis, and therapy, from 1999 to 2016. It seems to be increasingly clear that neurodegeneration in HIV-1 affected patients is a multi-faceted disease involving numerous factors, from chronic inflammation to central nervous system (CNS) compartmentalization of HIV. Diagnosis of HAND may benefit from both laboratory analysis and advanced specific neuroimaging techniques. As regards HAND therapy, modified HAART combinations and simplification strategies have been tested, while novel exciting frontiers seem to involve the use of nanoparticles with the ability to cross the Blood-Brain Barrier (BBB). Albeit highly active antiretroviral therapy (HAART) allowed a major decrease in morbidity and mortality for AIDS patients, CNS involvement still represents a challenge in HIV patients even today, affecting up to 50% of patients with access to combination antiretroviral therapy (cART). Future studies will have to focus on CNS compartmentalization, drugs' ability to penetrate and suppress viral replication in this compartment, and on new approaches to reduce HIV-associated neuroinflammation.

  11. Growth hormone axis treatments for HIV-associated lipodystrophy: a systematic review of placebo-controlled trials.

    Science.gov (United States)

    Sivakumar, T; Mechanic, Oj; Fehmie, D A; Paul, Bt

    2011-09-01

    HIV-associated lipodystrophy is a disorder of fat metabolism that occurs in patients with HIV infection. It can cause metabolic derangements and negative self-perceptions of body image, and result in noncompliance with highly active antiretroviral therapy (HAART). Growth hormone (GH) axis drugs have been evaluated for treatment of this disorder, but no systematic review has been conducted previously. The aim of the review was to compare the effects of GH axis drugs vs. placebo in changing visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and lean body mass (LBM) in patients with HIV-associated lipodystrophy. We searched MEDLINE (1996-2009), CENTRAL (Issue 4, 2009), Web of Science, Summons, Google Scholar, the Food and Drug Administration (FDA) website, and Clinicaltrials.gov from 13 October 2009 to 7 June 2010. We excluded newspaper articles and book reviews from the Summons search; this was the only search limitation applied. We also manually reviewed references of included articles. Inclusion criteria were as follows: randomized placebo-controlled trial (RCT); study participants with HIV-associated lipodystrophy; intervention consisting of GH, growth hormone releasing hormone (GHRH), tesamorelin or insulin-like growth factor-1 (IGF-1); study including at least one primary outcome of interest: change in VAT, SAT or LBM. Two independent reviewers extracted data and assessed study quality using a standardized form. The authors of one study were contacted for missing information. The main effect was calculated as a summary of the mean differences in VAT, SAT and LBM between the intervention and placebo groups in the included studies. Subgroup analyses were performed to assess different GH axis drug classes. Ten RCTs including 1511 patients were included in the review. All had a low risk of bias and passed the test of heterogeneity for each primary outcome. Compared with placebo, GH axis treatments decreased VAT [weighted mean difference (WMD) -25.20

  12. [Retrospective study of neuromeningeal cryptococcosis in patients infected with HIV in the infectious diseases unit of university hospital of Casablanca, Morocco].

    Science.gov (United States)

    Dollo, I; Marih, L; El Fane, M; Es-Sebbani, M; Sodqi, M; Oulad Lahsen, A; Chakib, A; El Kadioui, F; Hamdani, A; El Mabrouki, M J; Soussi Abdallaoui, M; Karima, Z; Hassoune, S; Maaroufi, A; Marhoum El Filali, K

    2016-12-01

    To report the cases of neuromeningeal cryptococcosis and to describe the clinical, paraclinical, therapeutic and outcomes of patients. Retrospective study of 43 patients infected with HIV admitted from January first 2010 to June 30th 2015 in the infectious disease unit of UHC Ibn Rochd, for neuromeningeal cryptococcus. The mean frequency of neuromeningeal cryptococcosis in patients infected with HIV was 1.4%. The mean age was 39 years and a sex ratio of 1.38. The mean CD4 count was 70 cells/mm(3). The diagnosis of HIV was revealed by neuromeningeal cryptococcus in 77% of cases. Fifteen days interval was reported between the first symptom and hospital admission. Headache (77%) was the most represented clinical sign. The cerebrospinal fluid analysis showed hypoglycorachy (67%), hyperproteinorachy (65%) and lymphocytosis (63%). Chinese ink direct examination for Cryptococcus neoformans in CSF was positive in 86% of cases and all cases were positive after culture on Sabouraud's medium. Patients were treated with monotherapy amphotericin B (42%) or fluconazole (28%) and bitherapy amphotéricine B/fluconazole (28%). Fatal evolution was observed in 60% of cases. Neuromeningeal cryptococcosis remains a severe opportunistic infection in HIV patients with a heavy mortality rate. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  13. Long-term surveillance and treatment of subclinical cryptococcosis and nasal colonization by Cryptococcus neoformans and C. gattii species complex in captive koalas (Phascolarctes cinereus).

    Science.gov (United States)

    Kido, Nobuhide; Makimura, Koichi; Kamegaya, Chihiro; Shindo, Izumi; Shibata, Eri; Omiya, Tomoko; Yamamoto, Yasuhiko

    2012-04-01

    Cryptococcosis is an important systemic mycosis caused by members of the Cryptococcus neoformans species complex. This disease is potentially fatal in various animals, including koalas. We describe the long-term surveillance and treatment of subclinical cryptococcosis and nasal colonization of koalas by Cryptococcus neoformans and C. gattii. Of the 15 animals investigated through the use of samples obtained by nasal swabs, antigen titer measurements, and pathologic examination, C. neoformans was found associated with nine koalas and C. gattii with one animal. Nine koalas showed subclinical disease and one clinical infections and antigenemia. Treatment with fluconazole, itraconazole and amphotericin B upon detection of C. neoformans or C. gattii was not effective. The results of the present study showed that C. neoformans was the predominant species isolated from the nasal swab samples and the fungus might have naturally become associated with the koalas' nasal cavities at Kanazawa Zoological Gardens. The unclear treatment effectiveness might have been caused by a shorter treatment period that is routinely used and unstable itraconazole absorption. This investigation also underscores the need for identifying effective treatment regimens for subclinical cryptococcosis and efficient measures for eradicating C. neoformans and C. gattii in koalas.

  14. Symptomatic relapse of HIV-associated cryptococcal meningitis: recurrent cryptococcal meningitis or Cryptococcus-related immune reconstitution inflammatory syndrome?

    Science.gov (United States)

    Jhamb, Rajat; Kashyap, Bineeta; Das, Shukla; Berry, Neha; Garg, Arun

    2014-04-01

    Cryptococcosis, a significant opportunistic infection, has become a global concern since the advent of immunosuppressive chemotherapy or in immunodeficient patients. Host responses range from a harmless colonization to disseminated disease. An accurate or definitive diagnosis in patients with cryptococcal meningitis is often delayed because of the similar clinical presentation and biochemical or cerebrospinal fluid findings to those of a variety of infectious and non-infectious aetiologies, most of which are also especially prevalent in developing countries. Rarely, patients with cryptococcal meningitis can develop immune reconstitution inflammatory syndrome (IRIS) when initiated on combination antiretroviral therapy (cART) the diagnosis which is often missed and can be fatal. Due to the similar presentation of infection and IRIS, it is often confused with the relapse of cryptococcal meningitis. We report a case of paradoxical recurrent meningitis in response to the initiation of cART in a patient diagnosed with cryptococcal meningitis and propose that the recurrent symptoms resulted from a therapy-induced reconstitution of the immune response against residual Cryptococcus neoformans.

  15. Randomized, Double-Blind, Crossover Trial of Amitriptyline for Analgesia in Painful HIV-Associated Sensory Neuropathy.

    Directory of Open Access Journals (Sweden)

    Natalya Dinat

    Full Text Available We conducted a randomized, double-blind, placebo-controlled, crossover study at a single center in South Africa, to ascertain whether amitriptyline is an effective analgesic for painful HIV-associated sensory neuropathy of moderate to severe intensity in: i antiretroviral drug naive individuals, and ii antiretroviral drug users. 124 HIV-infected participants (antiretroviral drug naive = 62, antiretroviral drug users = 62 who met the study criteria for painful HIV-associated sensory neuropathy were randomized to once-daily oral amitriptyline (titrated to a median: interquartile range of 50: 25-50 mg or placebo for six weeks, followed by a three-week washout period and subsequent treatment crossover. The primary outcome measure was change from baseline in worst pain intensity of the feet (measured by participant self-report using an 11-point numerical pain rating scale after six weeks of treatment. 122 of 124 participants completed all study visits and were included in the analysis of the primary outcome. In the antiretroviral drug-naive group (n = 61 there was no significant difference in the mean change in pain score from baseline after six weeks of treatment with placebo or amitriptyline [amitriptyline: 2.8 (SD 3.3 vs. placebo: 2.8 (3.4]. Similarly, there was no significant difference in the change in pain score after six weeks of treatment with placebo or amitriptyline in the antiretroviral drug-user group (n = 61 [amitriptyline: 2.7 (3.3 vs. placebo: 2.1 (2.8]. Controlling for period effects and treatment order effects did not alter the outcome of the analyses. Nor did analyzing the intention-to-treat cohort (missing data interpolated using baseline observation carried forward alter the outcome of the analyses. In summary, amitriptyline, at the doses used here, was no more effective than an inactive placebo at reducing pain intensity in individuals with painful HIV-associated sensory neuropathy of moderate to severe intensity, irrespective of

  16. The changing role of HIV-associated oral candidiasis in the era of HAART.

    Science.gov (United States)

    Patuwo, Christopher; Young, Keane; Lin, Meng; Pardi, Vanessa; Murata, Ramiro M

    2015-02-01

    Oral candidiasis is the most common fungal opportunistic infection to affect the oral cavity among HIV patients. The advent of highly active antiretroviral therapy (HAART) has changed the epidemiology of candidiasis, with many studies reporting a decrease in prevalence. However, some studies report rare cases of increased prevalence. This systematic review clarifies the role of oral candidiasis in the HAART era as a marker of immune status and successful therapy for the HIV-infected population.

  17. FDG-PET/CT imaging in the management of HIV-associated multicentric Castleman's disease

    Energy Technology Data Exchange (ETDEWEB)

    Barker, Rob; Kazmi, Fahrad; Stebbing, Justin; Chinn, Roger [Imperial College School of Medicine, The Chelsea and Westminster Hospital, Department of Radiology, London (United Kingdom); Ngan, Sarah; Bower, Mark [Imperial College School of Medicine, The Chelsea and Westminster Hospital, Department of Oncology, London (United Kingdom); Nelson, Mark [Imperial College School of Medicine, The Chelsea and Westminster Hospital, Department of HIV Medicine, London (United Kingdom); O' Doherty, Michael [St. Thomas' Hospital, Clinical PET Centre, Guys and St. Thomas Hospital Trust, London (United Kingdom)

    2009-04-15

    To evaluate the role of FDG-PET/CT scanning in the management of HIV-associated multicentric Castleman's disease (MCD) a rare lymphoproliferative disorder associated with infection by human herpesvirus 8 (HHV8). Nine patients with histologically confirmed MCD underwent fused FDG-PET/CT scans at initial MCD diagnosis (n = 3), at MCD relapse (n = 4), or during remission (n = 2). All seven patients with active MCD had markedly elevated plasma HHV8 viral loads, but the patients in remission had no HHV8 viraemia. The three patients with newly diagnosed MCD were not on antiretroviral therapy at the time of imaging, but the other six were all on fully suppressive antiretroviral regimens. In the seven patients with active MCD (newly diagnosed or relapse) 33/91 lymph node groups (36%) included radiologically enlarged nodes on the CT scan, whilst 57/91 lymph node groups (63%) showed enhanced FDG uptake on the PET scan. In scans from patients in remission, there were no enlarged lymph nodes on the CT scan but 3 lymph nodes (11%) demonstrated enhanced FDG uptake. The median SUV recorded for the seven patients with active MCD was 4.8 (range 2.6-9.3) which was significantly higher than the median value of 2.5 recorded for the patients in remission (Mann-Whitney U test, p = 0.011). Despite the small number of patients, in HIV-positive individuals with active MCD, FDG-PET scans more frequently detected abnormal uptake than CT scans detected enlarged lymph nodes. FDG-PET scanning has a useful role in the management of HIV-associated MCD in selecting appropriate sites for biopsy, and in staging and monitoring these lymphoproliferations. (orig.)

  18. HIV-associated disruption of tight and adherens junctions of oral epithelial cells facilitates HSV-1 infection and spread.

    Science.gov (United States)

    Sufiawati, Irna; Tugizov, Sharof M

    2014-01-01

    Herpes simplex virus (HSV) types 1 and 2 are the most common opportunistic infections in HIV/AIDS. In these immunocompromised individuals, HSV-1 reactivates and replicates in oral epithelium, leading to oral disorders such as ulcers, gingivitis, and necrotic lesions. Although the increased risk of HSV infection may be mediated in part by HIV-induced immune dysfunction, direct or indirect interactions of HIV and HSV at the molecular level may also play a role. In this report we show that prolonged interaction of the HIV proteins tat and gp120 and cell-free HIV virions with polarized oral epithelial cells leads to disruption of tight and adherens junctions of epithelial cells through the mitogen-activated protein kinase signaling pathway. HIV-induced disruption of oral epithelial junctions facilitates HSV-1 paracellular spread between the epithelial cells. Furthermore, HIV-associated disruption of adherens junctions exposes sequestered nectin-1, an adhesion protein and critical receptor for HSV envelope glycoprotein D (gD). Exposure of nectin-1 facilitates binding of HSV-1 gD, which substantially increases HSV-1 infection of epithelial cells with disrupted junctions over that of cells with intact junctions. Exposed nectin-1 from disrupted adherens junctions also increases the cell-to-cell spread of HSV-1 from infected to uninfected oral epithelial cells. Antibodies to nectin-1 and HSV-1 gD substantially reduce HSV-1 infection and cell-to-cell spread, indicating that HIV-promoted HSV infection and spread are mediated by the interaction of HSV gD with HIV-exposed nectin-1. Our data suggest that HIV-associated disruption of oral epithelial junctions may potentiate HSV-1 infection and its paracellular and cell-to-cell spread within the oral mucosal epithelium. This could be one of the possible mechanisms of rapid development of HSV-associated oral lesions in HIV-infected individuals.

  19. HIV-associated disruption of tight and adherens junctions of oral epithelial cells facilitates HSV-1 infection and spread.

    Directory of Open Access Journals (Sweden)

    Irna Sufiawati

    Full Text Available Herpes simplex virus (HSV types 1 and 2 are the most common opportunistic infections in HIV/AIDS. In these immunocompromised individuals, HSV-1 reactivates and replicates in oral epithelium, leading to oral disorders such as ulcers, gingivitis, and necrotic lesions. Although the increased risk of HSV infection may be mediated in part by HIV-induced immune dysfunction, direct or indirect interactions of HIV and HSV at the molecular level may also play a role. In this report we show that prolonged interaction of the HIV proteins tat and gp120 and cell-free HIV virions with polarized oral epithelial cells leads to disruption of tight and adherens junctions of epithelial cells through the mitogen-activated protein kinase signaling pathway. HIV-induced disruption of oral epithelial junctions facilitates HSV-1 paracellular spread between the epithelial cells. Furthermore, HIV-associated disruption of adherens junctions exposes sequestered nectin-1, an adhesion protein and critical receptor for HSV envelope glycoprotein D (gD. Exposure of nectin-1 facilitates binding of HSV-1 gD, which substantially increases HSV-1 infection of epithelial cells with disrupted junctions over that of cells with intact junctions. Exposed nectin-1 from disrupted adherens junctions also increases the cell-to-cell spread of HSV-1 from infected to uninfected oral epithelial cells. Antibodies to nectin-1 and HSV-1 gD substantially reduce HSV-1 infection and cell-to-cell spread, indicating that HIV-promoted HSV infection and spread are mediated by the interaction of HSV gD with HIV-exposed nectin-1. Our data suggest that HIV-associated disruption of oral epithelial junctions may potentiate HSV-1 infection and its paracellular and cell-to-cell spread within the oral mucosal epithelium. This could be one of the possible mechanisms of rapid development of HSV-associated oral lesions in HIV-infected individuals.

  20. First report of two cases of cryptococcosis in Tripoli, Libya, infected with Cryptococcus neoformans isolates present in the urban area.

    Science.gov (United States)

    Ellabib, M S; Krema, Z A; Allafi, A A; Cogliati, M

    2017-05-30

    Cryptococcosis is a potentially fatal fungal disease caused by the basidiomycetes yeasts Cryptococcus neoformans and C. gattii with high predilection to invade the central nervous system mainly in immunocompromised hosts. Skin can be secondarily involved in disseminated infection or be exceptionally involved as primary cutaneous infection by inoculation with contaminated materials. We report the first two Libyan cases of cryptococcal meningitis in HIV patients, in which one of them presented a secondary cutaneous involvement due to systemic dissemination. The first patient was a 17-year-old female, had fever, cough, headache and intractable vomiting as well as itchy water bumps on her skin and upper limbs. The cutaneous eruption prompted the accurate diagnosis. Cultures were positive for C. neoformans in both cerebrospinal fluid and skin specimens, as well as cryptococcal antigen was detected in serum. The isolate was identified, by molecular analysis, as C. neoformans AD-hybrid belonging to molecular type VNIII and mating type αAAα, the same genotype found for some environmental isolates recovered from olive trees in Tripoli. The second patient was a 36-years-old male with a long history of HIV on irregular treatment. Cryptococcal antigen in serum was positive and cultures yielded the growth of C. neoformans var. grubii, molecular type VNI and mating type αA. Both patients did not respond adequately to treatment and died of impaired central nervous system function and respiratory failure, respectively. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  1. Pulmonary and Meningeal Cryptococcosis after Corticosteroid Therapy for Autoimmune Hepatitis: Coexistence of Cryptococci within Pulmonary Cancer Nodule

    Directory of Open Access Journals (Sweden)

    Takashi Yuri

    2013-01-01

    Full Text Available A case of autoimmune hepatitis complicated with pulmonary and meningeal cryptococcosis during long-term treatment with corticosteroid is reported. An 84-year-old woman who received long-term corticosteroid therapy (40 mg/day prednisolone for two years for autoimmune hepatitis developed a headache, slight fever, and anorexia and was diagnosed with cryptococcal meningitis two months prior to hospital admission. Due to deterioration of her condition, the patient was transferred to our university hospital. After admission, a pulmonary nodule 1 cm in diameter was noticed in the patient’s right lower lobe. Cryptococcal meningitis was diagnosed as positive for cryptococcal antigen from both serum and cerebrospinal fluid (CSF as well as the growth of Cryptococcus neoformans (C. neoformans in fungal culture. A combination therapy of amphotericin B and flucytosine was started, and the corticosteroid therapy was gradually reduced and finally discontinued. In addition to continuous cryptococcal infection, complications of Pseudomonas aeruginosa and methicillin-resistance Staphylococcus aureus infection caused death after a 2-month hospitalization. Autopsy disclosed encapsulated yeast in the lungs and subarachnoid space characteristic of Cryptococcus. The pulmonary nodule was found to be squamous cell carcinoma coexisting with C. neoformans within and around the cancer cell nests.

  2. HIV-Associated Central Nervous System Disease in Patients Admitted at the Douala General Hospital between 2004 and 2009: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Henry Namme Luma

    2013-01-01

    Full Text Available Background. Studies on HIV-associated central nervous system (CNS diseases in Cameroon are rare. The aim of this study was to describe the clinical presentation, identify aetiological factors, and determine predictors of mortality in HIV patients with CNS disease. Methods. From January 1, 2004 and December 31, 2009, we did at the Douala General Hospital a clinical case note review of 672 admitted adult (age ≥ 18 years HIV-1 patients, and 44.6% (300/672 of whom were diagnosed and treated for HIV-associated CNS disease. Results. The mean age of the study population was years, and median CD4 count was 49 cells/mm3 (interquartile range (QR: 17–90. The most common clinical presentations were headache (83%, focal signs (40.6%, and fever (37.7%. Toxoplasma encephalitis and cryptococcal meningitis were the leading aetiologies of HIV-associated CNS disease in 32.3% and 25% of patients, respectively. Overall mortality was 49%. Primary central nervous system lymphoma (PCNSL and bacterial meningitis had the highest case fatality rates of 100% followed by tuberculous meningitis (79.8%. Low CD4 count was an independent predictor of fatality (AOR: 3.2, 95%CI: 2.0–5.2. Conclusions. HIV-associated CNS disease is common in Douala. CNS symptoms in HIV patients need urgent investigation because of their association with diseases of high case fatality.

  3. Primary pulmonary cryptococcosis: a case report and literature review%原发性肺隐球菌病例报告及文献复习

    Institute of Scientific and Technical Information of China (English)

    朱光发; 陈东; 王新霞; 王增智; 刘双

    2012-01-01

    Objective:To investigate the clinical and pathological features of pulmonary cryptococcosis, improve the understanding of pulmonary cryptococcosis and reduce misdiagnosis in clinical scenario. Methods; Retrospectively analyzed the diagnosis and treatment of one patient with primary pulmonary cryptococcosis, reviewed the literature and summarized the pathogenesis, clinical manifestations, diagnosis and treatment of pulmonary cryptococcosis. Results; A male patient, 56 years old, had a basis disease of diabetes, due to the attack of Menieres syndrome, he went to hospital, chest X-ray Photography showed multiple subpleural patchy or mass shadows within the right lung. Ordinary empirical anti-bacterial therapy failed and percutaneous-needle lung biopsy was performed because of suspicion of lung cancer. The patient was admitted into hospital because fever and cough after lung biopsy. Pathological examinations showed granuloma formation with C. Neoformans spores, PAS and methenamine silver staining were positive. The diagnosis of primary pulmonary cryptococcosis was conformed. Fluconazole 400mg / day was given intravenously for 6 weeks when the lung lesion was significantly absorbed and fluconazole was switched to oral administration. The patient was discharged and recommended him to continue to use fluconazole for at least 6 months. Conclusion: Pulmonary cryptococcosis is lack of specificities of clinical and imaging findings and easily to be misdiagnosed and mistreated. Clinician should with alert in suspected patient. Prompt lung biopsy and pathology with special stains can confirm the diagnosis. Less invasive percutaneous lung biopsy is the preferred. Antifungal therapy should be initiated after a comprehensive assessment of this condition.%目的:探讨肺隐球菌病的临床及病理特点,提高对肺隐球菌病的认识,以减少误诊.方法:回顾性分析1例原发性肺隐球菌病的诊断和治疗经过,分析总结治疗经验,结合文献

  4. Case of Pulmonary Cryptococcosis Mimicking Hematogeneous Metastases in an Immuocompetent Patient: Value of Absent 18F-Fluorodeoxylucose Uptake on Positron Emission Tomography/CT Scan

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chiao-Hua [Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan (China); Tzao, Ching [Department of Thoracic Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan (China); Chang, Tsun-Hou; Chang, Wei-Chou; Huang, Guo-Shu [Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan (China); Lin, Chih-Kung; Lin, Hsin-Chung [Department of Pathology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan (China); Hsu, Hsian-He [Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan (China)

    2013-07-01

    The radiologic appearance of multiple discrete pulmonary nodules in immunocompetent patients, with cryptococcal infection, has been rarely described. We describe a case of pulmonary cryptococcosis, presenting with bilaterally and randomly distributed nodules on a computed tomography, mimicking hematogeneous metastases. Positron emission tomography does not demonstrate 18F-fluorodeoxyglucose (FDG) uptake, suggesting a low probability for malignancy, which is a crucial piece of information for clinicians when making a management decision. We find the absence of FDG uptake correlates with the pathologic finding of an infectious nodule, composed of fibrosis and necrosis.

  5. CAE of pulmonary cryptococcosis mimicking hematogenous metastases in an immunocompetent patient: Value of absent 1{sup 8F}- fluorodeoxyglucose uptake on position emission tomography/CT scan

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    Lee, Chiao Hua; Tzao, Ching; Chang, Tsun Hou; Chang, Wei Chou; Huang, Guo Shu; Lin, Chih Kung; Lin, Hsin Chung; Hsu, Hsian He [Tri-Service General Hospital and National Defense Medical Center, Taipei (China)

    2013-06-15

    The radiologic appearance of multiple discrete pulmonary nodules in immunocompetent patients, with cryptococcal infection, has been rarely described. We describe a case of pulmonary cryptococcosis, presenting with bilaterally and randomly distributed nodules on a computed tomography, mimicking hematogeneous metastases. Positron emission tomography does not demonstrate 1{sup 8F}-fluorodeoxyglucose (FDG) uptake, suggesting a low probability for malignancy, which is a crucial piece of information for clinicians when making a management decision. We find the absence of FDG uptake correlates with the pathologic finding of an infectious nodule, composed of fibrosis and necrosis.

  6. Hypoxia-inducible factor-1 α/platelet derived growth factor axis in HIV-associated pulmonary vascular remodeling

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    Bartolome Sonja

    2011-08-01

    Full Text Available Abstract Background Human immunodeficiency virus (HIV infected patients are at increased risk for the development of pulmonary arterial hypertension (PAH. Recent reports have demonstrated that HIV associated viral proteins induce reactive oxygen species (ROS with resultant endothelial cell dysfunction and related vascular injury. In this study, we explored the impact of HIV protein induced oxidative stress on production of hypoxia inducible factor (HIF-1α and platelet-derived growth factor (PDGF, critical mediators implicated in the pathogenesis of HIV-PAH. Methods The lungs from 4-5 months old HIV-1 transgenic (Tg rats were assessed for the presence of pulmonary vascular remodeling and HIF-1α/PDGF-BB expression in comparison with wild type controls. Human primary pulmonary arterial endothelial cells (HPAEC were treated with HIV-associated proteins in the presence or absence of pretreatment with antioxidants, for 24 hrs followed by estimation of ROS levels and western blot analysis of HIF-1α or PDGF-BB. Results HIV-Tg rats, a model with marked viral protein induced vascular oxidative stress in the absence of active HIV-1 replication demonstrated significant medial thickening of pulmonary vessels and increased right ventricular mass compared to wild-type controls, with increased expression of HIF-1α and PDGF-BB in HIV-Tg rats. The up-regulation of both HIF-1α and PDGF-B chain mRNA in each HIV-Tg rat was directly correlated with an increase in right ventricular/left ventricular+septum ratio. Supporting our in-vivo findings, HPAECs treated with HIV-proteins: Tat and gp120, demonstrated increased ROS and parallel increase of PDGF-BB expression with the maximum induction observed on treatment with R5 type gp-120CM. Pre-treatment of endothelial cells with antioxidants or transfection of cells with HIF-1α small interfering RNA resulted in abrogation of gp-120CM mediated induction of PDGF-BB, therefore, confirming that ROS generation and

  7. Toxicity of Amphotericin B Deoxycholate-Based Induction Therapy in Patients with HIV-Associated Cryptococcal Meningitis.

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    Bicanic, Tihana; Bottomley, Christian; Loyse, Angela; Brouwer, Annemarie E; Muzoora, Conrad; Taseera, Kabanda; Jackson, Arthur; Phulusa, Jacob; Hosseinipour, Mina C; van der Horst, Charles; Limmathurotsakul, Direk; White, Nicholas J; Wilson, Douglas; Wood, Robin; Meintjes, Graeme; Harrison, Thomas S; Jarvis, Joseph N

    2015-12-01

    Amphotericin B deoxycholate (AmBd) is the recommended induction treatment for HIV-associated cryptococcal meningitis (CM). Its use is hampered by toxicities that include electrolyte abnormalities, nephrotoxicity, and anemia. Protocols to minimize toxicity are applied inconsistently. In a clinical trial cohort of AmBd-based CM induction treatment, a standardized protocol of preemptive hydration and electrolyte supplementation was applied. Changes in blood counts, electrolyte levels, and creatinine levels over 14 days were analyzed in relation to the AmBd dose, treatment duration (short course of 5 to 7 days or standard course of 14 days), addition of flucytosine (5FC), and outcome. In the 368 patients studied, the hemoglobin levels dropped by a mean of 1.5 g/dl (95% confidence interval [CI], 1.0 to 1.9 g/dl) following 7 days of AmBd and by a mean of 2.3 g/dl (95% CI, 1.1 to 3.6 g/dl) after 14 days. Serum creatinine levels increased by 37 μmol/liter (95% CI, 30 to 45 μmol/liter) by day 7 and by 49 μmol/liter (95% CI, 35 to 64μmol/liter) by day 14 of AmBd treatment. Overall, 33% of patients developed grade III/IV anemia, 5.6% developed grade III hypokalemia, 9.5% had creatinine levels that exceeded 220 μmol, and 6% discontinued AmBd prematurely. The addition of 5FC was associated with a slight increase in anemia but not neutropenia. Laboratory abnormalities stabilized or reversed during the second week in patients on short-course induction. Grade III/IV anemia (adjusted odds ratio [aOR], 2.2; 95% CI, 1.1 to 4.3; P = 0.028) and nephrotoxicity (aOR, 4.5; 95% CI, 1.8 to 11; P = 0.001) were risk factors for 10-week mortality. In summary, routine intravenous saline hydration and preemptive electrolyte replacement during AmBd-based induction regimens for HIV-associated CM minimized the incidence of hypokalemia and nephrotoxicity. Anemia remained a concerning adverse effect. The addition of flucytosine was not associated with increased neutropenia. Shorter AmBd courses

  8. Cerebrospinal fluid cytokine profiles predict risk of early mortality and immune reconstitution inflammatory syndrome in HIV-associated cryptococcal meningitis.

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    Joseph N Jarvis

    2015-04-01

    Full Text Available Understanding the host immune response during cryptococcal meningitis (CM is of critical importance for the development of immunomodulatory therapies. We profiled the cerebrospinal fluid (CSF immune-response in ninety patients with HIV-associated CM, and examined associations between immune phenotype and clinical outcome. CSF cytokine, chemokine, and macrophage activation marker concentrations were assayed at disease presentation, and associations between these parameters and microbiological and clinical outcomes were examined using principal component analysis (PCA. PCA demonstrated a co-correlated CSF cytokine and chemokine response consisting primarily of Th1, Th2, and Th17-type cytokines. The presence of this CSF cytokine response was associated with evidence of increased macrophage activation, more rapid clearance of Cryptococci from CSF, and survival at 2 weeks. The key components of this protective immune-response were interleukin (IL-6 and interferon-γ, IL-4, IL-10 and IL-17 levels also made a modest positive contribution to the PC1 score. A second component of co-correlated chemokines was identified by PCA, consisting primarily of monocyte chemotactic protein-1 (MCP-1 and macrophage inflammatory protein-1α (MIP-1α. High CSF chemokine concentrations were associated with low peripheral CD4 cell counts and CSF lymphocyte counts and were predictive of immune reconstitution inflammatory syndrome (IRIS. In conclusion CSF cytokine and chemokine profiles predict risk of early mortality and IRIS in HIV-associated CM. We speculate that the presence of even minimal Cryptococcus-specific Th1-type CD4+ T-cell responses lead to increased recruitment of circulating lymphocytes and monocytes into the central nervous system (CNS, more effective activation of CNS macrophages and microglial cells, and faster organism clearance; while high CNS chemokine levels may predispose to over recruitment or inappropriate recruitment of immune cells to the CNS and

  9. Cross-cultural assessment of HIV-associated cognitive impairment using the Kaufman assessment battery for children: a systematic review.

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    van Wyhe, Kaylee S; van de Water, Tanya; Boivin, Michael J; Cotton, Mark F; Thomas, Kevin Gf

    2017-06-14

    Despite improved efficacy of, and access to, combination antiretroviral therapy (cART), HIV-associated cognitive impairments remain prevalent in both children and adults. Neuropsychological tests that detect such impairment can help clinicians formulate effective treatment plans. The Kaufman Assessment Battery for Children (KABC), although developed and standardized in the United States, is used frequently in many different countries and cultural contexts to assess paediatric performance across various cognitive domains. This systematic review investigated the cross-cultural utility of the original KABC, and its 2nd edition (KABC-II), in detecting HIV-associated cognitive impairment in children and adolescents. We entered relevant keywords and MeSH terms into the PubMed, PsycInfo, EBSCOHost, ProQuest, and Scopus databases, with search limits set from 1983-2017. Two independent reviewers evaluated the retrieved abstracts and manuscripts. Studies eligible for inclusion in the review were those that (a) used the KABC/KABC-II to assess cognitive function in children/adolescents aged 2-18 years, (b) featured a definition of cognitive impairment (e.g. >2 SD below the mean) or compared the performance of HIV-infected and uninfected control groups, and (c) used a sample excluded from population on which the instruments were normed. We identified nine studies (eight conducted in African countries, and one in the United Kingdom) to comprise the review's sample. All studies detected cognitive impairment in HIV-infected children, including those who were cART-naïve or who were cART treated and clinically stable. KABC/KABC-II subtests assessing simultaneous processing appeared most sensitive. Evaluation of the methodological quality of the selected studies by two independent reviews suggested that shortcomings included reporting and selection biases. This systematic review provides evidence for the cross-cultural utility of the KABC/KABC-II, particularly the simultaneous

  10. HIV-associated neurocognitive disorders: recent advances in pathogenesis, biomarkers, and treatment [version 1; referees: 4 approved

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    Antonia Carroll

    2017-03-01

    Full Text Available HIV-associated neurocognitive disorders (HAND remain prevalent despite plasma viral suppression by antiretroviral agents. In fact, the prevalence of milder subtypes of cognitive impairment is increasing. Neuropsychologic testing remains the “gold standard” of diagnosis; however, this is time consuming and costly in a resource-poor environment. Recently developed screening tools, such as CogState and the revised HIV dementia scale, have very good sensitivity and specificity in the more severe stages of HAND. However, questions remain regarding the utility of, optimal population for, and insensitivity of tests in mild HAND. Recognition of ongoing viral persistence and the inflammatory milieu in the central nervous system (CNS has advanced our understanding of the pathogenesis of HAND and facilitated the development of biomarkers of CNS disease. The importance of the monocyte-macrophage lineage cell and the astrocyte as viral reservoirs, HIV viral proteins, self-perpetuating CNS inflammation, and CCR5 chemokine receptor neurotropism has been identified. Whilst biomarkers demonstrate monocyte activation, inflammation, and neuronal injury, they remain limited in their clinical utility. The improved understanding of pathogenic mechanisms has led to novel approaches to the treatment of HAND; however, despite these advances, the optimal management is still undefined.

  11. Investigating changes in brain network properties in HIV-associated neurocognitive disease (HAND) using mutual connectivity analysis (MCA)

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    Abidin, Anas Zainul; D'Souza, Adora M.; Nagarajan, Mahesh B.; Wismüller, Axel

    2016-03-01

    About 50% of subjects infected with HIV present deficits in cognitive domains, which are known collectively as HIV associated neurocognitive disorder (HAND). The underlying synaptodendritic damage can be captured using resting state functional MRI, as has been demonstrated by a few earlier studies. Such damage may induce topological changes of brain connectivity networks. We test this hypothesis by capturing the functional interdependence of 90 brain network nodes using a Mutual Connectivity Analysis (MCA) framework with non-linear time series modeling based on Generalized Radial Basis function (GRBF) neural networks. The network nodes are selected based on the regions defined in the Automated Anatomic Labeling (AAL) atlas. Each node is represented by the average time series of the voxels of that region. The resulting networks are then characterized using graph-theoretic measures that quantify various network topology properties at a global as well as at a local level. We tested for differences in these properties in network graphs obtained for 10 subjects (6 male and 4 female, 5 HIV+ and 5 HIV-). Global network properties captured some differences between these subject cohorts, though significant differences were seen only with the clustering coefficient measure. Local network properties, such as local efficiency and the degree of connections, captured significant differences in regions of the frontal lobe, precentral and cingulate cortex amongst a few others. These results suggest that our method can be used to effectively capture differences occurring in brain network connectivity properties revealed by resting-state functional MRI in neurological disease states, such as HAND.

  12. CCL3L1 gene copy number in individuals with and without HIV-associated neurocognitive disorder

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    Brown A

    2012-01-01

    Full Text Available Amanda Brown1, Ned Sacktor1, Karen Marder2, Bruce Cohen3, Giovanni Schifitto4, Richard L Skolasky1, Jason Creighton1, Liping Guo1, Justin C McArthur11Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 2Department of Neurology, Psychiatry, Sergievsky Center and Taub Institute on Alzheimers Disease and the Aging Brain, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, 3Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 4Department of Neurology, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USABackground: CCL3L1 copy number variation has been implicated as a marker for susceptibility and immunity to human immunodeficiency virus (HIV-1 infection and its pathogenic sequelae. Some of these findings have been confirmed in several, but not all, subsequent independent cohort studies. A three-fold risk for the development of HIV-associated dementia was reported in individuals possessing a CCL3L1 copy number below the ethnic group median combined with a detrimental CCR5 genotype. With the availability of antiretroviral therapy since 1996, there has been a significant decline in HIV-associated dementia, and milder forms of HIV-associated neurocognitive impairment (HAND are now most prevalent. Moreover, patients are living longer with HIV-1 infection and it is recognized that aging may be a contributory factor to the development of cognitive disorder. Thus, the need for biomarkers that can be used in clinical practice to identify and provide optimal treatment for those at increased risk for HAND is great. HAND affects 20%–30% of HIV-infected individuals, and several genetic loci which have been shown to confer susceptibility to HIV infection may also modulate the development of neurocognitive disorder. The aim of this study was to determine whether CCL3L1 chemokine gene copy number in self-defined ethnic

  13. Methamphetamine and inflammatory cytokines increase neuronal Na+/K+-ATPase isoform 3: relevance for HIV associated neurocognitive disorders.

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    Gurudutt Pendyala

    Full Text Available Methamphetamine (METH abuse in conjunction with human immunodeficiency virus (HIV exacerbates neuropathogenesis and accelerates neurocognitive impairments in the central nervous system (CNS, collectively termed HIV Associated Neurocognitive Disorders (HAND. Since both HIV and METH have been implicated in altering the synaptic architecture, this study focused on investigating alterations in synaptic proteins. Employing a quantitative proteomics approach on synaptosomes isolated from the caudate nucleus from two groups of rhesus monkeys chronically infected with simian immunodeficiency virus (SIV differing by one regimen, METH treatment, we identified the neuron specific Na(+/K(+-ATPase alpha 1 isoform 3 (ATP1A3 to be up regulated after METH treatment, and validated its up regulation by METH in vitro. Further studies on signaling mechanisms revealed that the activation of ATP1A3 involves the extracellular regulated kinase (ERK pathway. Given its function in maintaining ionic gradients and emerging role as a signaling molecule, changes in ATP1A3 yields insights into the mechanisms associated with HAND and interactions with drugs of abuse.

  14. Self-Predictions of Prospective Memory in HIV-Associated Neurocognitive Disorders: Evidence of a Metamemory Deficit

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    Casaletto, Kaitlin Blackstone; Doyle, Katie L.; Weber, Erica; Woods, Steven Paul; Heaton, Robert K.; Grant, Igor; Atkinson, J. Hampton; Ellis, Ronald J.; Letendre, Scott; Marcotte, Thomas D.; Marquie-Beck, Jennifer; Sherman, Melanie; Ellis, Ronald J.; Letendre, Scott; McCutchan, J. Allen; Best, Brookie; Schrier, Rachel; Rosario, Debra; Heaton, Robert K.; Atkinson, J. Hampton; Woods, Steven Paul; D, Psy; Marcotte, Thomas D.; Cherner, Mariana; Moore, David J.; Dawson, Matthew; Fennema-Notestine, Christine; Buchsbaum, Monte S.; Hesselink, John; Archibald, Sarah L.; Brown, Gregory; Buxton, Richard; Dale, Anders; Liu, Thomas; Masliah, Eliezer; Achim, Cristian; Smith, David M.; Richman, Douglas; McCutchan, J. Allen; Cherner, Mariana; Achim, Cristian; Lipton, Stuart; Atkinson, J. Hampton; Marquie-Beck, Jennifer; Gamst, Anthony C.; Cushman, Clint; Abramson, Ian; Vaida, Florin; Deutsch, Reena; Umlauf, Anya

    2014-01-01

    HIV-associated neurocognitive disorders (HAND) are associated with deficits in prospective memory (PM; “remembering to remember”), conferring risk of daily functioning declines. However, self-perceptions of PM functioning are not reliably associated with PM performance in HIV, suggesting a possible deficit in awareness of PM abilities (meta-PM). Our study examined meta-PM in HAND and its correlates using self-predictions of laboratory-based PM performance. Performance-based PM abilities, self-reported prediction of PM performance, and PM complaints in everyday life were assessed in 49 individuals with HAND, 93 HIV+ without HAND (HIV+ noHAND), and 121 seronegative adults (HIV−). After controlling for group-level differences, HAND was associated with a greater number of PM symptoms in everyday life and worse PM performance when compared with both HIV+ noHAND and HIV− samples. Although HAND individuals reported somewhat lower predictions regarding their laboratory PM performance relative to the other study groups, they nevertheless exhibited significantly greater inaccurate overconfidence in time-based PM abilities. Within the HAND group, overconfidence in time-based meta-PM was associated with executive dysfunction and antiretroviral (ARV) nonadherence. HAND individuals evidenced a moderate deficit in awareness of PM functioning characterized by overconfidence in time-based PM abilities. Overconfidence in PM may result in absence of compensatory strategy use, and lead to increased errors in daily functioning (e.g., ARV nonadherence). PMID:25404005

  15. A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa.

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    Joska, J A; Witten, J; Thomas, K G; Robertson, C; Casson-Crook, M; Roosa, H; Creighton, J; Lyons, J; McArthur, J; Sacktor, N C

    2016-08-01

    Screening for HIV-associated neurocognitive disorders (HAND) is important to improve clinical outcomes. We compared the diagnostic sensitivity and specificity of the mini-mental state examination, International HIV dementia scale (IHDS), Montreal cognitive assessment, Simioni symptom questionnaire and cognitive assessment tool-rapid version (CAT-rapid) to a gold standard neuropsychological battery. Antiretroviral-experienced participants from Cape Town, South Africa, and Baltimore, USA, were recruited. The sensitivity and specificity of the five tools, as well as those of the combined IHDS and CAT-rapid, were established using 2 × 2 contingency tables and ROC analysis. More than a third (65165) had symptomatic HAND. In detecting HIV-D, the CAT-Rapid had good sensitivity (94 %) and weak specificity (52 %) (cut-point ≤10), while the IHDS showed fair sensitivity (68 %) and good specificity (86 %) (cut-point ≤10). The combined IHDS and CAT-rapid showed excellent sensitivity and specificity for HIV-D at a cut-off score of ≤16 (out of 20; 89 and 82 %). No tool was adequate in screening for any HAND. The combination IHDS and CAT-rapid tool appears to be a good screener for HIV-D but is only fairly sensitive and poorly specific in screening for any HAND. Screening for milder forms of HAND continues to be a clinical challenge.

  16. Neuroimaging of HIV-associated cryptococcal meningitis: comparison of magnetic resonance imaging findings in patients with and without immune reconstitution.

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    Katchanov, Juri; Branding, Gordian; Jefferys, Laura; Arastéh, Keikawus; Stocker, Hartmut; Siebert, Eberhard

    2016-02-01

    To determine the frequency, imaging characteristics, neuroanatomical distribution and dynamics of magnetic resonance imaging findings in HIV-associated cryptococcal meningitis in immunocompromised patients we compared patients without antiretroviral therapy with patients undergoing immune reconstitution. Neuroimaging and clinical data of 21 consecutive patients presenting to a German HIV centre in a 10-year period between 2005 and 2014 were reviewed. We identified eight patients with magnetic resonance imaging findings related to cryptococcal disease: five patients without antiretroviral therapy and three patients receiving effective antiretroviral therapy resulting in immune reconstitution. The pattern of magnetic resonance imaging manifestations was different in the two groups. In patients not on antiretroviral therapy, pseudocysts (n = 3) and lacunar ischaemic lesions (n = 2) were detected. Contrast-enhancing focal leptomeningeal and/or parenchymal lesions were found in all patients under immune reconstitution (n = 3). Magnetic resonance imaging lesions suggestive of leptomeningitis or meningoencephalitis were detected in all patients with a recurrence of cryptococcal meningitis under immune reconstitution, which differs from the classical magnetic resonance imaging findings in patients without antiretroviral therapy. In antiretroviral therapy-treated patients with past medical history of cryptococcal meningitis, detection of contrast-enhancing focal meningeal and/or parenchymal lesions should prompt further investigations for a recurrence of cryptococcal meningitis under immune reconstitution.

  17. Molecular epidemiology of HIV-associated tuberculosis in Dar es Salaam, Tanzania: strain predominance, clustering, and polyclonal disease.

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    Adams, Lisa V; Kreiswirth, Barry N; Arbeit, Robert D; Soini, Hanna; Mtei, Lillian; Matee, Mecky; Bakari, Muhammad; Lahey, Timothy; Wieland-Alter, Wendy; Shashkina, Elena; Kurepina, Natalia; Driscoll, Jeffrey R; Pallangyo, Kisali; Horsburgh, C Robert; von Reyn, C Fordham

    2012-08-01

    Molecular typing of Mycobacterium tuberculosis can be used to elucidate the epidemiology of tuberculosis, including the rates of clustering, the frequency of polyclonal disease, and the distribution of genotypic families. We performed IS6110 typing and spoligotyping on M. tuberculosis strains isolated from HIV-infected subjects at baseline or during follow-up in the DarDar Trial in Tanzania and on selected community isolates. Clustering occurred in 203 (74%) of 275 subjects: 124 (80%) of 155 HIV-infected subjects with baseline isolates, 56 (69%) of 81 HIV-infected subjects with endpoint isolates, and 23 (59%) of 39 community controls. Overall, 113 (41%) subjects had an isolate representing the East Indian "GD" family. The rate of clustering was similar among vaccine and placebo recipients and among subjects with or without cellular immune responses to mycobacterial antigens. Polyclonal disease was detected in 6 (43%) of 14 patients with multiple specimens typed. Most cases of HIV-associated tuberculosis among subjects from this study in Dar es Salaam resulted from recently acquired infection. Polyclonal infection was detected and isolates representing the East Indian GD strain family were the most common.

  18. Altered brain functions in HIV positive patients free of HIV- associated neurocognitive disorders: A MRI study during unilateral hand movements

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    Jing Zhao

    2015-03-01

    Full Text Available This paper aimed to investigate the brain activity of human immunodeficiency virus (HIV positive patients with normal cognition during unilateral hand movement and whether highly active antiretroviral therapy (HAART could affect the brain function. Functional magnetic resonance imaging (fMRI was performed for 60 HIV positive (HIV+ subjects and −42 healthy age-matched right-handed control subjects. Each subject was evaluated by the neuropsychological test and examined with fMRI during left and right hand movement tasks. HIV+ subjects showed greater activation in anterior cingulum, precuneus, occipital lobes, ipsilateral postcentral gyrus and contralateral cerebellum compared with control group during right hand movement task. However, during left hand movement no statistically significant difference was detected between these two groups. HAART medication for HIV+ subjects lowered the increased activity to normal level. Meanwhile patients receiving the regimen of zidovudine, lamivudine and efavirenz showed lower activity at bilateral caudate and ipsilateral inferior frontal gyrus in comparison with subjects receiving other HAART regimens. Therefore, HIV+ subjects demonstrated brain asymmetry in motor cortex, with increased activity present during right hand movement but absent during left hand movement. HAART proves effective in HIV+ subjects even with normal cognition and the specific regimen of HAART could prevent cerebral abnormal functions. Meanwhile, this study validates that during motor tasks, fMRI can detect the brain signal changes prior to the occurrences of other HIV- associated dysfunctions.

  19. Genetically Modified Peripheral Blood Stem Cell Transplant in Treating Patients With HIV-Associated Non-Hodgkin or Hodgkin Lymphoma

    Science.gov (United States)

    2015-05-06

    Adult Nasal Type Extranodal NK/T-cell Lymphoma; AIDS-related Diffuse Large Cell Lymphoma; AIDS-related Diffuse Mixed Cell Lymphoma; AIDS-related Diffuse Small Cleaved Cell Lymphoma; AIDS-related Immunoblastic Large Cell Lymphoma; AIDS-related Lymphoblastic Lymphoma; AIDS-related Peripheral/Systemic Lymphoma; AIDS-related Small Noncleaved Cell Lymphoma; Anaplastic Large Cell Lymphoma; Angioimmunoblastic T-cell Lymphoma; Cutaneous B-cell Non-Hodgkin Lymphoma; Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue; Hepatosplenic T-cell Lymphoma; HIV-associated Hodgkin Lymphoma; Intraocular Lymphoma; Nodal Marginal Zone B-cell Lymphoma; Noncutaneous Extranodal Lymphoma; Peripheral T-cell Lymphoma; Recurrent Adult Burkitt Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Adult Diffuse Mixed Cell Lymphoma; Recurrent Adult Diffuse Small Cleaved Cell Lymphoma; Recurrent Adult Grade III Lymphomatoid Granulomatosis; Recurrent Adult Hodgkin Lymphoma; Recurrent Adult Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Adult T-cell Leukemia/Lymphoma; Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Mycosis Fungoides/Sezary Syndrome; Recurrent Small Lymphocytic Lymphoma; Refractory Hairy Cell Leukemia; Small Intestine Lymphoma; Splenic Marginal Zone Lymphoma; Stage I AIDS-related Lymphoma; Stage II AIDS-related Lymphoma; Stage III AIDS-related Lymphoma; Stage IV AIDS-related Lymphoma; T-cell Large Granular Lymphocyte Leukemia; Testicular Lymphoma; Waldenström Macroglobulinemia

  20. Hemostatic Changes Associated With Increased Mortality Rates in Hospitalized Patients With HIV-Associated Tuberculosis: A Prospective Cohort Study.

    Science.gov (United States)

    Janssen, Saskia; Schutz, Charlotte; Ward, Amy M; Huson, Mischa A M; Wilkinson, Robert J; Burton, Rosie; Maartens, Gary; Wilkinson, Katalin A; Meijers, Joost C M; Lutter, René; Grobusch, Martin P; Meintjes, Graeme; van der Poll, Tom

    2017-01-15

    Mortality rates remain high for human immunodeficiency virus (HIV)-associated tuberculosis, and our knowledge of contributing mechanisms is limited. We aimed to determine whether hemostatic changes in HIV-tuberculosis were associated with mortality or decreased survival time and the contribution of mycobacteremia to these effects. We conducted a prospective study in Khayelitsha, South Africa, in hospitalized HIV-infected patients with CD4 cell counts tuberculosis. HIV-infected outpatients without tuberculosis served as controls. Plasma biomarkers reflecting activation of procoagulation and anticoagulation, fibrinolysis, endothelial cell activation, matricellular protein release, and tissue damage were measured at admission. Cox proportional hazard models were used to assess variables associated with 12-week mortality rates. Of 59 patients with HIV-tuberculosis, 16 (27%) died after a median of 12 days (interquartile range, 0-24 days); 29 (64%) of the 45 not receiving anticoagulants fulfilled criteria for disseminated intravascular coagulation. Decreased survival time was associated with higher concentrations of markers of fibrinolysis, endothelial activation, matricellular protein release, and tissue damage and with decreased concentrations for markers of anticoagulation. In patients who died, coagulation factors involved in the common pathway were depleted (factor II, V, X), which corresponded to increased plasma clotting times. Mycobacteremia modestly influenced hemostatic changes without affecting mortality. Patients with severe HIV-tuberculosis display a hypercoagulable state and activation of the endothelium, which is associated with mortality.

  1. Relationship of depression and catastrophizing to pain, disability, and medication adherence in patients with HIV-associated sensory neuropathy.

    Science.gov (United States)

    Lucey, Brendan P; Clifford, David B; Creighton, Jason; Edwards, Robert R; McArthur, Justin C; Haythornthwaite, Jennifer

    2011-08-01

    Few studies have examined how patients with chronic HIV infection cope with pain and how pain relates to medication adherence. Pain coping strategies such as catastrophizing are often associated with increased pain and disability and may also influence adherence to medications. The goal of our study is to assess the relationship of catastrophizing and depression to pain, disability, and medication adherence through questionnaires administered to a cross-section of patients with HIV-associated sensory neuropathy. In our study, 46 HIV-seropositive subjects completed questionnaires evaluating neuropathic pain severity, pain catastrophizing, pain-related disability, depressive symptoms, severity of antiretroviral therapy (ART) side effects, and common reasons for medication nonadherence. Hierarchical regression analysis indicated that pain catastrophizing correlated with severity of neuropathic pain independent of depressive symptoms. Furthermore, depressive symptoms were not associated with multiple factors independent of pain catastrophizing such as severity of neuropathic pain and pain-related disability. Pain catastrophizing, but not depressive symptoms, correlated with increased pain disability even after controlling for the effects of age and neuropathic pain. We also found that poor adherence attributed to fear of side effects or forgetfulness was associated with increased severity of neuropathic pain, while depressive symptoms but not catastrophizing correlated with ART side effects. These findings suggest that both catastrophizing and depressive symptoms are important factors to consider in the management of pain from HIV neuropathy and adherence to ART.

  2. Flipping the switches: CD40 and CD45 modulation of microglial activation states in HIV associated dementia (HAD

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    Jin Jingji

    2011-01-01

    Full Text Available Abstract Microglial dysfunction is associated with the pathogenesis and progression of a number of neurodegenerative disorders including HIV associated dementia (HAD. HIV promotion of an M1 antigen presenting cell (APC - like microglial phenotype, through the promotion of CD40 activity, may impair endogenous mechanisms important for amyloid- beta (Aβ protein clearance. Further, a chronic pro-inflammatory cycle is established in this manner. CD45 is a protein tyrosine phosphatase receptor which negatively regulates CD40L-CD40-induced microglial M1 activation; an effect leading to the promotion of an M2 phenotype better suited to phagocytose and clear Aβ. Moreover, this CD45 mediated activation state appears to dampen harmful cytokine production. As such, this property of microglial CD45 as a regulatory "off switch" for a CD40-promoted M1, APC-type microglia activation phenotype may represent a critical therapeutic target for the prevention and treatment of neurodegeneration, as well as microglial dysfunction, found in patients with HAD.

  3. Incidence, clinical spectrum, risk factors and impact of HIV-associated immune reconstitution inflammatory syndrome in South Africa.

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    Lewis John Haddow

    Full Text Available BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS is a widely recognised complication of antiretroviral therapy (ART, but there are still limited data from resource-limited settings. Our objective was to characterize the incidence, clinical spectrum, risk factors and contribution to mortality of IRIS in two urban ART clinics in South Africa. METHODS AND FINDINGS: 498 adults initiating ART in Durban, South Africa were followed prospectively for 24 weeks. IRIS diagnosis was based on consensus expert opinion, and classified by mode of presentation (paradoxical worsening of known opportunistic infection [OI] or unmasking of subclinical disease. 114 patients (22.9% developed IRIS (36% paradoxical, 64% unmasking. Mucocutaneous conditions accounted for 68% of IRIS events, mainly folliculitis, warts, genital ulcers and herpes zoster. Tuberculosis (TB accounted for 25% of IRIS events. 18/135 (13.3% patients with major pre-ART OIs (e.g. TB, cryptococcosis developed paradoxical IRIS related to the same OI. Risk factors for this type of IRIS were baseline viral load >5.5 vs. 30 days of OI treatment prior to ART (2.66; 1.16-6.09. Unmasking IRIS related to major OIs occurred in 25/498 patients (5.0%, and risk factors for this type of IRIS were baseline C-reactive protein ≥25 vs. 12 g/dL (3.36; 1.32-8.52, ≥10% vs. <10% weight loss prior to ART (2.31; 1.05-5.11 and mediastinal lymphadenopathy on pre-ART chest x-ray (9.15; 4.10-20.42. IRIS accounted for 6/25 (24% deaths, 13/65 (20% hospitalizations and 10/35 (29% ART interruptions or discontinuations. CONCLUSION: IRIS occurred in almost one quarter of patients initiating ART, and accounted for one quarter of deaths in the first 6 months. Priority strategies to reduce IRIS-associated morbidity and mortality in ART programmes include earlier ART initiation before onset of advanced immunodeficiency, improved pre-ART screening for TB and cryptococcal infection, optimization of OI therapy prior to ART

  4. HIV-Associated Burkitt Lymphoma: Good Efficacy and Tolerance of Intensive Chemotherapy Including CODOX-M/IVAC with or without Rituximab in the HAART Era

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    J. A. Rodrigo

    2012-01-01

    Full Text Available Background. The outcome of HIV-associated non-Hodgkin lymphoma (NHL has improved substantially in the highly active antiretroviral therapy (HAART era. However, HIV-Burkitt lymphoma (BL, which accounts for up to 20% of HIV-NHL, has poor outcome with standard chemotherapy. Patients and Methods. We retrospectively reviewed HIV-BL treated in the HAART era with the Magrath regimen (CODOX-M/IVAC±R at four Canadian centres. Results. Fourteen patients with HIV-BL received at least one CODOX-M/IVAC±R treatment. Median age at BL diagnosis was 45.5 years, CD4 count 375 cells/mL and HIV viral load (VL 250 cells/mL and undetectable, respectively, in 4. Conclusion. Intensive chemotherapy with CODOX-M/IVAC±R yielded acceptable toxicity and good survival rates in patients with HIV-associated Burkitt lymphoma receiving HAART.

  5. Regional differences in astrocyte activation in HIV-associated dementia Diferencias regionales en la activación astrocitaria en demencia asociada a HIV

    OpenAIRE

    María C. Vanzani; Rubén F. Iacono; Caccuri, Roberto L.; Alcides R. Troncoso; María I. Berria

    2006-01-01

    Since astrogliosis is a histological marker usually observed in HIV-associated dementia (HIV-D), we decided to investigate the potential relationship between the expression of glial fibrillary acidic protein (GFAP) and the regional distribution of cells positive (+) for this specific marker of astrocyte activation. Histological sections of brain tissues obtained at necropsy from 5 HIV-D patients and 5 age-matched controls without history of neuropsychiatric illness were immunostained with per...

  6. Persistent dizziness and recurrent syncope due to HIV-associated Addison’s disease: Case report from a resource-limited setting

    Directory of Open Access Journals (Sweden)

    D Kibirige

    2012-09-01

    Full Text Available Addison’s disease or primary adrenal insufficiency is a well-recognised fatal endocrine condition among HIV-infected patients. HIV infection is associated with adrenal gland destruction and profound disruption of the hypothalamic-pituitary adrenal axis. We describe a case of HIV-associated Addison’s disease in a 58-year-old newly diagnosed HIV-seropositive male patient, highlighting its occurrence in this era of HIV/AIDS pandemic.

  7. Histopathology, serology and cultures in the diagnosis of cryptococcosis Histopatologia, sorologia e cultivo no diagnóstico da criptococose

    Directory of Open Access Journals (Sweden)

    Alexandra Flávia Gazzoni

    2009-10-01

    Full Text Available Cryptococcosis is one of the most common opportunistic fungal infections in patients with acquired immunodeficiency syndrome (AIDS. We report 13 cases of cryptococcal infection based on histopathology, serology and cultures. Epidemiological analysis, histochemical techniques of hematoxilin and eosin (HE and Grocot's silver (GMS, as well special histochemical techniques such as Mayer's mucicarmine (MM and Fontana-Masson (FM, cryptococcal antigen test (CrAg and isolation on fungal media: Sabouraud's (SAB, brain-heart infusion agar (BHI and canavanine-glycine-bromothymol blue (CGB agar were analyzed. Unsatisfactory staining results by MM stain associated to negative titers by CrAg test, which FM stain confirmed that capsule-deficient Cryptococcus infections were observed in four cases. Eight isolated cases were identified as follows: six cases were infection with Cryptococcus neoformans and two cases were Cryptococcus gattii.A criptococose é a mais comum infecção fúngica oportunística observada em pacientes com síndrome da imunodeficiência adquirida (AIDS. Relatamos 13 casos da infecção baseados no diagnóstico histopatológico, sorológico e cultivo. Foram analisadas: a epidemiologia, as técnicas histoquímicas básicas de hematoxilina-eosina (HE e coloração pela prata (GMS, bem como as técnicas histoquímicas especiais de mucicarmim de Mayer (MM e Fontana-Masson (FM, o teste do antígeno criptocóccico (CrAg e o isolamento em cultivos em ágar-Sabouraud (SAB, ágar infusão de cérebro-coração (BHI e meio com canavanina azul de bromotimol (CGB. Em quatro casos, resultados tintoriais insatisfatórios pela coloração de MM associados a títulos negativos pelo teste do CrAg, a coloração de FM confirmou a infecção pelo Cryptococcus deficiente de cápsula. Oito isolados foram identificados: seis casos apresentaram a infecção por Cryptococcus neoformans e dois casos apresentaram a infecção por Cryptococcus gattii.

  8. Excess soluble CD40L contributes to blood brain barrier permeability in vivo: implications for HIV-associated neurocognitive disorders.

    Directory of Open Access Journals (Sweden)

    Donna C Davidson

    Full Text Available Despite the use of anti-retroviral therapies, a majority of HIV-infected individuals still develop HIV-Associated Neurocognitive Disorders (HAND, indicating that host inflammatory mediators, in addition to viral proteins, may be contributing to these disorders. Consistently, we have previously shown that levels of the inflammatory mediator soluble CD40L (sCD40L are elevated in the circulation of HIV-infected, cognitively impaired individuals as compared to their infected, non-impaired counterparts. Recent studies from our group suggest a role for the CD40/CD40L dyad in blood brain barrier (BBB permeability and interestingly, sCD40L is thought to regulate BBB permeability in other inflammatory disorders of the CNS. Using complementary multiphoton microscopy and quantitative analyses in wild-type and CD40L deficient mice, we now reveal that the HIV transactivator of transcription (Tat can induce BBB permeability in a CD40L-dependent manner. This permeability of the BBB was found to be the result of aberrant platelet activation induced by Tat, since depletion of platelets prior to treatment reversed Tat-induced BBB permeability. Furthermore, Tat treatment led to an increase in granulocyte antigen 1 (Gr1 positive monocytes, indicating an expansion of the inflammatory subset of cells in these mice, which were found to adhere more readily to the brain microvasculature in Tat treated animals. Exploring the mechanisms by which the BBB becomes compromised during HIV infection has the potential to reveal novel therapeutic targets, thereby aiding in the development of adjunct therapies for the management of HAND, which are currently lacking.

  9. Excess soluble CD40L contributes to blood brain barrier permeability in vivo: implications for HIV-associated neurocognitive disorders.

    Science.gov (United States)

    Davidson, Donna C; Hirschman, Michael P; Sun, Anita; Singh, Meera V; Kasischke, Karl; Maggirwar, Sanjay B

    2012-01-01

    Despite the use of anti-retroviral therapies, a majority of HIV-infected individuals still develop HIV-Associated Neurocognitive Disorders (HAND), indicating that host inflammatory mediators, in addition to viral proteins, may be contributing to these disorders. Consistently, we have previously shown that levels of the inflammatory mediator soluble CD40L (sCD40L) are elevated in the circulation of HIV-infected, cognitively impaired individuals as compared to their infected, non-impaired counterparts. Recent studies from our group suggest a role for the CD40/CD40L dyad in blood brain barrier (BBB) permeability and interestingly, sCD40L is thought to regulate BBB permeability in other inflammatory disorders of the CNS. Using complementary multiphoton microscopy and quantitative analyses in wild-type and CD40L deficient mice, we now reveal that the HIV transactivator of transcription (Tat) can induce BBB permeability in a CD40L-dependent manner. This permeability of the BBB was found to be the result of aberrant platelet activation induced by Tat, since depletion of platelets prior to treatment reversed Tat-induced BBB permeability. Furthermore, Tat treatment led to an increase in granulocyte antigen 1 (Gr1) positive monocytes, indicating an expansion of the inflammatory subset of cells in these mice, which were found to adhere more readily to the brain microvasculature in Tat treated animals. Exploring the mechanisms by which the BBB becomes compromised during HIV infection has the potential to reveal novel therapeutic targets, thereby aiding in the development of adjunct therapies for the management of HAND, which are currently lacking.

  10. Identifying HIV associated neurocognitive disorder using large-scale Granger causality analysis on resting-state functional MRI

    Science.gov (United States)

    DSouza, Adora M.; Abidin, Anas Z.; Leistritz, Lutz; Wismüller, Axel

    2017-02-01

    We investigate the applicability of large-scale Granger Causality (lsGC) for extracting a measure of multivariate information flow between pairs of regional brain activities from resting-state functional MRI (fMRI) and test the effectiveness of these measures for predicting a disease state. Such pairwise multivariate measures of interaction provide high-dimensional representations of connectivity profiles for each subject and are used in a machine learning task to distinguish between healthy controls and individuals presenting with symptoms of HIV Associated Neurocognitive Disorder (HAND). Cognitive impairment in several domains can occur as a result of HIV infection of the central nervous system. The current paradigm for assessing such impairment is through neuropsychological testing. With fMRI data analysis, we aim at non-invasively capturing differences in brain connectivity patterns between healthy subjects and subjects presenting with symptoms of HAND. To classify the extracted interaction patterns among brain regions, we use a prototype-based learning algorithm called Generalized Matrix Learning Vector Quantization (GMLVQ). Our approach to characterize connectivity using lsGC followed by GMLVQ for subsequent classification yields good prediction results with an accuracy of 87% and an area under the ROC curve (AUC) of up to 0.90. We obtain a statistically significant improvement (p<0.01) over a conventional Granger causality approach (accuracy = 0.76, AUC = 0.74). High accuracy and AUC values using our multivariate method to connectivity analysis suggests that our approach is able to better capture changes in interaction patterns between different brain regions when compared to conventional Granger causality analysis known from the literature.

  11. Gender and HIV-associated pulmonary tuberculosis: presentation and outcome at one year after beginning antituberculosis treatment in Uganda

    Directory of Open Access Journals (Sweden)

    Ellner Jerrold J

    2002-09-01

    Full Text Available Abstract Background Tuberculosis is responsible for more female deaths around the earth than any other infectious disease. Reports have suggested that responses to tuberculosis may differ between men and women. We investigated gender related differences in the presentation and one year outcomes of HIV-infected adults with initial episodes of pulmonary tuberculosis in Uganda. Methods We enrolled and followed up a cohort of 105 male and 109 female HIV-infected adults on treatment for initial episodes of culture-confirmed pulmonary tuberculosis between March 1993 and March 1995. A favorable outcome was defined as being cured and alive at one year while an unfavorable outcome was not being cured or dead. Subjects were followed-up by serial medical examinations, complete blood counts, serum β2 microglobulin, CD4+ cell counts, sputum examinations, and chest x-rays. Results Male patients were older, had higher body mass indices, and lower serum β2 microglobulin levels than female patients at presentation. At one year, there was no difference between male and female patients in the likelihood of experiencing a favorable outcome (RR 1.02, 95% CI 0.89–1.17. This effect persisted after controlling for symptoms, serum β2 microglobulin, CD4+ cell count, and severity of disease on chest x-ray (OR 1.07, 95% CI 0.54–2.13 with a repeated measures model. Conclusions While differences existed between males and females with HIV-associated pulmonary tuberculosis at presentation, the outcomes at one year after the initiation of tuberculosis treatment were similar in Uganda. Women in areas with a high HIV and tuberculosis prevalence should be encouraged to present for screening at the first sign of tuberculosis symptoms.

  12. HIV-associated vasculopathy

    African Journals Online (AJOL)

    infected individuals was 33 million.3 Managing these patients has placed a huge ... for example, there may be compressive symptoms due to airway obstruction ... is usually reversed, indicative of advanced immunosuppression. However, the ...

  13. HIV Associated Sensory Neuropathy

    OpenAIRE

    G, Amruth; S, Praveen-kumar; B, Nataraju; BS, Nagaraja

    2014-01-01

    Background: In the era of highly active antiretroviral therapy, sensory neuropathies have increased in prevalence. We have documented the frequency and profile of the two most common forms of sensory neuropathies associated with Human Immunodeficiency Virus (HIV) infection and looked into clinicoelectrophysiological correlates to differentiate the two entities.

  14. HIV-Associated Neurocysticercosis.

    Science.gov (United States)

    Anand, Kuljeet Singh; Wadhwa, Ankur; Garg, Jyoti; Mahajan, Rakesh Kumar

    2015-01-01

    Few cases of HIV and neurocysticercosis co-infection have been reported till date. The symptomatic manifestation of cysticercosis may be further reduced by interactions between the 2 disease processes. In patients with HIV, the diagnosis of neurocysticercosis is challenging and management must be individualized depending on the stage and the coexistent opportunistic conditions. We present 2 such cases. First was a 35-year-old driver seropositive for HIV-1 presented with complex partial seizures and a CD4 count of 530 cells/mm(3). The second case was a 40-year-old businessman with a CD4 count of 350 cells/mm(3). Both of them had multiple parenchymal lesions, with 1 being a large cystic lesion. Relatively high CD4 count and a positive enzyme-linked immunosorbent assay increased the likelihood for diagnosis and treatment. Both of our patients received cysticidal therapy, and none of them deteriorated with treatment.

  15. HIV-Associated Tuberculosis

    Directory of Open Access Journals (Sweden)

    Kogieleum Naidoo

    2011-01-01

    Full Text Available The intersecting HIV and Tuberculosis epidemics in countries with a high disease burden of both infections pose many challenges and opportunities. For patients infected with HIV in high TB burden countries, the diagnosis of TB, ARV drug choices in treating HIV-TB coinfected patients, when to initiate ARV treatment in relation to TB treatment, managing immune reconstitution, minimising risk of getting infected with TB and/or managing recurrent TB, minimizing airborne transmission, and infection control are key issues. In addition, given the disproportionate burden of HIV in women in these settings, sexual reproductive health issues and particular high mortality rates associated with TB during pregnancy are important. The scaleup and resource allocation to access antiretroviral treatment in these high HIV and TB settings provide a unique opportunity to strengthen both services and impact positively in meeting Millennium Development Goal 6.

  16. Primary Cutaneous Cryptococcosis Treated with Debridement and Fluconazole Monotherapy in an Immunosuppressed Patient: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Jennifer Wang

    2015-01-01

    Full Text Available Cryptococcus neoformans is an opportunistic yeast present in the environment. Practitioners are familiar with the presentation and management of the most common manifestation of cryptococcal infection, meningoencephalitis, in patients with AIDS or other conditions of immunocompromise. There is less awareness, however, of uncommon presentations where experience rather than evidence guides therapy. We report a case of primary cutaneous cryptococcosis (PCC in a patient who had been immunosuppressed by chronic high-dose corticosteroid for the treatment of severe asthma. This case highlights the importance of early recognition of aggressive cellulitis that fails standard empiric antibiotic treatment in an immunocompromised patient. It also demonstrates successful treatment of PCC with a multispecialty approach including local debridement and fluconazole monotherapy.

  17. Pharmacological treatment of painful HIV-associated sensory neuropathy: a systematic review and meta-analysis of randomised controlled trials.

    Directory of Open Access Journals (Sweden)

    Tudor J C Phillips

    Full Text Available BACKGROUND: Significant pain from HIV-associated sensory neuropathy (HIV-SN affects ∼40% of HIV infected individuals treated with antiretroviral therapy (ART. The prevalence of HIV-SN has increased despite the more widespread use of ART. With the global HIV prevalence estimated at 33 million, and with infected individuals gaining increased access to ART, painful HIV-SN represents a large and expanding world health problem. There is an urgent need to develop effective pain management strategies for this condition. METHOD AND FINDINGS: OBJECTIVE: To evaluate the clinical effectiveness of analgesics in treating painful HIV-SN. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Cochrane central register of controlled trials, www.clinicaltrials.gov, www.controlled-trials.com and the reference lists of retrieved articles. SELECTION CRITERIA: Prospective, double-blinded, randomised controlled trials (RCTs investigating the pharmacological treatment of painful HIV-SN with sufficient quality assessed using a modified Jadad scoring method. REVIEW METHODS: Four authors assessed the eligibility of articles for inclusion. Agreement of inclusion was reached by consensus and arbitration. Two authors conducted data extraction and analysis. Dichotomous outcome measures (≥ 30% and ≥ 50% pain reduction were sought from RCTs reporting interventions with statistically significant efficacies greater than placebo. These data were used to calculate RR and NNT values. RESULTS: Of 44 studies identified, 19 were RCTs. Of these, 14 fulfilled the inclusion criteria. Interventions demonstrating greater efficacy than placebo were smoked cannabis NNT 3.38 95%CI(1.38 to 4.10, topical capsaicin 8%, and recombinant human nerve growth factor (rhNGF. No superiority over placebo was reported in RCTs that examined amitriptyline (100mg/day, gabapentin (2.4 g/day, pregabalin (1200 mg/day, prosaptide (16 mg/day, peptide-T (6 mg/day, acetyl-L-carnitine (1g

  18. The mitochondrial DNA T16189C polymorphism and HIV-associated cardiomyopathy: a genotype-phenotype association study

    Directory of Open Access Journals (Sweden)

    Poulton Joanna

    2009-04-01

    Full Text Available Abstract Background The mitochondrial DNA (mtDNA T16189C polymorphism, with a homopolymeric C-tract of 10–12 cytosines, is a putative genetic risk factor for idiopathic dilated cardiomyopathy in the African and British populations. We hypothesized that this variant may predispose to dilated cardiomyopathy in people who are infected with the human immunodeficiency virus (HIV. Methods A case-control study of 30 HIV-positive cases with dilated cardiomyopathy and 37 HIV-positive controls without dilated cardiomyopathy was conducted. The study was confined to persons of black African ancestry to minimize confounding of results by population admixture. HIV-positive patients with an echocardiographically confirmed diagnosis of dilated cardiomyopathy and HIV-positive controls with echocardiographically normal hearts were studied. Patients with secondary causes of cardiomyopathy (such as hypertension, diabetes, pregnancy, alcoholism, valvular heart disease, and opportunistic infection were excluded from the study. DNA samples were sequenced for the mtDNA T16189C polymorphism with a homopolymeric C-tract in the forward and reverse directions on an ABI3100 sequencer. Results The cases and controls were well matched for age (median 35 years versus 34 years, P = 0.93, gender (males 60% vs 53%, P = 0.54, and stage of HIV disease (mean CD4 T cell count 260.7/μL vs. 176/μL, P = 0.21. The mtDNA T16189C variant with a homopolymeric C-tract was detected at a frequency of 26.7% (8/30 in the HIV-associated cardiomyopathy cases and 13.5% (5/37 in the HIV-positive controls. There was no significant difference between cases and controls (Odds Ratio 2.33, 95% Confidence Interval 0.67–8.06, p = 0.11. Conclusion The mtDNA T16189C variant with a homopolymeric C-tract is not associated with dilated cardiomyopathy in black African people infected with HIV.

  19. Natural Products as Anti-HIV Agents and Role in HIV-Associated Neurocognitive Disorders (HAND): A Brief Overview.

    Science.gov (United States)

    Kurapati, Kesava Rao V; Atluri, Venkata S; Samikkannu, Thangavel; Garcia, Gabriella; Nair, Madhavan P N

    2015-01-01

    As the threat of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) persists to rise, effective drug treatments are required to treat the infected people. Even though combination antiretroviral therapy (cART) provides stable viral suppression, it is not devoid of undesirable side effects, especially in persons undergoing long-term treatment. The present therapy finds its limitations in the emergence of multidrug resistance and accordingly finding new drugs and novel targets is the need of the hour to treat the infected persons and further to attack HIV reservoirs in the body like brain, lymph nodes to achieve the ultimate goal of complete eradication of HIV and AIDS. Natural products such as plant-originated compounds and plant extracts have enormous potential to become drug leads with anti-HIV and neuroprotective activity. Accordingly, many research groups are exploring the biodiversity of the plant kingdom to find new and better anti-HIV drugs with novel mechanisms of action and for HIV-associated neurocognitive disorders (HAND). The basic challenge that still persists is to develop viral replication-targeted therapy using novel anti-HIV compounds with new mode of action, accepted toxicity and less resistance profile. Against this backdrop, the World Health Organization (WHO) suggested the need to evaluate ethno-medicines for the management of HIV/AIDS. Consequently, there is need to evaluate traditional medicine, particularly medicinal plants and other natural products that may yield effective and affordable therapeutic agents. Although there are a good number of reports on traditional uses of plants to treat various diseases, knowledge of herbal remedies used to manage HIV/AIDS and HAND are scanty, vague and not well documented. In this review, plant substances showing a promising action that is anti-HIV and HAND will be explored along with what they interact. Since some plant substances are also known to modulate several cellular

  20. Natural Products as Anti-HIV Agents and Role in HIV-Associated Neurocognitive Disorders (HAND: A Brief Overview

    Directory of Open Access Journals (Sweden)

    Kesava Rao Venkata Kurapati

    2016-01-01

    Full Text Available As the threat of Human Immunodeficiency Virus (HIV/Acquired Immunodeficiency Syndrome (AIDS persists to rise, effective drug treatments are required to treat the infected people. Even though combination antiretroviral therapy (cART provides stable viral suppression, it is not devoid of undesirable side effects, especially in persons undergoing long-term treatment. The present therapy finds its limitations in the emergence of multidrug resistance and accordingly finding new drugs and novel targets is the need of the hour to treat the infected persons and further to attack HIV reservoirs in the body like brain, lymph nodes to achieve the ultimate goal of complete eradication of HIV and AIDS. Natural products such as plant-originated compounds and plant extracts have enormous potential to become drug leads with anti-HIV and neuroprotective activity. Accordingly, many research groups are exploring the biodiversity of the plant kingdom to find new and better anti-HIV drugs with novel mechanisms of action and for HIV-associated neurocognitive disorders (HAND. The basic challenge that still persists is to develop viral replication-targeted therapy using novel anti-HIV compounds with new mode of action, accepted toxicity and less resistance profile. Against this backdrop, the World Health Organization (WHO suggested the need to evaluate ethno-medicines for the management of HIV/AIDS. Consequently, there is need to evaluate traditional medicine, particularly medicinal plants and other natural products that may yield effective and affordable therapeutic agents. Although there are a good number of reports on traditional uses of plants to treat various diseases, knowledge of herbal remedies used to manage HIV/AIDS and HAND are scanty, vague and not well documented. In this review, plant substances showing a promising action that is anti-HIV and HAND will be explored along with what they interact. Since some plant substances are also known to modulate

  1. Cryptococcosis in nervous system of dogs – report of three cases/ Criptococose no sistema nervoso de cães - relato de três casos

    Directory of Open Access Journals (Sweden)

    Alexandre Mendes Amude

    2005-06-01

    Full Text Available Cryptococcosis is a systemic mycosis caused by yeast-like organism Cryptococcus neoformans. The infection in dogs occurs commonly by inhalation of the airborne or yeast. The neurological signs in dogs are similar to other inflammatory and infectious diseases of the central nervous system. The aim of the present paper is to report three cases of cryptococcosis in the nervous system of dogs, and reinforce the importance of this disease in differential diagnosis of progressive or multifocal alterations in the nervous system whether linked or not to systemic alterations. The diagnosis can only be confirmed through fungal culture and/or the visualization of the agent after adequate staining of the cerebral spinal fluid, or antibody titer when it is available.A criptococose é uma micose sistêmica oportunista causada pela levedura Cryptococcus neoformans. A infecção em cães ocorre mais comumente pela inalação de leveduras ou esporos. As alterações neurológicas encontradas são muito semelhantes a outras doenças inflamatórias e infecciosas do sistema nervoso. O objetivo do presente trabalho é relatar três casos de criptococose no sistema nervoso de cães, ressaltando a importância desta doença no diagnóstico diferencial de alterações neurológicas progressivas ou multifocais associadas ou não a alterações sistêmicas. O diagnóstico só pode ser confirmado através de cultura fúngica e/ou visualização do agente após coloração adequada do líquor, ou sorologia, quando disponível.

  2. The enhancement of astrocytic-derived monocyte chemoattractant protein-1 induced by the interaction of opiate and HIV tat in HIV-associated dementia

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    HIV-associated dementia(HAD)is a public health problem and is particularly prevalent in drug abusers.The neuropathogenesis of human immunodeficiency virus(HIV)infection involves a complex cascade of inflammatory events,including monocyte/macrophage infiltration in the brain,glial immune activation and release of neurotoxic substances.In these events,astrocytic-derived monocyte chemoattractant protein-1(MCP-1)plays an important role,whose release is elevated by HIV transactivator of transcription(HIV tat)and...

  3. Interrupción exitosa de la profilaxis secundaria antifúngica en la criptococosis asociada al sida Successful discontinuation of antifungal secondary prophylaxis in AIDS-related cryptococcosis

    Directory of Open Access Journals (Sweden)

    R. Negroni

    2004-09-01

    Full Text Available Se presentan los datos clínicos de 22 pacientes con criptococosis asociada al VIH que interrumpieron la profilaxis antifúngica secundaria, después de haber recibido la terapéutica antirretroviral de gran actividad (TARGA. Fueron 14 varones y 8 mujeres con edades comprendidas entre los 15 y los 50 años (X: 34 años. Todos presentaron un síndrome infeccioso general grave y 19 tuvieron meningoencefalitis. En el momento del diagnóstico 59% de los enfermos tenía recuentos de células CD4+ The clinical and laboratory data of 22 patients with AIDS related cryptococcosis who were able to interrupt antifungal secondary prophylaxis afterHAART administration, are presented. They were 14 males and 8 females, between 15 and 50years old (X: 34 years old. All patients presented fever andsevere deterioration of their general health status, and 19 exhibited a meningeal syndrome. At the start of antifungal treatment, 59% of the cases presented < 50 CD4+ cells/µl, the median viral burden was 134,804 RNA copies/ml and the median titer ofserum cryptococcal antigen was 1/3,000. Amphotericin B by intravenous route, (0.7 mg/kg/day or fluconazole (600 to 800 mg/day were given as a treatment of the initial episode, up to CSF cultures negativization. Oral fluconazole (200 mg/day or intravenous amphotericin B, 50 mg twice a week, were given as a secondary prophylaxis. The secondary prophylaxis was interrupted when the patients had received HAART for an average lapse of 19 months (6 to 36 months and the medianCD4+ cells counts was 249/µl. The follow up after secondary prophylaxis discontinuation lasted for a median lapse of 22 months. These data seem to show that secondary prophylaxisis not necessary when the patient are clinically asymptomatic and the CD4+ cells counts are above 150/µl.

  4. Cryptococcosis (C. gattii)

    Science.gov (United States)

    ... Foodborne, Waterborne, and Environmental Diseases Mycotic Diseases Branch C. gattii Infection Recommend on Facebook Tweet Share Compartir Case Reporting C. gattii infection is reportable in some states. Healthcare ...

  5. Cryptococcosis (C. neoformans)

    Science.gov (United States)

    ... Foodborne, Waterborne, and Environmental Diseases Mycotic Diseases Branch C. neoformans Infection Recommend on Facebook Tweet Share Compartir ... throughout the world. People can become infected with C. neoformans after breathing in the microscopic fungus, although ...

  6. Antiretroviral medications disrupt microglial phagocytosis of β-amyloid and increase its production by neurons: Implications for HIV-associated neurocognitive disorders

    Directory of Open Access Journals (Sweden)

    Giunta Brian

    2011-06-01

    Full Text Available Abstract Up to 50% of long-term HIV infected patients, including those with systemically well-controlled infection, commonly experience memory problems and slowness, difficulties in concentration, planning, and multitasking. Deposition of Aβ plaques is also a common pathological feature of HIV infection. However, it is not clear whether this accumulation is due to AD-like processes, HIV-associated immunosuppression, Tat protein-induced Aβ elevations, and/or the effects of single highly active antiretroviral therapy (ART. Here we evaluated the effects of several ART medications (Zidovudine, Lamivudine, Indinavir, and Abacavir alone and in combination on: 1 Aβ1-40, 42 generation in murine N2a cells transfected with the human "Swedish" mutant form of APP; 2 microglial phagocytosis of FITC-Aβ1-42 peptides in cultured murine N9 microglia. We report for the first time that these antiretroviral compounds (10 μM generally increase Aβ generation (~50-200% in SweAPP N2a cells and markedly inhibit microglial phagocytosis of FITC-Aβ1-42 peptides in murine microglia. The most significant amyloidogenic effects were observed with combined ART (p in vitro studies, these findings raise the possibility that ART may play a casual role in the elevated Aβ found in the brains of those infected with HIV. Therefore these compounds may consequently contribute to cognitive decline observed in HIV associated neurocognitive disorders (HAND.

  7. Abrogation of IL-4 receptor-α-dependent alternatively activated macrophages is sufficient to confer resistance against pulmonary cryptococcosis despite an ongoing T(h)2 response.

    Science.gov (United States)

    Müller, Uwe; Stenzel, Werner; Piehler, Daniel; Grahnert, Andreas; Protschka, Martina; Köhler, Gabriele; Frey, Oliver; Held, Josephin; Richter, Tina; Eschke, Maria; Kamradt, Thomas; Brombacher, Frank; Alber, Gottfried

    2013-08-01

    In the murine model of pulmonary infection with Cryptococcus neoformans, IL-4 receptor α (IL-4Rα)-dependent polyfunctional T(h)2 cells induce disease progression associated with alternative activation of lung macrophages. To characterize the effector role of IL-4Rα-dependent alternatively activated macrophages (aaMph), we intra-nasally infected mice with genetically ablated IL-4Rα expression on macrophages (LysM(Cre)IL-4Rα(-/lox) mice) and IL-4Rα(-/lox) littermates. LysM(Cre)IL-4Rα(-/lox) mice were significantly more resistant to pulmonary cryptococcosis with higher survival rates and lower lung burden than non-deficient heterozygous littermates. Infected LysM(Cre)IL-4Rα(-/lox) mice had reduced but detectable numbers of aaMph expressing arginase-1, chitinase-like enzyme (YM1) and CD206. Similar pulmonary expression of inducible nitric oxide synthase was found in LysM(Cre)IL-4Rα(-/lox) and IL-4Rα(-/lox) control mice, but macrophages from LysM(Cre)IL-4Rα(-/lox) mice showed a higher potential to produce nitric oxide. In contrast to the differences in the macrophage phenotype, pulmonary T(h)2 responses were similar in infected LysM(Cre)IL-4Rα(-/lox) and IL-4Rα(-/lox) mice with each mouse strain harboring polyfunctional T(h)2 cells. Consistently, type 2 pulmonary allergic inflammation associated with eosinophil recruitment and epithelial mucus production was present in lungs of both LysM(Cre)IL-4Rα(-/lox) and IL-4Rα(-/lox) mice. Our results demonstrate that, despite residual IL-4Rα-independent alternative macrophage activation and ongoing T(h)2-dependent allergic inflammation, abrogation of IL-4Rα-dependent aaMph is sufficient to confer resistance in pulmonary cryptococcosis. This is even evident on a relatively resistant heterozygous IL-4Rα(+/-) background indicating a key contribution of macrophage IL-4Rα expression to susceptibility in allergic bronchopulmonary mycosis.

  8. Clinical efficacy of first- and second-line treatments for HIV-associated Pneumocystis jirovecii pneumonia: a tri-centre cohort study

    DEFF Research Database (Denmark)

    Helweg-Larsen, Jannik; Benfield, Thomas; Atzori, Chiara

    2009-01-01

    OBJECTIVES: First-line therapy for Pneumocystis jirovecii pneumonia (PCP) is trimethoprim/sulfamethoxazole. Few data exist to guide the choice of second-line therapy for patients failing or developing toxicity to first-line therapy. METHODS: A case note review of 1122 patients with 1188 episodes...... of HIV-associated PCP from three observational cohorts in Copenhagen, London and Milan, between 1989 and 2004, was conducted. RESULTS: Trimethoprim/sulfamethoxazole (962 PCP episodes, 81%) was the most frequently used first-line therapy, followed by intravenous pentamidine (87 episodes, 7%), clindamycin......-associated PCP, and was associated with more treatment changes. Clindamycin/primaquine appeared superior to pentamidine as second-line therapy for PCP in patients failing or developing toxicity with trimethoprim/sulfamethoxazole. In patients failing first-line treatment with non...

  9. Testing a Computerized Cognitive Training Protocol in Adults Aging With HIV-Associated Neurocognitive Disorders: Randomized Controlled Trial Rationale and Protocol.

    Science.gov (United States)

    Vance, David; Fazeli, Pariya; Shacka, John; Nicholson, William; McKie, Peggy; Raper, James; Azuero, Andres; Wadley, Virginia; Ball, Karlene

    2017-04-26

    HIV-associated neurocognitive disorders occur in nearly 50% of adults with HIV. Such disorders can interfere with everyday functioning such as driving and medication adherence. Therefore, cognitive interventions are needed to address such neurocognitive disorders as well as improve everyday functioning, especially as people age with HIV. This article reports and discusses the overall rationale and development of speed of processing training, a computerized Internet cognitive training program, to improve this specific neurocognitive ability as well as everyday functioning and quality of life in adults aging with HIV. Although this protocol has been shown to improve speed of processing, everyday functioning, and quality of life in healthy, community-dwelling older adults in the advanced cognitive training in vital elderly (ACTIVE) study, its efficacy in adults aging with HIV has not been established. Nevertheless, such a cognitive intervention is particularly germane as 52%-59% of adults with HIV experience HIV-associated neurocognitive disorders (HAND), and both the frequency and severity of such disorders may increase with advancing age. The description of this longitudinal randomized controlled trial covers the following: (1) rationale for speed of processing training in this clinical population, (2) overview of overall study design, (3) eligibility criteria and HAND, (4) intervention dosage, (5) assessment battery, and (6) examination of biomarkers. The project was funded in April 2016 and enrolment is on-going. The first results are expected to be submitted for publication in 2020. Similar novel cognitive intervention approaches are suggested as they may be of value to those with HAND and may utilize similar features of this current randomized controlled trial (RCT) protocol to examine their therapeutic efficacy. ClinicalTrials.gov NCT02758093; https://clinicaltrials.gov/ct2/show/NCT02758093 (Archived by Webcite at http://www.webcitation.org/6p8C5fBCX).

  10. Disseminated cutaneous cryptococcosis in a patient with AIDS Criptococose cutânea disseminada em paciente com SIDA. Relato de caso

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    Sandra Lopes Mattos e Dinato

    2006-12-01

    Full Text Available The authors study a patient carrying Aids, with exuberant dermatological manifestations of cryptococcosis. They stress the therapeutic effectiveness of short-term amphotericin B. The authors reviewed cases of cutaneous infection with Cryptococcus reported in the national and international literature, verifying that the frequency has increased with the AIDS epidemic. Also, they discuss about the differential diagnosis with some cases of dermatosis, particularly with the disseminated giant molluscum contagiosum. In relation to the therapy, they affirm that the choice of drug depends on the organ involved, as well as the immune state of the patient.Os autores estudam um paciente portador de SIDA, com manifestações dermatológicas exuberantes de criptococose. Destacam a eficácia terapêutica da anfotericina B, a curto prazo. Revisam os casos de criptococose cutânea relatados na literatura nacional e internacional, ressaltando o aumento de sua freqüência com a epidemia da SIDA. Também discutem o diagnóstico diferencial com várias dermatoses, particularmente com o molusco contagioso gigante disseminado. Em relação à terapêutica, afirmam que a escolha da droga depende do órgão comprometido, assim como do estado imunológico do paciente.

  11. Molecular characterisation of the causative agents of Cryptococcosis in patients of a tertiary healthcare facility in the state of Amazonas-Brazil.

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    Freire, Ana Karla Lima; dos Santos Bentes, Amaury; de Lima Sampaio, Ivanete; Matsuura, Ani Beatriz Jackisch; Ogusku, Maurício Morishi; Salem, Julia Ignez; Wanke, Bodo; de Souza, João Vicente Braga

    2012-05-01

    As there are four major molecular types of Cryptococcus neoformans (VNI, VNII, VNIII and VNIV) and four molecular types of Cryptococcus gattii (VGI, VGII, VGIII and VGIV), it is important to identify the specific groups causing cryptococcosis in different geographical regions. Here, we investigated the molecular types of 57 cryptococcal isolates from patients in a tertiary care hospital in the state of Amazonas, Brazil, between 2006 and 2010. The isolates were characterised by PCR fingerprinting using the M13 minisatellite and confirmed by URA5-RFLP analysis, and the presence of specific genes from the mating type locus (MATα and MATa) of these species was analysed by PCR. Most of the patients were male (66.7%), between 16 and 30 years of age (51.7%), and HIV-positive (75.0%). Most isolates were collected from cerebrospinal fluid samples (71.7%). Most of the C. neoformans isolates (n=40) were characterised as members of the VNI molecular group (n=39), a unique isolate was characterised as VNII whereas all isolates of C. gattii (n=17) were members of the VGII molecular group. With regard to mating types, 55 isolates were type 'α', and only two were type 'a'. This study revealed the prevalence of the VNI molecular group and provides the first reported observation of the VNII molecular group in the northern region of Brazil. © 2012 Blackwell Verlag GmbH.

  12. “My body's a 50 year-old but my brain is definitely an 85 year-old”: exploring the experiences of men ageing with HIV-associated neurocognitive challenges

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    Lisa Hopcroft

    2013-07-01

    Full Text Available Introduction: Research investigating HIV, neurocognition and ageing is well developed using neuropsychometric or other quantitative approaches; however, little is known about individuals’ subjective experiences. The purpose of this article is to explore the experiences of men aged 50 and older who self-identify as having HIV-associated neurocognitive challenges. In particular, this study uses the Episodic Disability Framework (EDF to explore participants’ perceptions regarding: 1 symptoms/impairments, difficulties with day-to-day activities, challenges with social inclusion and uncertainty; 2 ageing as related to their HIV-associated neurocognitive challenges, and 3 the episodic nature of their HIV-associated neurocognitive challenges. Methods: This qualitative, interpretive study involved in-depth, semi-structured interviews with 12 men aged 50 years and older who self-identified as having HIV-associated neurocognitive challenges. Participants were recruited from a neurobehavioural research unit (NBRU at a large hospital in Toronto, Canada. Data were analyzed thematically and with reference to the EDF. Results: Participants’ experiences reflected all concepts within the EDF to some extent. Difficulties with daily activities were diverse but were addressed using similar living strategies. Participants described challenges with work and social relationships resulting from neurocognitive challenges. Participants downplayed the significance of uncertainty in their lives, which they attributed to effective living strategies. Most men reported confusion regarding the link between their neurocognitive challenges and ageing. Others discussed ageing as an asset that helped with coping. Conclusions: This is the first study to use a disability framework to examine the subjective experiences of men ageing with HIV-associated neurocognitive challenges. Findings reframe the episodic disability experienced by these individuals as being predictably

  13. Generalized systemic cryptococcosis in a dog after immunosuppressive corticotherapy Criptococose sistêmica generalizada em cão após corticoterapia imunossupressora

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    C.S. Honsho

    2003-04-01

    Full Text Available A male Boxer dog aged 2 years and 11 months was referred to the veterinary hospital with a history of a gastrointestinal disorder of two months duration, with apathy, hyporexia, progressive weight loss and visual deficit. Ataxia and vocalization were observed during hospitalization. The animal had been treated previously with antibiotics and immunosuppressive doses of corticoids to control chronic inflammatory bowel disease. The dog died five days later. Gross and microscopic observations indicated systemic cryptococcosis. The alimentary tract, eyes, brain, kidneys, pancreas and lymph nodes were involved.Um cão da raça Boxer, macho, com 2 anos e 11 meses de idade foi encaminhado ao hospital veterinário com histórico de distúrbio gastroentérico de dois meses de duração, apatia, hiporexia, emagrecimento progressivo e deficiência visual. Ataxia e vocalização foram observadas posteriormente. O animal estava sendo tratado em outra clínica veterinária com antibióticos e doses imunossupressoras de corticóides, direcionados ao controle de provável enterite alimentar. A morte ocorreu após cinco dias. As observações macro e microscópica revelaram tratar-se de criptococose sistêmica, atingindo trato digestório, olhos, SNC, rins, pâncreas e linfonodos. O presente relato enfatiza a infecção fúngica criptocócica quanto aos seus aspectos grastrointestinais iniciais a serem considerados no diagnóstico clínico, ressaltando a imunossupressão induzida pela corticoterapia.

  14. HIV associated neurocognitive disorders (HAND in Malawian adults and effect on adherence to combination anti-retroviral therapy: a cross sectional study.

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    Christine M Kelly

    Full Text Available Little is known about the prevalence and burden of HIV associated neurocognitive disorder (HAND among patients on combination antiretroviral therapy (cART in sub-Saharan Africa. We estimated the prevalence of HAND in adult Malawians on cART and investigated the relationship between HAND and adherence to cART.HIV positive adults in Blantyre, Malawi underwent a full medical history, neurocognitive test battery, depression score, Karnofsky Performance Score and adherence assessment. The Frascati criteria were used to diagnose HAND and the Global Deficit Score (GDS was also assessed. Blood was drawn for CD4 count and plasma nevirapine and efavirenz concentrations. HIV negative adults were recruited from the HIV testing clinic to provide normative scores for the neurocognitive battery.One hundred and six HIV positive patients, with median (range age 39 (18-71 years, 73% female and median (range CD4 count 323.5 (68-1039 cells/µl were studied. Symptomatic neurocognitive impairment was present in 15% (12% mild neurocognitive disorder [MND], 3% HIV associated dementia [HAD]. A further 55% fulfilled Frascati criteria for asymptomatic neurocognitive impairment (ANI; however factors other than neurocognitive impairment could have confounded this estimate. Neither the symptomatic (MND and HAD nor asymptomatic (ANI forms of HAND were associated with subtherapeutic nevirapine/efavirenz concentrations, adjusted odds ratio 1.44 (CI. 0.234, 8.798; p = 0.696 and aOR 0.577 (CI. 0.09, 3.605; p = 0.556 respectively. All patients with subtherapeutic nevirapine/efavirenz levels had a GDS of less than 0.6, consistent with normal neurocognition.Fifteen percent of adult Malawians on cART had a diagnosis of MND or HAD. Subtherapeutic drug concentrations were found exclusively in patients with normal neurocognitive function suggesting HAND did not affect cART adherence. Further study of HAND requires more robust locally derived normative neurocognitive values and

  15. Síndrome demencial asociado a VIH/sida: A propósito de un paciente HIV Associated Dementia, a case report

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    Ricardo Boza-Cordero

    2011-12-01

    Full Text Available El VIH afecta el sistema nervioso produciendo variadas manifestaciones clínicas, siendo las alteraciones neuropsicológicas las más frecuentes. Se pueden encontrar cambios histopatológicos por VIH hasta en el 25% de necropsias. Actualmente se considera que la demencia asociada al VIH (DA-VIH es la causa más frecuente de demencia en personas menores de 40 años. El diagnóstico de esta entidad es importante porque se considera a la DA-VIH como enfermedad definitoria de sida, su presencia influiría definitivamente en la adherencia al tratamiento y se ha observado que su evolución podría ser revertida con el uso de medicamentos antirretrovirales. El estudio y seguimiento de estos pacientes deberá basarse en las manifestaciones clínicas, análisis neuropsicológicos y el uso de neuroimágenes. Se presenta el caso de un paciente masculino de 39 años que inició con pérdida progresiva de la memoria y temblor fino distal al que se le diagnosticó síndrome demencial asociado a VIH estudiado por medios clínicos, neuropsicológicos y por neuroimágenes. Se hace énfasis en la fisiopatología de este trastorno, la importancia de su diagnóstico adecuado así como del uso del tratamiento antirretroviral.HIV affects the nervous system producing different clinical symptoms, being the neuropsychological impairment one of the most common. Histopathological changes due to HIV are found in up to 25% of autopsies. Currently it is considered that HIV-associated dementia is the most common cause of dementia in people less than 40 years. The diagnosis of this entity is important because it considers the HIV-associated demntia defining illness of AIDS, also its presence definitely influence adherence to treatment and has been observed that the trend could be reversed with the use of antiretroviral drugs. The study and monitoring of these patients should be based on the clinical observation, neuropsychological analysis and the use of neuroimaging. We

  16. In Vitro and In Vivo Effects of IGF-I on Adiposity in HIV-associated Metabolic Disease: A Pilot Study

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    Kim, Roy J.; Vaghani, Sumit; Zifchak, Larisa M.; Quinn, Joseph H.; He, Weimian; Tebas, Pablo; Frank, Ian

    2013-01-01

    Background and Aims We tested the effects of recombinant insulin-like growth factor-I (IGF-I) in an adipocyte model of HIV lipodystrophy and in an open label study on body composition and metabolism in patients with HIV lipodystrophy. Methods The effects of IGF-I on ritonavir-induced adipocyte cell death were studied in vitro. We assessed lipid accumulation, IGF signaling, apoptosis, and gene expression. We conducted a 24-week open label trial of recombinant IGF-I in ten adults with HIV associated lipoatrophy. Laboratory assessments included glucose, insulin, lipids, and IGF-I. At weeks 0 and 24, body composition studies were performed including skinfold measurement, dual-energy x-ray absorptiometry, and computed tomography of the abdomen and thigh. Results In vitro, ritonavir increased delipidation and apoptosis of adipocytes, whereas co-treatment with IGF-I attenuated the effect. In the clinical study, subcutaneous adipose tissue did not increase in patients after treatment with IGF-I; however, there was a decrease in the proportion of abdominal fat (39.8 ± 7% vs. 34.6 ± 7%, p = 0.007). IGF-I levels increased with treatment (143 ± 28 µg/L at week 0 vs. 453 ± 212 µg/L at week 24, p = 0.002), whereas IGFBP-3 levels declined (3.554 ± 1.146 mg/L vs. 3.235 ± 1.151 mg/L, p = 0.02). Insulin at week 12 week decreased significantly (90.1 ± 39.8 pmol/L vs. 33.2 ± 19.6 pmol/L, p = 0.002). There was a nonsignificant decrease in visceral adipose tissue (155.2 ± 68 cm2 at week 0 vs. 140.6 ± 70 cm2 at week 24, p = 0.08). Conclusions Use of recombinant IGF-I may lower fasting insulin and abdominal fat in patients with lipoatrophy associated with HIV infection. Further evaluation of this agent for treatment of HIV-associated lipodystrophy may be warranted. PMID:23867790

  17. A Prospective, Multicentre, Open-Label Single-Arm Exploratory Study to Evaluate Efficacy and Safety of Saroglitazar on Hypertriglyceridemia in HIV Associated Lipodystrophy.

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    Alka Deshpande

    Full Text Available This study was designed to explore the efficacy and safety of saroglitazar 4 mg on hypertriglyceridemia in patients with HIV associated lipodystrophy.During this 12-week prospective, multi-centric, open-label, single arm exploratory study, 50 patients were enrolled to receive saroglitazar 4 mg orally once daily in the morning before breakfast. The primary efficacy endpoint was the percent change in triglyceride (TG levels from baseline to Week 6 and Week 12. The secondary efficacy endpoints were assessment of low-density-lipoprotein (LDL, very-low-density-lipoprotein (VLDL, high-density-lipoprotein (HDL, non-HDL cholesterol, total cholesterol, apo-lipoprotein (Apo A1, Apo B, and C-peptide and fasting insulin for HOMA beta and HOMA IR. Safety assessment was performed during the study.Saroglitazar 4 mg significantly decreased the serum TG levels from baseline at Week 6 (percent change: -40.98; 95% CI: -50.82, -31.15 and Week 12 (percent change -45.11; 95% CI: -52.37, -37.86. Reduction in VLDL cholesterol (percent change: -46.33; 95% CI: -52.89, -39.76 and total cholesterol (percent change: 7.37; 95% CI: 1.96, 12.78 was observed at week 12 from baseline. Saroglitazar increased HDL cholesterol (percent change: 34.56, 95% CI: 22.22, 46.90, Apo A1 (percent change: 33.16; 95% CI: 18.69, 47.63 and Apo B (percent change: 10.55, 95% CI: 2.86, 18.25 levels at week 12 from baseline. Saroglitazar treatment led to increase in the C-peptide (percent change: 59.42, 95% CI: 48.78, 70.06, fasting insulin levels (percent change: 47.10; 95% CI: 38.63, 55.57, HOMA of beta cell function for C-peptide (percent change: 71.67; 95% CI: 39.09, 104.26 and HOMA of insulin resistance for C-peptide (percent change: 58.29, 95% CI: 46.74, 69.83 at week 12 from baseline. Saroglitazar treatment was safe and well tolerated in this study.Overall, the observed changes in lipid profile after 12 weeks of saroglitazar treatment were in the direction of improvement in patients with HIV

  18. [Acute psychosis as a side effect of efavirenz therapy with metabolic anomalies: an important differential diagnosis of HIV-associated psychoses].

    Science.gov (United States)

    Hinsch, M C; Reichelt, D; Husstedt, I W

    2014-10-01

    Among patients with human immunodeficiency virus (HIV) infections psychiatric disease poses a particular challenge for caregivers. Neuropsychiatric side effects of efavirenz have been described in up to 40% of patients showing dizziness, insomnia, unusual dreams, mood instability, personality alterations and thought disorders. In immigrants from Africa and South America these side effects may be related to elevated plasma concentrations of efavirenz due to polymorphisms of cytochrome P450 isozymes (especially G516T). Alleles for these polymorphisms are more frequent in African and South American patients. We report a case of a 52-year-old patient from Guinea who was referred to the department of neurology under the diagnosis of HIV-associated neurocognitive disorder (HAND). Since the start of combined antiretroviral therapy (cART) including efavirenz the patient had suffered severe personality alterations, acoustic and visual hallucinations and delusions which led to discrimination and reduced quality of life. Diagnostic procedures including magnetic resonance imaging (MRT) and spinal fluid analysis resulted in normal values and did not explain the disease. After switching to nevirapin instead of efavirenz the psychotic symptoms disappeared within 5 days.

  19. Health-Related Everyday Functioning in the Internet Age: HIV-Associated Neurocognitive Disorders Disrupt Online Pharmacy and Health Chart Navigation Skills

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    Woods, Steven Paul; Iudicello, Jennifer E.; Morgan, Erin E.; Cameron, Marizela V.; Doyle, Katie L.; Smith, Tyler V.; Cushman, Clint

    2016-01-01

    This study evaluated the effects of HIV-associated Neurocognitive Disorders (HAND) on 2 Internet-based tests of healthcare management. Study participants included 46 individuals with HIV infection, 19 of whom were diagnosed with HAND, and 21 seronegatives. Participants were administered Internet-based tests of online pharmacy and health records navigation skills in which they used mock credentials to log in to an experimenter-controlled website and independently perform a series of typical online health-related behaviors (e.g., refill a prescription, read and interpret an electronic chart note). HAND was associated with significantly lower accuracy on both the online pharmacy and health records navigation tasks. Among the HIV+ participants, poorer performance on the online healthcare navigation tasks was associated with fewer years of education, higher plasma viral load, less frequent Internet use, and lower health literacy. Findings indicate that individuals with HAND may have marked difficulties navigating the Internet to complete important health-related behaviors. PMID:26743327

  20. Diagnostic utility of the HIV dementia scale and the international HIV dementia scale in screening for HIV-associated neurocognitive disorders among Spanish-speaking adults.

    Science.gov (United States)

    López, Enrique; Steiner, Alexander J; Smith, Kimberly; Thaler, Nicholas S; Hardy, David J; Levine, Andrew J; Al-Kharafi, Hussah T; Yamakawa, Cristina; Goodkin, Karl

    2016-08-15

    Given that neurocognitive impairment is a frequent complication of HIV-1 infection in Spanish-speaking adults, the limited number of studies assessing HIV-associated neurocognitive disorders (HAND) in this population raises serious clinical concern. In addition to being appropriately translated, instruments need to be modified, normed, and validated accordingly. The purpose of the current study was to examine the diagnostic utility of the HIV Dementia Scale (HDS) and International HIV Dementia Scale (IHDS) to screen for HAND in Spanish-speaking adults living with HIV infection. Participants were classified as either HAND (N = 47) or No-HAND (N = 53) after completing a comprehensive neuropsychological evaluation. Receiver operating characteristic analyses found the HDS (AUC = .706) was more sensitive to detecting HAND than the IHDS (AUC = .600). Optimal cutoff scores were 9.5 for the HDS (PPV = 65.2%, NPV = 71.4%) and 9.0 for the IHDS (PPV = 59.4%, NPV = 59.1%). Canonical Correlation Analysis found the HDS converged with attention and executive functioning. Findings suggest that while the IHDS may not be an appropriate screening instrument with this population, the HDS retains sufficient statistical validity and clinical utility to screen for HAND in Spanish-speaking adults as a time-efficient and cost-effective measure in clinical settings with limited resources.

  1. Trends in Kaposi's sarcoma-associated Herpesvirus antibodies prior to the development of HIV-associated Kaposi's sarcoma: A nested case-control study

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    Wakeham, Katie; Johnston, W Thomas; Nalwoga, Angela; Webb, Emily L; Mayanja, Billy N; Miley, Wendell; Elliott, Alison M; Whitby, Denise; Newton, Robert

    2015-01-01

    HIV-associated Kaposi's sarcoma (KS) is a public health challenge in sub-Saharan Africa since both the causative agent, Kaposi's sarcoma associated-herpesvirus (KSHV), and the major risk factor, HIV, are prevalent. In a nested case-control study within a long-standing clinical cohort in rural Uganda, we used stored sera to examine the evolution of antibody titres against the KSHV antigens K8.1 and latency-associated nuclear antigen (LANA) among 30 HIV-infected subjects who subsequently developed HIV-related KS (cases) and among 108 matched HIV/KSHV coinfected controls who did not develop KS. Throughout the 6 years prior to diagnosis, antibody titres to K8.1 and LANA were significantly higher among cases than controls (p < 0.0001), and titres increased prior to diagnosis in the cases. K8.1 titres differed more between KS cases and controls, compared to LANA titres. These differences in titre between cases and controls suggest a role for lytic viral replication in the pathogenesis of HIV-related KS in this setting. PMID:25395177

  2. Investigating changes in resting-state connectivity from functional MRI data in patients with HIV associated neurocognitive disorder using MCA and machine learning

    Science.gov (United States)

    DSouza, Adora M.; Abidin, Anas Z.; Wismüller, Axel

    2017-03-01

    Infection of the brain by the Human Immunodeficiency Virus (HIV) causes irreversible damage to the synaptic connections resulting in cognitive impairment. Patients with HIV infection, showing signs of impairment in multiple cognitive domains, as assessed by neuropsychological testing, are said to exhibit symptoms of HIV Associated Neurocognitive Disorder (HAND). In this study, we use resting-state functional MRI (fMRI) data to distinguish between healthy subjects and subjects with symptoms of HAND. To this end, we first establish a measure of interaction between pairs of regional time-series by quantifying their non-linear functional connectivity using Mutual Connectivity Analysis (MCA). Subsequently, we use a classifier to distinguish patterns of interaction between healthy and diseased individuals. Our results, quantified as the mean Area under the ROC curve (AUC) over 75 iterations, indicate that, using fMRI data, we can discriminate between the two cohorts well (AUC > 0.8). Specifically, we find that MCA (mean AUC = 0.89) based connectivity features perform significantly better (p < 0.05) when compared to cross-correlation (mean AUC = 0.82) at the classification task. A higher AUC using our approach suggests that such a nonlinear approach is better able to capture connectivity changes between brain regions and has potential for the development of novel neuro-imaging biomarkers.

  3. 5-fluorocitosina e anfotericina-B no tratamento da criptococose do sistema nervoso central Amphotericin-B and 5-fluorocytosine in the treatment of cryptococcosis of the central nervous system: report of two cases

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    J. P. S. Nobrega

    1975-09-01

    Full Text Available Registro de dois casos de criptococose do sistema nervoso central, em um deles associada a candidíase. Em ambos foram utilizados no tratamento anfotericina-B e 5-fluorocitosina. Em função dos resultados obtidos são feitas considerações quanto à utilidade de cada uma das drogas no tratamento da criptococose, bem como quanto ao uso associado de ambas.Two cases of cryptococcosis of the central nervous system are reported. The treatment was based on the association of amphotericin-B with 5-fluorocytosine. Details on the therapeutic proprieties of these drugs are discussed considering the results obtained. Amphotericin-B was administered intravenously and intrathecally in the two cases. The total amount of amphotericin administered intravenously in the first case was 5.375 mgm, and the oral doses of 5-fluorocytosine were not superior to 100 mgm/kg/of body weight. This patient died 130 days after the first symptoms of the disease. The second patient had been submitted previously to kidney transplantation after bilateral nephrectomy, and inmunossupressive drugs were administered to him since then. Candidiasis and cryptococcosis of the central nervous system developped two years later. 5-fluorocytosine was administered orally (200 mgm/kg of body weight and amphotericin-B. The total amount of this drug administered intravenously was 2.00 mgm. There was complete clinical and laboratory remission of the mycoses in this case.

  4. Analysis of One Case of AIDS with Cryptococcal Meningitis and Pulmonary Cryptococcosis%表现为隐球菌性脑膜炎、肺隐球菌病的艾滋病1例分析

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    周其达; 华键; 韩杨; 查蕾蕾

    2015-01-01

    Objective: To analyze the clinical characteristics of AIDS with cryptococcal meningitis and pulmonary cryptococcosis.Methods:The clinical data,including manifestations,diagnosis and treatment,of an AIDS case with cryptococcal meningitis and pulmonary cryptococcosis were investigated retrospectively.Results:As condition deteriorated rapidly,the patient died.Conclusion:AIDS with cryptococcal infection manifests of meningitis and pulmonary damages Mainly and combined with high mortality.%目的:分析艾滋病合并隐球菌感染的临床特点.方法:回顾分析1例以隐球菌性脑膜炎、肺影球菌病为首发表现的艾滋病病例的临床表现、诊断及治疗.结果:患者因病情迅速恶化,治疗无效死亡.结论:艾滋病合并隐球菌感染以脑膜炎及肺部损害为主,病死率高.

  5. Diagnostic accuracy of a low-cost, urine antigen, point-of-care screening assay for HIV-associated pulmonary tuberculosis before antiretroviral therapy: a descriptive study.

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    Lawn, Stephen D; Kerkhoff, Andrew D; Vogt, Monica; Wood, Robin

    2012-03-01

    The diagnostic accuracy of sputum smear microscopy and routine chest radiology for HIV-associated tuberculosis is poor, and culture-based diagnosis is slow, expensive, and is unavailable in most resource-limited settings. We assessed the diagnostic accuracy of a urine antigen test Determine TB-LAM Ag (Determine TB-LAM; Alere, Waltham, MA, USA) for screening for HIV-associated pulmonary tuberculosis before antiretroviral therapy (ART). In this descriptive study, consecutive adults referred to a community-based ART clinic in Gugulethu township, South Africa, were all screened for tuberculosis by obtaining sputum samples for fluorescence microscopy, automated liquid culture (gold-standard test), and Xpert MTB/RIF assays (Cepheid, Sunnyvale, CA, USA) and urine samples for the Clearview TB-ELISA (TB-ELISA; Alere, Waltham, MA, USA) and Determine TB-LAM test. Patients with Mycobacterium tuberculosis cultured from one or more sputum samples were defined as cases of tuberculosis. The diagnostic accuracy of Determine TB-LAM used alone or combined with sputum smear microscopy was compared with that of sputum culture and the Xpert MTB/RIF assay for all patients and subgroups of patients stratified by CD4 cell count. Patients were recruited between March 12, 2010, and April 20, 2011. Of 602 patients enrolled, 542 were able to provide one or more sputum samples, and 94 had culture-positive tuberculosis (prevalence 17·4%, 95% CI 14·2-20·8). Complete results from all tests were available for 516 patients (median CD4 count, 169·5 cells per μL; IQR 100-233), including 85 culture-positive tuberculosis, 24 of whom (28·2%, 95% CI 19·0-39·0) had sputum smear-positive disease. Determine TB-LAM test strips provided results within 30 min. Agreement was very high between two independent readers of the test strips (κ=0·97) and between the test strips and TB-ELISA (κ=0·84). Determine TB-LAM had highest sensitivity at low CD4 cell counts: 66·7% (95% CI 41·0-86·7) at test

  6. Current status of HIV/AIDS in the ART era.

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    Yoshimura, Kazuhisa

    2017-01-01

    Human immunodeficiency virus (HIV) spread to humans from chimpanzees (HIV-1 groups M and N), gorillas (HIV-1 groups P and O), and sooty mangabeys (HIV-2). HIV is spread mainly through blood or body fluids. Subjects can become infected with HIV by sexual contact, needle sharing, blood transfusions, or maternal transmissions as a blood-borne virus or via breast-milk. The incubation period of HIV-1 from infection to the development of AIDS ranges from 8 to 11 years. In the past 3 decades, HIV has caused a great burden to global wealth and health. According to the WHO global health survey, 36.7 million people were infected with HIV, causing 1.1 million deaths in 2015. Since the discovery of HIV-1, many anti-retroviral drugs have been developed. Following the discovery and wide-spread use of anti-retroviral therapy (ART) the life expectancy of HIV infected individuals has substantially increased. By 2015, all major guidelines recommended treating all HIV-infected adults regardless of their CD4 count. Despite effective ART with virological suppression, HIV-associated neurocognitive disorders (HAND), cardiovascular diseases (CVD), metabolic syndrome (MS), bone abnormalities and non-HIV-associated malignancies remain a major complication associated with HIV infection. In this review article, I would like to describe recent ART status and problems in the ART-era.

  7. Acute kidney injury and inflammatory immune reconstitution syndrome in mixed genotype (A/E) hepatitis B virus co-infection in HIV-associated lymphoma.

    Science.gov (United States)

    Tajima, Katsushi; Kohno, Kei; Shiono, Yosuke; Suzuki, Ikuko; Kato, Yuichi; Hiroshima, Yuki; Yamamoto, Masakazu; Ohtake, Hiroya; Iwaba, Akiko; Yamakawa, Mitsunori; Kato, Takeo

    2013-01-01

    We report a first case of HIV-associated lymphoma (HAL) presenting with acute kidney injury (AKI) and inflammatory immune reconstitution syndrome (IRIS). A 39-year-old male, treated with nonsteroidal anti-inflammatory drugs (NSAIDs) for one month prior to admission, developed AKI, left testicular tumor, and recurrent swelling of the right parotid gland. A resected testicular tumor exhibited features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. Renal biopsy showed hydro-degeneration of renal tubules, interstitial inflammatory cells, and a small number of lymphoma cells in the sub-capsule, compatible with acute interstitial nephritis. His renal dysfunction rapidly recovered following chemotherapy and combination antiretroviral therapy (cART). He developed pneumonia concomitantly with a decrease in HIV-RNA level and an increase in CD4+ cells after the first cycle of chemotherapy, which spontaneously resolved after the second cycle of chemotherapy without additional anti-infection drugs; thus, his pneumonia fulfilled the diagnostic criteria for IRIS. We suggest that IRIS may frequently develop during chemotherapy for HAL, but may be overlooked. He was coinfected with hepatitis B virus (HBV), which genotypes known as is associated with liver-related mortality and response to antiviral therapy; recently, an intimate interplay between HIV and HBV in the onset of lymphoma has been reported. Therefore, we addressed the HBV genotype in the patient. The analysis revealed that he exhibited a mixed genotype (A/E) not native to Japan and primarily found in Europe and North America or West Africa. These findings suggest that universal vaccination for juveniles against HBV is warranted in Japan.

  8. Efavirenz Promotes β-Secretase Expression and Increased Aβ1-40,42 via Oxidative Stress and Reduced Microglial Phagocytosis: Implications for HIV Associated Neurocognitive Disorders (HAND)

    Science.gov (United States)

    Brown, Lecia A. M.; Jin, Jingji; Ferrell, Darren; Sadic, Edin; Obregon, Demian; Smith, Adam J.; Tan, Jun; Giunta, Brian

    2014-01-01

    Efavirenz (EFV) is among the most commonly used antiretroviral drugs globally, causes neurological symptoms that interfere with adherence and reduce tolerability, and may have central nervous system (CNS) effects that contribute in part to HIV associated neurocognitive disorders (HAND) in patients on combination antiretroviral therapy (cART). Thus we evaluated a commonly used EFV containing regimen: EFV/zidovudine (AZT)/lamivudine (3TC) in murine N2a cells transfected with the human “Swedish” mutant form of amyloid precursor protein (SweAPP N2a cells) to assess for promotion of amyloid-beta (Aβ) production. Treatment with EFV or the EFV containing regimen generated significantly increased soluble amyloid beta (Aβ), and promoted increased β-secretase-1 (BACE-1) expression while 3TC, AZT, or, vehicle control did not significantly alter these endpoints. Further, EFV or the EFV containing regimen promoted significantly more mitochondrial stress in SweAPP N2a cells as compared to 3TC, AZT, or vehicle control. We next tested the EFV containing regimen in Aβ - producing Tg2576 mice combined or singly using clinically relevant doses. EFV or the EFV containing regimen promoted significantly more BACE-1 expression and soluble Aβ generation while 3TC, AZT, or vehicle control did not. Finally, microglial Aβ phagocytosis was significantly reduced by EFV or the EFV containing regimen but not by AZT, 3TC, or vehicle control alone. These data suggest the majority of Aβ promoting effects of this cART regimen are dependent upon EFV as it promotes both increased production, and decreased clearance of Aβ peptide. PMID:24759994

  9. Absolute leukocyte telomere length in HIV-infected and uninfected individuals: evidence of accelerated cell senescence in HIV-associated chronic obstructive pulmonary disease.

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    Joseph C Y Liu

    Full Text Available Combination antiretroviral therapy (cART has extended the longevity of human immunodeficiency virus (HIV-infected individuals. However, this has resulted in greater awareness of age-associated diseases such as chronic obstructive pulmonary disease (COPD. Accelerated cellular senescence may be responsible, but its magnitude as measured by leukocyte telomere length is unknown and its relationship to HIV-associated COPD has not yet been established. We measured absolute telomere length (aTL in peripheral leukocytes from 231 HIV-infected adults. Comparisons were made to 691 HIV-uninfected individuals from a population-based sample. Subject quartiles of aTL were assessed for relationships with measures of HIV disease severity, airflow obstruction, and emphysema severity on computed tomographic (CT imaging. Multivariable regression models identified factors associated with shortened aTL. Compared to HIV-uninfected subjects, the mean aTL in HIV-infected patients was markedly shorter by 27 kbp/genome (p<0.001; however, the slopes of aTL vs. age were not different (p=0.469. Patients with longer known durations of HIV infection (p=0.019 and lower nadir CD4 cell counts (p=0.023 had shorter aTL. Shorter aTL were also associated with older age (p=0.026, smoking (p=0.005, reduced forced expiratory volume in one second (p=0.030, and worse CT emphysema severity score (p=0.049. HIV-infected subjects demonstrate advanced cellular aging, yet in a cART-treated cohort, the relationship between aTL and age appears no different from that of HIV-uninfected subjects.

  10. Human synaptic plasticity gene expression profile and dendritic spine density changes in HIV-infected human CNS cells: role in HIV-associated neurocognitive disorders (HAND.

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    Venkata Subba Rao Atluri

    Full Text Available HIV-associated neurocognitive disorders (HAND is characterized by development of cognitive, behavioral and motor abnormalities, and occur in approximately 50% of HIV infected individuals. Our current understanding of HAND emanates mainly from HIV-1 subtype B (clade B, which is prevalent in USA and Western countries. However very little information is available on neuropathogenesis of HIV-1 subtype C (clade C that exists in Sub-Saharan Africa and Asia. Therefore, studies to identify specific neuropathogenic mechanisms associated with HAND are worth pursuing to dissect the mechanisms underlying this modulation and to prevent HAND particularly in clade B infection. In this study, we have investigated 84 key human synaptic plasticity genes differential expression profile in clade B and clade C infected primary human astrocytes by using RT(2 Profile PCR Array human Synaptic Plasticity kit. Among these, 31 and 21 synaptic genes were significantly (≥3 fold down-regulated and 5 genes were significantly (≥3 fold up-regulated in clade B and clade C infected cells, respectively compared to the uninfected control astrocytes. In flow-cytometry analysis, down-regulation of postsynaptic density and dendrite spine morphology regulatory proteins (ARC, NMDAR1 and GRM1 was confirmed in both clade B and C infected primary human astrocytes and SK-N-MC neuroblastoma cells. Further, spine density and dendrite morphology changes by confocal microscopic analysis indicates significantly decreased spine density, loss of spines and decreased dendrite diameter, total dendrite and spine area in clade B infected SK-N-MC neuroblastoma cells compared to uninfected and clade C infected cells. We have also observed that, in clade B infected astrocytes, induction of apoptosis was significantly higher than in the clade C infected astrocytes. In conclusion, this study suggests that down-regulation of synaptic plasticity genes, decreased dendritic spine density and induction of

  11. HIV相关神经认知功能障碍的研究进展%Research progress on HIV associated neurocognitive disorders

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    杨馨; 杨峥嵘

    2016-01-01

    HIV infections not only damage the immune system,but also cause a series of nervous system lesions including HIV associated neurocognitive disorders (HAND),which affects life quality and survival rate of HIV and AIDS patients.Although the application of HAART can obviously improve the symptoms of HAND,antiretroviral drugs which can effectively penetrate into the central nervous system are limited,and the research progress of HAND is slow.In this paper,the concept,the pathogenesis of HAND,epidemiological situation,influence factors,diagnosis and treatment are summarized,so as to provide references for clinical research.%HIV感染不仅损害免疫系统,而且还可引起一系列神经系统的病变,其中包括HIV相关神经认知功能障碍(HAND),影响了HIV感染者和AIDS患者的生存质量及生存率.同时,尽管HAART的应用能明显改善HAND症状,但是真正能有效渗透进中枢神经系统的抗逆转录病毒药物相当有限,HAND的研究进展缓慢.本文就HAND概念、发病机制、流行病学状况及特点、影响因素、诊断、治疗等方面进行综述,从而为临床研究提供参考.

  12. Decrease of aquaporin-4 and excitatory amino acid transporter-2 indicate astrocyte dysfunction for pathogenesis of cortical degeneration in HIV-associated neurocognitive disorders.

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    Xing, Hui Qin; Zhang, Yu; Izumo, Kimiko; Arishima, Shiho; Kubota, Ryuji; Ye, Xiang; Xu, Qiping; Mori, Kazuyasu; Izumo, Shuji

    2017-02-01

    Human immunodeficiency virus (HIV) encephalitis and degeneration of cerebral cortex are established histopathologies of HIV-associated neurocognitive disorders (HAND). We previously reported decreased excitatory amino acid transporter-2 (EAAT-2) and astrocytic apoptosis in cortical degeneration using SIVmac239 and simian-human immunodeficiency virus (SHIV)-infected macaques and human AIDS autopsy cases. In the present study, we added highly pathogenic SIVsm543-3-infected macaques. These animals showed similar degenerative changes in the frontal cortex. Using 11 SIV-infected macaques, three SIVsm543-3, five SIVmac239 and three SHIV, we compared brain pathology caused by three different viruses and further analyzed the pathogenic process of HAND. We noticed vacuolar changes in perivascular processes of astrocytes by electron microscopy, and examined expression of astrocyte-specific protein aquaporin-4 (AQP4) by immunohistochemistry. APQ4 was diffusely positive in the neuropil and perivascular area in control brains. There was patchy or diffuse decrease of AQP4 staining in the neuropil of SIV-infected macaques, which was associated with EAAT-2 staining by double immunostaining. A quantitative analysis demonstrated significant positive correlation between areas of AQP4 and EAAT-2. Some astrocytes express EAAT-2 but not AQP4, and decrease of EAAT-2 expression tended to be less than the decrease of AQP4. Active-caspase-3 immunostaining demonstrated apoptosis of neurons and astrocytes in the area of AQP4/EAAT-2 reduction. These results suggest that AQP4 is damaged first and decrease of EAAT-2 may follow in pathogenesis of cortical degeneration. This is the first demonstration of decrease of AQP4 and its association with EAAT-2 decrease in AIDS brain, suggesting a role in the pathogenesis of HAND. © 2016 Japanese Society of Neuropathology.

  13. Study on clinical features in general paresis of insane, HIV-associated dementia and Creutzfeldt-Jakob disease behaved as dementia

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    LIU Wen-yan

    2012-06-01

    Full Text Available Objective To investigate the clinical features of general paresis of insane (GPI, HIV-associated dementia (HAD and Creutzfeldt -Jakob disease (CJD. Methods The clinical features, laboratory examination, electroencephalography (EEG, magnetic resonance imaging (MRI, treatment and prognosis of 19 patients (GPI, n = 8; HAD, n = 6; CJD, n = 5 were analyzed retrospectively. Results The cases of three groups had cognitive impairment. At the same time, multiple systems (pyramidal system, extrapyramidal system and cerebellar and multiple cranial nerves were involved. In GPI patients, the results of rapid plasma regain circle card test (RPR and treponema pallidum particle agglutination assay (TPPA were all positive in 8 cases, venereal disease research laboratory tests (VDRL of CSF were positive in 4 cases, and Head MRI showed encephalatrophy in 6 cases. In HAD patients, serologic tests for HIV of all cases were positive, the average protein of CSF was increased significantly and Pandy's test was positive in 2 cases, Head MRI were characterized with multiple space occupying lesions or diffuse abnormal density image. In CJD patients, CSF 14-3-3 protein showed positive in 4 patients, EEG showed diffuse slow waves in 5 case, in which 1 case showed typical periodic triphasic wave, Head MRI in 3 sporadic CJD patients (sCJD showed swelling like changes in sulus of cortex area and 1 varaint CJD (vCJD patient showed hockey like change in thalamencephalon. Conclusion The clinical characteristics of dementia caused by GPI, HAD or CJD are varied, and the diagnosis mainly depends on clinical features, positive findings in serum, CSF, EEG and MRI detections.

  14. Neurosyphilis Increases HIV-associated Central Nervous System Inflammation but Does Not Explain Cognitive Impairment in HIV-infected Individuals with Syphilis.

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    Ho, Emily L; Maxwell, Clare L; Dunaway, Shelia B; Sahi, Sharon K; Tantalo, Lauren C; Lukehart, Sheila A; Marra, Christina M

    2017-05-19

    HIV-infected individuals with previous syphilis have cognitive impairment. We tested the hypothesis that neurosyphilis causes cognitive impairment in HIV by amplifying HIV-related CNS inflammation. 132 HIV-infected participants enrolled in a study of CSF abnormalities in syphilis underwent the mental alternation test (MAT), venipuncture and lumbar puncture. CSF concentrations of chemokine (C-X-C motif) ligand 10 (CXCL10), chemokine (C-C motif) ligand 2 (CCL2) and neurofilament light (NFL) were determined by commercial assays. The proportion of peripheral blood mononuclear cells (PBMCs) and of CSF white blood cells (WBCs) that were activated monocytes (CD14+CD16+) was determined by flow cytometry. Neurosyphilis was defined as detection of T. pallidum 16S RNA in CSF or CSF white blood cells (WBCs) >20/ul or a reactive CSF-Venereal Disease Research Laboratory (VDRL) test; uncomplicated syphilis was defined as undetectable CSF T. pallidum, CSF WBCs ≤5/ul and nonreactive CSF-VDRL. MAT <18 was considered low. Median proportion of PBMCs that were activated monocytes (16.6 vs. 5.3), and median CSF CXCL10 (10,658 vs. 2,530 units), CCL2 (519 vs. 337 units) and HIV RNA (727 vs. 50 c/ml) were higher in neurosyphilis than in uncomplicated syphilis (P≤0.001 for all comparisons). Neurosyphilis was not related to low MAT scores. Participants with low MAT scores had higher median CSF CXCL10 (10,299 vs.3,650 units, P=0.008) and CCL2 (519 vs. 365 units, P=0.04) concentrations than those with high MAT scores. Neurosyphilis may augment HIV-associated CNS inflammation, but it does not explain cognitive impairment in HIV-infected individuals with syphilis.

  15. Lessons learned developing a diagnostic tool for HIV-associated dementia feasible to implement in resource-limited settings: pilot testing in Kenya.

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    Judith Kwasa

    Full Text Available To conduct a preliminary evaluation of the utility and reliability of a diagnostic tool for HIV-associated dementia (HAD for use by primary health care workers (HCW which would be feasible to implement in resource-limited settings.In resource-limited settings, HAD is an indication for anti-retroviral therapy regardless of CD4 T-cell count. Anti-retroviral therapy, the treatment for HAD, is now increasingly available in resource-limited settings. Nonetheless, HAD remains under-diagnosed likely because of limited clinical expertise and availability of diagnostic tests. Thus, a simple diagnostic tool which is practical to implement in resource-limited settings is an urgent need.A convenience sample of 30 HIV-infected outpatients was enrolled in Western Kenya. We assessed the sensitivity and specificity of a diagnostic tool for HAD as administered by a primary HCW. This was compared to an expert clinical assessment which included examination by a physician, neuropsychological testing, and in selected cases, brain imaging. Agreement between HCW and an expert examiner on certain tool components was measured using Kappa statistic.The sample was 57% male, mean age was 38.6 years, mean CD4 T-cell count was 323 cells/µL, and 54% had less than a secondary school education. Six (20% of the subjects were diagnosed with HAD by expert clinical assessment. The diagnostic tool was 63% sensitive and 67% specific for HAD. Agreement between HCW and expert examiners was poor for many individual items of the diagnostic tool (K = .03-.65. This diagnostic tool had moderate sensitivity and specificity for HAD. However, reliability was poor, suggesting that substantial training and formal evaluations of training adequacy will be critical to enable HCW to reliably administer a brief diagnostic tool for HAD.

  16. Vorinostat positively regulates synaptic plasticity genes expression and spine density in HIV infected neurons: role of nicotine in progression of HIV-associated neurocognitive disorder

    Science.gov (United States)

    2014-01-01

    Background HIV-associated neurocognitive disorder (HAND) is characterized by development of cognitive, behavioral and motor abnormalities, and occurs in approximately 50% of HIV infected individuals. In the United States, the prevalence of cigarette smoking ranges from 35-70% in HIV-infected individuals compared to 20% in general population. Cognitive impairment in heavy cigarette smokers has been well reported. However, the synergistic effects of nicotine and HIV infection and the underlying mechanisms in the development of HAND are unknown. Results In this study, we explored the role of nicotine in the progression of HAND using SK-N-MC, a neuronal cell line. SK-N-MC cells were infected with HIV-1 in the presence or absence of nicotine for 7 days. We observed significant increase in HIV infectivity in SK-N-MC treated with nicotine compared to untreated HIV-infected neuronal cells. HIV and nicotine synergize to significantly dysregulate the expression of synaptic plasticity genes and spine density; with a concomitant increase of HDAC2 levels in SK-N-MC cells. In addition, inhibition of HDAC2 up-regulation with the use of vorinostat resulted in HIV latency breakdown and recovery of synaptic plasticity genes expression and spine density in nicotine/HIV alone and in co-treated SK-N-MC cells. Furthermore, increased eIF2 alpha phosphorylation, which negatively regulates eukaryotic translational process, was observed in HIV alone and in co-treatment with nicotine compared to untreated control and nicotine alone treated SK-N-MC cells. Conclusions These results suggest that nicotine and HIV synergize to negatively regulate the synaptic plasticity gene expression and spine density and this may contribute to the increased risk of HAND in HIV infected smokers. Apart from disrupting latency, vorinostat may be a useful therapeutic to inhibit the negative regulatory effects on synaptic plasticity in HIV infected nicotine abusers. PMID:24886748

  17. Evidence for predilection of macrophage infiltration patterns in the deeper midline and mesial temporal structures of the brain uniquely in patients with HIV-associated dementia

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    Hsu Kenneth

    2009-12-01

    Full Text Available Abstract Background HIV-1 penetrates the central nervous system, which is vital for HIV-associated dementia (HAD. But the role of cellular infiltration and activation together with HIV in the development of HAD is poorly understood. Methods To study activation and infiltration patterns of macrophages, CD8+ T cells in relation to HIV in diverse CNS areas of patients with and without dementia. 46 brain regions from two rapidly progressing severely demented patients and 53 regions from 4 HIV+ non-dementia patients were analyzed. Macrophage and CD8+ T cell infiltration of the CNS in relation to HIV was assessed using immuno-histochemical analysis with anti-HIV (P24, anti-CD8 and anti-CD68, anti-S-100A8 and granzyme B antibodies (cellular activation. Statistical analysis was performed with SPSS 12.0 with Student's t test and ANOVA. Results Overall, the patterns of infiltration of macrophages and CD8+ T cells were indiscernible between patients with and without dementia, but the co-localization of macrophages and CD8+ T cells along with HIV P24 antigen in the deeper midline and mesial temporal structures of the brain segregated the two groups. This predilection of infected macrophages and CD8+ T cells to the middle part of the brain was unique to both HAD patients, along with unique nature of provirus gag gene sequences derived from macrophages in the midline and mesial temporal structures. Conclusion Strong predilection of infected macrophages and CD8+ T cells was typical of the deeper midline and mesial temporal structures uniquely in HAD patients, which has some influence on neurocognitive impairment during HIV infection.

  18. Efavirenz promotes β-secretase expression and increased Aβ1-40,42 via oxidative stress and reduced microglial phagocytosis: implications for HIV associated neurocognitive disorders (HAND.

    Directory of Open Access Journals (Sweden)

    Lecia A M Brown

    Full Text Available Efavirenz (EFV is among the most commonly used antiretroviral drugs globally, causes neurological symptoms that interfere with adherence and reduce tolerability, and may have central nervous system (CNS effects that contribute in part to HIV associated neurocognitive disorders (HAND in patients on combination antiretroviral therapy (cART. Thus we evaluated a commonly used EFV containing regimen: EFV/zidovudine (AZT/lamivudine (3TC in murine N2a cells transfected with the human "Swedish" mutant form of amyloid precursor protein (SweAPP N2a cells to assess for promotion of amyloid-beta (Aβ production. Treatment with EFV or the EFV containing regimen generated significantly increased soluble amyloid beta (Aβ, and promoted increased β-secretase-1 (BACE-1 expression while 3TC, AZT, or, vehicle control did not significantly alter these endpoints. Further, EFV or the EFV containing regimen promoted significantly more mitochondrial stress in SweAPP N2a cells as compared to 3TC, AZT, or vehicle control. We next tested the EFV containing regimen in Aβ - producing Tg2576 mice combined or singly using clinically relevant doses. EFV or the EFV containing regimen promoted significantly more BACE-1 expression and soluble Aβ generation while 3TC, AZT, or vehicle control did not. Finally, microglial Aβ phagocytosis was significantly reduced by EFV or the EFV containing regimen but not by AZT, 3TC, or vehicle control alone. These data suggest the majority of Aβ promoting effects of this cART regimen are dependent upon EFV as it promotes both increased production, and decreased clearance of Aβ peptide.

  19. Clinical features and outcomes of renal transplant patients with cryptococcosis%肾移植术后新生隐球菌病的临床特点及转归

    Institute of Scientific and Technical Information of China (English)

    许书添; 谢红浪; 陈劲松; 文吉秋; 何群鹏; 刘丽; 胡伟新; 刘志红

    2012-01-01

    目的:分析肾移植术后新生隐球菌病的临床特点,旨在提高诊治水平. 方法:回顾性分析6例肾移植术后新生隐球菌感染患者的临床特点、实验室检查结果、治疗及转归. 结果:6例患者中5例原发病为慢性肾小球肾炎,1例为原发性高草酸尿症(Ⅰ型);全部患者均系首次肾移植,发病中位时间为移植术后6年.6例患者HIV均阴性,2例乙肝表面抗原携带者,1例丙型病毒性肝炎;3例合并糖尿病,且血糖控制不佳;3例合并高血压;3例合并皮肤感染;1例有鸽子接触史.所有患者均存在发热和头痛症状,且有不同程度意识障碍,其中3例癫痫;5例脑膜刺激征阳性;2例视力下降,1例听力下降.本组患者均体型消瘦,T淋巴细胞亚群CD4+、CD8+计数偏低,存在不同程度贫血,白蛋白和前白蛋白低下,移植肾功能不全.6例患者均颅内高压(23.5 ~41 cmH2O),脑脊液蛋白含量均高于正常,但葡萄糖降低;5例脑脊液墨汁染色找到新生隐球菌,4例脑脊液培养出新生隐球菌;3例新生隐球菌菌血症,3例皮损活检组织培养新生隐球菌阳性,2例合并肺部酵母菌感染,4例诊断符合全身播散性新生隐球菌病.4例采用氟康唑治疗,1例伊曲康唑,1例氟康唑续伏立康唑;经上述药物治疗后,3例治愈并行维持性血液透析治疗,余3例死亡. 结论:肾移植术后新生隐球菌易播散至皮肤,常因非特异性皮肤改变而延误诊断,因此有必要早期行皮肤组织活检以及特殊染色.早期明确诊断和及时治疗是提高此病救治成功率的关键.%Objective; To retrospectively investigate the clinical features and outcomes of kidney transplant patients with cryptococcosis. Methodology; Six patients, 3 male and 3 female, with cryptococcosis after renal transplantation were involved in this study. The clinical manifestations, laboratory data, skin tissue pathological examination,treatment and prognosis were

  20. Platelet-derived growth factor (PDGF-BB-mediated induction of monocyte chemoattractant protein 1 in human astrocytes: implications for HIV-associated neuroinflammation

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    Bethel-Brown Crystal

    2012-12-01

    Full Text Available Abstract Chemokine (C-C motif ligand 2, also known as monocyte chemoattractant protein 1 (MCP-1 is an important factor for the pathogenesis of HIV-associated neurocognitive disorders (HAND. The mechanisms of MCP-1-mediated neuropathogenesis, in part, revolve around its neuroinflammatory role and the recruitment of monocytes into the central nervous system (CNS via the disrupted blood-brain barrier (BBB. We have previously demonstrated that HIV-1/HIV-1 Tat upregulate platelet-derived growth factor (PDGF-BB, a known cerebrovascular permeant; subsequently, the present study was aimed at exploring the regulation of MCP-1 by PDGF-BB in astrocytes with implications in HAND. Specifically, the data herein demonstrate that exposure of human astrocytes to HIV-1 LAI elevated PDGF-B and MCP-1 levels. Furthermore, treating astrocytes with the human recombinant PDGF-BB protein significantly increased the production and release of MCP-1 at both the RNA and protein levels. MCP-1 induction was regulated by activation of extracellular-signal-regulated kinase (ERK1/2, c-Jun N-terminal kinase (JNK and p38 mitogen-activated protein (MAP kinases and phosphatidylinositol 3-kinase (PI3K/Akt pathways and the downstream transcription factor, nuclear factor κB (NFκB. Chromatin immunoprecipitation (ChIP assays demonstrated increased binding of NFκB to the human MCP-1 promoter following PDGF-BB exposure. Conditioned media from PDGF-BB-treated astrocytes increased monocyte transmigration through human brain microvascular endothelial cells (HBMECs, an effect that was blocked by STI-571, a tyrosine kinase inhibitor (PDGF receptor (PDGF-R blocker. PDGF-BB-mediated release of MCP-1 was critical for increased permeability in an in vitro BBB model as evidenced by blocking antibody assays. Since MCP-1 is linked to disease severity, understanding its modulation by PDGF-BB could aid in understanding the proinflammatory responses in HAND. These results suggest that astrocyte

  1. Excellent clinical outcomes and retention in care for adults with HIV-associated Kaposi sarcoma treated with systemic chemotherapy and integrated antiretroviral therapy in rural Malawi

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    Michael E Herce

    2015-05-01

    Full Text Available Introduction: HIV-associated Kaposi sarcoma (HIV-KS is the most common cancer in Malawi. In 2008, the non-governmental organization, Partners In Health, and the Ministry of Health established the Neno Kaposi Sarcoma Clinic (NKSC to treat HIV-KS in rural Neno district. We aimed to evaluate 12-month clinical outcomes and retention in care for HIV-KS patients in the NKSC, and to describe our implementation model, which featured protocol-guided chemotherapy, integrated antiretroviral therapy (ART and psychosocial support delivered by community health workers. Methods: We conducted a retrospective cohort study using routine clinical data from 114 adult HIV-KS patients who received ART and ≥1 chemotherapy cycle in the NKSC between March 2008 and February 2012. Results: At enrolment 97% of patients (n/N=103/106 had advanced HIV-KS (stage T1. Most patients were male (n/N=85/114, 75% with median age 36 years (interquartile range, IQR: 29–42. Patients started ART a median of 77 days prior to chemotherapy (IQR: 36–252, with 97% (n/N=105/108 receiving nevirapine/lamivudine/stavudine. Following standardized protocols, we treated 20 patients (18% with first-line paclitaxel and 94 patients (82% with bleomycin plus vincristine (BV. Of the 94 BV patients, 24 (26% failed to respond to BV requiring change to second-line paclitaxel. A Division of AIDS grade 3/4 adverse event occurred in 29% of patients (n/N=30/102. Neutropenia was the most common grade 3/4 event (n/N=17/102, 17%. Twelve months after chemotherapy initiation, 83% of patients (95% CI: 74–89% were alive, including 88 (77% retained in care. Overall survival (OS at 12 months did not differ by initial chemotherapy regimen (p=0.6. Among patients with T1 disease, low body mass index (BMI (adjusted hazard ratio, aHR=4.10, 95% CI: 1.06–15.89 and 1 g/dL decrease in baseline haemoglobin (aHR=1.52, 95% CI: 1.03–2.25 were associated with increased death or loss to follow-up at 12 months. Conclusions

  2. Interferon gamma increases survival in urine experimental cryptococcosis El Interferon gamma incrementa la sobrevida de un modelo experimental murino de criptococosis

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    Amadeo J. Bava

    1995-10-01

    Full Text Available Systemic disease by Cryptococcus neoformans (C. neoformans is a common opportunistic infection in immunodeficient patients. Cellular immunity seems to be the most important determinant of resistance. The aim of this study was to assess the effect of recombinant rat interferon gamma (IFN-gamma in murine cryptococcosis (Balb/c mice infected by IP route with the Rivas strain of C. neoformans, evaluating survival time, macroscopic and microscopic examination of the organs, and massive seeding of brain homogenate. IFN-gamma treatment, at a daily dose of 10,000 IU, did not modify significantly these variables when mice were challenged with a high inoculum (10(7 yeasts and treatment was delayed to 5 days after infection (median survival 21 days in control mice vs. 23 days in IFN-treated. Another set of experiments suggested that IFN-gamma treatment, at a dose of 10,000 IU/day, begun at the moment of infection could be useful (it prolonged survival from 20 to 28 days, although the difference did not achieve statistical signification. When used simultaneously with infection by 3.5 x 10(5 yeasts, IFN-gamma at 10,000 IU/day for 15 days significantly prolonged survival of mice (p = 0.004. These results suggest that, depending on the experimental conditions, IFN-gamma can improve survival of mice infected with a lethal dose of C. neoformans.Se evaluó la efectividad del interferon-gamma (IFN-gamma recombinante de rata en un modelo experimental de criptococosis desarollado en ratones Balb/C inoculados por vía intraperitoneal con la cepa Rivas de Cryptococcus neoformans (C. neoformans. Se tuvieron en cuenta el tiempo de sobrevida de los animales, el aspecto macroscópico de los órganos en la autopsia, la presencia de levaduras capsuladas en los tejidos y la siembra masiva de un homogenato de cerebro. El tratamiento con IFN-gamma, en dosis diarias de 10.000 UI, no modificó estos parámetros cuando la dosis infectante fue de 10(7 levaduras y el tratamiento se

  3. HMGB1/anti-HMGB1 antibodies define a molecular signature of early stages of HIV-Associated Neurocognitive Isorders (HAND).

    Science.gov (United States)

    Gougeon, Marie-Lise; Poirier-Beaudouin, Béatrice; Durant, Jacques; Lebrun-Frenay, Christine; Saïdi, Héla; Seffer, Valérie; Ticchioni, Michel; Chanalet, Stephane; Carsenti, Helene; Harvey-Langton, Alexandra; Laffon, Muriel; Cottalorda, Jacqueline; Pradier, Christian; Dellamonica, Pierre; Vassallo, Matteo

    2017-02-01

    HIV-associated neurocognitive disorders (HAND) persist in the post-HAART era, characterized by asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorders (MND). High mobility group box 1 (HMGB1) is a non-histone chromosomal protein widely expressed in the nucleus of all eukaryotic cells, including brain cells, which acts as a potent proinflammatory cytokine when actively secreted from immune cells. Recent reports suggested that HMGB1 acts on microglial cells to promote neuroinflammation. In this study, our aim was to determine whether HMGB1 is involved in HAND, but also to identify early new markers of neurological impairment in HIV-infected patients. CSF and serum were collected from 103 HIV-1-infected patients enrolled in Neuradapt, a prospective study of the prevalence of HAND in HIV-1 infected patients at Nice University Hospital. Stored fluids were assessed for immunological, virological, and brain metabolite parameters. In addition to HIV RNA and DNA measurements, expression of T-cell surface markers of activation (CD38 and HLA-DR) was analyzed on whole blood. Concentration of 27 cytokines and chemokines was measured using multiplex bead assays on serum and CSF. Concentration of HMGB1 and anti-HMGB1 IgG autoantibodies were also measured on the same samples. Changes in cerebral metabolites N-acetyl aspartate (NAA), Choline (Cho) and creatinine (Cr) were assessed by magnetic resonance microscopy (MRS). Clinical, virological and immunological characteristics were comparable between HAND (n = 30) and no HAND (n = 73) patients, except the absolute numbers of CD8(+) T cells, which were higher in patients with HAND. Among the 29 molecules tested, only 4 of them were significantly upregulated in the CSF from HAND patients as compared to healthy donors i.e. HMGB1, anti-HMGB1 IgG antibodies, IP-10 and MCP1. CSF HMGB1 levels were positively correlated with HIV-1 DNA in aviremic HAND patients, suggesting a positive impact of HMGB1 on HIV reservoirs

  4. Regional differences in astrocyte activation in HIV-associated dementia Diferencias regionales en la activación astrocitaria en demencia asociada a HIV

    Directory of Open Access Journals (Sweden)

    María C. Vanzani

    2006-04-01

    Full Text Available Since astrogliosis is a histological marker usually observed in HIV-associated dementia (HIV-D, we decided to investigate the potential relationship between the expression of glial fibrillary acidic protein (GFAP and the regional distribution of cells positive (+ for this specific marker of astrocyte activation. Histological sections of brain tissues obtained at necropsy from 5 HIV-D patients and 5 age-matched controls without history of neuropsychiatric illness were immunostained with peroxidase. Mean numbers of GFAP(+ astrocytes were significantly increased in entorhinal cortex, hippocampus and subcortical white matter of patients, but values in frontal cortex and basal ganglia were similar to those of controls. In contrast, surface density of immunoreactive GFAP was significantly increased in all tested brain areas from all patients, including unusually affected regions such as entorhinal cortex and hippocampus. Therefore, such consistent finding of hypertrophic astrocytes, ranging from highest cell percentajes in subcortical white matter to lowest in basal ganglia indicates that quantification of surface density in GFAP (+ cells appears to be a more reliable approach to score gliosis than the counting of their cell nuclei. Because astrocyte activation involves both protective and detrimental effects on adjacent neuronal subsets, the evidence of regional differences in this reactive potential highlights the importance of accurately defining their contribution to the neuropathogenesis not only of HIV-D, but of a wide range of neurodegenerative disorders.Siendo la astrogliosis un signo histológico habitualmente presente en demencia asociada a HIV, se investigó la eventual relación entre expresión de proteína gliofibrilar ácida (GFAP y localización regional de células positivas para ese marcador específico de la activación astrocitaria. Por inmunoperoxidasa, se procesaron cortes histológicos de tejidos cerebrales obtenidos por

  5. Is it time to rethink how neuropsychological tests are used to diagnose mild forms of HIV-associated neurocognitive disorders? Impact of false-positive rates on prevalence and power.

    Science.gov (United States)

    Meyer, Ana-Claire L; Boscardin, W John; Kwasa, Judith K; Price, Richard W

    2013-01-01

    Between 0 and 48% of normal HIV-uninfected individuals score below threshold neuropsychological test scores for HIV-associated neurocognitive disorders (HAND) or are false positives. There has been little effort to understand the effect of varied interpretations of research criteria for HAND on false-positive frequencies, prevalence and analytic estimates. The proportion of normal individuals scoring below Z score thresholds drawn from research criteria for HAND, or false-positive frequencies, was estimated in a normal Kenyan population and a simulated normal population using varied interpretations of research criteria for HAND. We calculated the impact of false-positive frequencies on prevalence estimates and statistical power. False-positive frequencies of 2-74% were observed for asymptomatic neurocognitive impairment/mild neurocognitive disorder and 0-8% for HIV-associated dementia. False-positive frequencies depended on the definition of an abnormal cognitive domain, Z score thresholds and neuropsychological battery size. Misclassification led to clinically important overestimation of prevalence and dramatic decreases in power. Minimizing false-positive frequencies is critical to decrease bias in prevalence estimates and minimize reductions in power in studies of association, particularly for mild forms of HAND. We recommend changing the Z score threshold to ≤-1.5 for mild impairment, limiting analysis to 3-5 cognitive domains and using the average Z score to define an abnormal domain. © 2013 S. Karger AG, Basel.

  6. Association of mannose binding lectin genetic polymorphisms with cryptococcosis%甘露糖结合凝集素基因多态性与隐球菌病易感性的遗传关联研究

    Institute of Scientific and Technical Information of China (English)

    区雪婷; 翁心华; 吴吉芹; 朱利平; 章强强; 王菲菲; 徐斌; 胡秀平; 王璇; 王睿莹

    2011-01-01

    目的 分析我国非AIDS隐球菌病患者甘露糖结合凝集素(MBL)基因多态性分布情况,并探讨其与隐球菌病易感性的关系.方法 采用病例一对照遗传关联研究,病例组为非AIDS相关隐球菌病患者167例,包括隐球菌脑膜炎103例和肺隐球菌感染64例,健康对照组为体检者208例.提取受试者外周血标本基因组DNA,PCR特异性扩增MBL基因DNA片段,对扩增产物进行序列分析,以检测MBL单核苷酸多态性(SNP),进一步探讨MBL基因多态性与隐球菌病易感性的遗传关联性.病例组与对照组比较采用χ2检验或Fisher确切概率检验,MBL基因型各组血浆MBL差异比较采用单因素方差分析.结果 167例隐球菌病患者MBL各等位基因、单倍型、基因型所占比例与健康对照组比较,差异均无统计学意义(P>0.05).但是,隐球菌脑膜炎患者MBL基因型缺陷组的构成比(16.5%)显著高于健康对照组(8.7%,χ2=4.25,P=0.0392,OR=2.09),在免疫正常隐球菌脑膜炎患者中(21.4%)差异更为显著(χ2=7.15,P=0.0075,OR=2.88).此外,隐球菌脑膜炎患者MBL基因型缺陷组的构成比显著高于非中枢神经系统感染患者(3.1%,Fisher确切概率检验,P=0.010,OR=6.13),在免疫正常患者中(分别为21.4%和4.0%)差异更为显著(P=0.009,OR=6.55).结论 MBL基因型缺陷是隐球菌脑膜炎的遗传易感因素,MBL缺陷的隐球菌病患者中枢神经系统更易受累.%Objective To describe the distribution of mannose binding lectin (MBL) genetic polymorphisms in non-acquired immunodeficiency syndrome (AIDS) patients with cryptococcosis in China and to verify the association of MBL polymorphisms with susceptibility to cryptococcosis.Methods The case-controlled genetic association study was conducted and 167 non-AIDS patients with cryptococcosis and 208 healthy controls were recruited. Genome DNA was extracted from the peripheral blood and MBL gene was amplified by polymerase chain reaction (PCR). Six

  7. Status epilepticus

    NARCIS (Netherlands)

    Hensiek, AE; Absalom, Anthony

    2006-01-01

    Status epilepticus is defined as epileptic activity that continues for more than 30 minutes as a single seizure or as recurrent seizures without inter-ictal return of consciousness. The seizure activity is usually classified as partial or generalized. Although status epilepticus is an uncommon admis

  8. Status epilepticus

    NARCIS (Netherlands)

    Hensiek, AE; Absalom, Anthony

    2006-01-01

    Status epilepticus is defined as epileptic activity that continues for more than 30 minutes as a single seizure or as recurrent seizures without inter-ictal return of consciousness. The seizure activity is usually classified as partial or generalized. Although status epilepticus is an uncommon admis

  9. Clinical and epidemiological features of 123 cases of cryptococcosis in Mato Grosso do Sul, Brazil Características clínicas e epidemiológicas de 123 casos de criptococose observados em Mato Grosso do Sul, Brasil

    Directory of Open Access Journals (Sweden)

    Andrea De Siqueira Campos Lindenberg

    2008-04-01

    Full Text Available To identify the clinical and epidemiological profile of cryptococcosis diagnosed at the University Hospital of the Federal University of Mato Grosso do Sul, Brazil, medical records of 123 patients admitted from January 1995 to December 2005 were analyzed. One hundred and four cases (84.5% had HIV infection, six (4.9% had other predisposing conditions and 13 (10.6% were immunocompetent. Male patients predominated (68.3% and their age ranged from 19 to 69 years (mean: 35.9. Most patients (73.2% were born and lived lifelong in the state of Mato Grosso do Sul. Involvement of the central nervous system occurred in 103 patients (83.7% and headache and vomiting were the most frequent symptoms. In 77 cases it was possible to identify the Cryptococcus species: 69 (89.6% C. neoformans and eight (10.4% C. gattii. Amphotericin B was the drug of choice for treatment (106/123, followed by fluconazole in 60% of cases. The overall lethality rate was 49.6%, being 51% among the HIV infected patients and 41.2% among the non-HIV infected (p > 0.05. Although cryptococcosis exhibited in our region a similar behavior to that described in the literature, the detection of an important rate of immunocompetent individuals and five C. gattii cryptococcosis in HIV-infected patients is noteworthy.O perfil clínico-epidemiológico de 123 casos de criptococose diagnosticados no Hospital Universitário da Universidade Federal de Mato Grosso do Sul, no período de janeiro de 1995 até dezembro de 2005, foi estudado retrospectivamente. Cento e quatro (84,9% casos tinham associação com HIV, seis (4,9% tinham outra condição predisponente e 13 (10,6% eram imunocompetentes. Houve predomínio do sexo masculino (68,3% e a idade variou de 19 a 69 anos (média de 35,9 anos. A maioria (73,2% era natural e procedente de Mato Grosso do Sul. O envolvimento do sistema nervoso central ocorreu em 103 (83,7% pacientes e os sintomas mais freqüentes foram cefaléia e vômitos. Em 77 casos foi

  10. Caracteristicas epidemiologicas de 105 casos de criptococosis diagnosticados en la república Argentina entre 1981-1990 Epidemiological characteristics of 105 cases of cryptococcosis diagnosed in Argentina, between 1981-1990

    Directory of Open Access Journals (Sweden)

    A.J. Bava

    1992-08-01

    Full Text Available Se presentan 105 casos de criptococosis diagnosticados en la República Argentina, entre 1981 y 1990. El número anual de casos fue hasta 1987, de 4 a 8, aumentó desde 1988 por influencia del SIDA y llegó a 35 casos en 1990. La criptococosis no asociada al SIDA se mantuvo entre 3 y 7 casos anuales. Globalmente, el grupo etario más afectado fue el de 20-39 años y la distribución por edad fue diferente en las poblaciones con y sin SIDA. La mediana de la edad de las poblaciones total, asociada al SIDA y a otras causas predisponentes fue de 30, 30 y 45 años, respectivamente. El predominio del sexo masculino fue mucho más evidente entre los pacientes HIV+ que en los que no padecían esta última infección. La causa predisponente fue el SIDA en 57 pacientes, otra en 20 y era desconocida en 28 casos. Estimando indirectamente, el porcentaje de pacientes con SIDA que padecieron criptococosis en este período fue 6,19% (57 casos en 920 HIV+. Cryptococcus neoformans variedad neoformans fue aislado de 101 pacientes y la variedad gattii (serotipo B de los 4 restantes. Los datos obtenidos son similares a los observados en Europa y Estados Unidos.Some epidemiological characteristics of 105 cases of cryptococcosis diagnosed in Argentina, between 1981-1990, were studied. Until 1987, the annual number of cases was 4-8. It has increased since 1988 by AIDS influence and reached 35 cases in 1990. The annual number of cases non associated with AIDS has remmained in 3-7 cases. The age median of the all patients, AIDS and non AIDS associated cases was 30, 30 and 45 years old, respectively. The 20-39 years old group was the most affected and the age distribution was different in AIDS and non AIDS population. Masculine predominance was more evident in AIDS than in non AIDS associated cases. The predisposing factor was AIDS in 57 patients, another different factor in 20 and unknown in 28 cases. The indirect estimation of the percentage of AIDS cases with

  11. Stock Status

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — These data inform the public of the most recent stock status for all stocks (FSSI and non-FSSI) in the fishery management unit contained in a fishery managment plan....

  12. A Case of Disseminated Cryptococcosis with HIV Negative Presenting Cutaneous Lesions as First Manifestation%以皮肤损害为首发症状的HIV阴性的播散性隐球菌病1例

    Institute of Scientific and Technical Information of China (English)

    谭琦; 王华; 罗晓燕; 肖异珠; 向娟; 李咏梅; 欧阳莹

    2011-01-01

    患者女,11岁.因"颜面四肢皮疹1个月,咳嗽伴低热1周"入院.皮肤科情况:颜面四肢分布红色结节,中央有脐凹.胸片显示双肺间质性改变.组织病理检查示组织中有多核巨细胞,PAS染色可见孢子.HIV检测(-).诊断:播散性隐球菌病.%A 11-year-old girl was admitted to our hospital with progressive skin lesions on her face and extremities for 1 month. She had a history of cough and low-grade fever 1 week before. Dermatologic physical examination revealed red nodules on the face and extremities. A chest radiograph disclosed a bilateral diffuse interstitial infiltrate. Histologic examination revealed multinucleated giant cells in the dermis and PAS stains showed cryptococcal organisms clearly. The result of HIV test was( - ). A diagnosis of disseminated cryptococcosis was made.

  13. HIV-1 expression induces cyclin D1 expression and pRb phosphorylation in infected podocytes: cell-cycle mechanisms contributing to the proliferative phenotype in HIV-associated nephropathy

    Directory of Open Access Journals (Sweden)

    Husain Mohammad

    2002-09-01

    Full Text Available Abstract Background The aberrant cell-cycle progression of HIV-1-infected kidney cells plays a major role in the pathogenesis of HIV-associated nephropathy, however the mechanisms whereby HIV-1 induces infected glomerular podocytes or infected tubular epithelium to exit quiescence are largely unknown. Here, we ask whether the expression of HIV-1 genes in infected podocytes induces cyclin D1 and phospho-pRb (Ser780 expression, hallmarks of cyclin D1-mediated G1 → S phase progression. Results We assessed cyclin D1 and phospho-pRb (Ser780 expression in two well-characterized models of HIV-associated nephropathy pathogenesis: HIV-1 infection of cultured podocytes and HIV-1 transgenic mice (Tg26. Compared to controls, cultured podocytes expressing HIV-1 genes, and podocytes and tubular epithelium from hyperplastic nephrons in Tg26 kidneys, had increased levels of phospho-pRb (Ser780, a target of active cyclin D1/cyclin-dependent kinase-4/6 known to promote G1 → S phase progression. HIV-1-infected podocytes showed markedly elevated cyclin D1 mRNA and cyclin D1 protein, the latter of which did not down-regulate during cell-cell contact or differentiation, suggesting post-transcriptional stabilization of cyclin D1 protein levels by HIV-1. The selective suppression of HIV-1 transcription by the cyclin-dependent kinase inhibitor, flavopiridol, abrogated cyclin D1 expression, underlying the requirement for HIV-1 encoded products to induce cyclin D1. Indeed, HIV-1 virus deleted of nef failed to induce cyclin D1 mRNA to the level of other single gene mutant viruses. Conclusions HIV-1 expression induces cyclin D1 and phospho-pRb (Ser780 expression in infected podocytes, suggesting that HIV-1 activates cyclin D1-dependent cell-cycle mechanisms to promote proliferation of infected renal epithelium.

  14. Compliance status

    Energy Technology Data Exchange (ETDEWEB)

    Black, D.G.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report summarizes the activities conducted to ensure that the Hanford Site is in compliance with federal environmental protection statutes and related Washington State and local environmental protection regulations and the status of Hanford`s compliance with these requirements. Environmental permits required under the environmental protection regulations are discussed under the applicable statute.

  15. Decreased chronic morbidity but elevated HIV associated cytokine levels in HIV-infected older adults receiving HIV treatment: benefit of enhanced access to care?

    Directory of Open Access Journals (Sweden)

    Portia C Mutevedzi

    Full Text Available BACKGROUND: The association of HIV with chronic morbidity and inflammatory markers (cytokines in older adults (50+years is potentially relevant for clinical care, but data from African populations is scarce. OBJECTIVE: To examine levels of chronic morbidity by HIV and ART status in older adults (50+years and subsequent associations with selected pro-inflammatory cytokines and body mass index. METHODS: Ordinary, ordered and generalized ordered logistic regression techniques were employed to compare chronic morbidity (heart disease (angina, arthritis, stroke, hypertension, asthma and diabetes and cytokines (Interleukins-1 and -6, C-Reactive Protein and Tumor Necrosis Factor-alpha by HIV and ART status on a cross-sectional random sample of 422 older adults nested within a defined rural South African population based demographic surveillance. RESULTS: Using a composite measure of all morbidities, controlling for age, gender, BMI, smoking and wealth quintile, HIV-infected individuals on ART had 51% decreased odds (95% CI:0.26-0.92 of current morbidity compared to HIV-uninfected. In adjusted regression, compared to HIV-uninfected, the proportional odds (aPOR of having elevated inflammation markers of IL6 (>1.56 pg/mL was nearly doubled in HIV-infected individuals on (aPOR 1.84; 95%CI: 1.05-3.21 and not on (aPOR 1.94; 95%CI: 1.11-3.41 ART. Compared to HIV-uninfected, HIV-infected individuals on ART had >twice partial proportional odds (apPOR=2.30;p=0.004 of having non-clinically significant raised hsCRP levels(>1 ug/mL; ART-naïve HIV-infected individuals had >double apPOR of having hsCRP levels indicative of increased heart disease risk(>3.9 ug/mL;p=0.008. CONCLUSIONS: Although HIV status was associated with increased inflammatory markers, our results highlight reduced morbidity in those receiving ART and underscore the need of pro-actively extending these services to HIV-uninfected older adults, beyond mere provision at fixed clinics. Providing

  16. Retrospective analysis of primary cutaneous cryptococcosis from 2000 to 2008%2000~2008年原发性皮肤隐球菌病回顾性分析

    Institute of Scientific and Technical Information of China (English)

    杨明辉; 温海; 朱元杰

    2011-01-01

    目的 了解2000-2008年间原发性皮肤隐球菌病(PCC)的流行病学及临床特征.方法 检索并回顾性分析2000-2008年文献报道的原发性皮肤隐球菌病病例资料,对比分析2000-2008年与1985-2000年报道的PCC病例及免疫正常与免疫受损PCC病例的特征是否存在差异.结果 共检索出2000-2008年间符合PCC诊断标准的病例28例.近8a来PCC仍好发于年龄较大者,但男性更多见;免疫正常或受损宿主均可发生PCC; HIV感染患者发生PCC几率更小;外伤可能为PCC重要的诱发因素;皮疹部位仍以四肢等暴露部位为主;皮疹性质由以前较特异的化脓性指头炎或蜂窝织炎为主变迁到以溃疡、结节、红斑、肿块等非特异性皮疹为主;治疗仍以抗真菌药物口服或与手术联合为主,氟康唑仍为一线药物;预后一般较好.结论 近年来PCC表现出一些新的特点.宿主的免疫状态可能不影响其发生PCC的机率或影响较小,而仅影响隐球菌感染后的转归.%Objective To study the epidemiology and clinical features of primary cutaneous cryptococcosis from 2000 to 2008.Methods Cases of primary cutaneous cryptococcosis from 2000 to 2008 were retrospectively analysed and the differences with those between 1985 and 2000 were compared.Results PCC occurred more commonly in the older and the male in the recent 8 years.There was no difference in the onset between immunocompetent and immunocompromised hosts, while HIV positive patients had the lower probability to get PCC,xternal injury might be the important causative factors,erythra still happened majorly in extremities or other exposure sites, the erythra had changed from whitlow or cellulitis to ulcer,nodus,erythema,and so on, the oral antifungal drugs combined with surgery were most acceptable treatment and fluconazole was still the first choice for PCC, and the prognosis was good.Conclusions In recent years, PCC obtained some new characteristics.We considered that the

  17. Criptococosis en pacientes con SIDA: estudio de casos en el Hospital Paroissien en el período 1996-2007 Cryptococcosis in AIDS patients: case study from 1996 to 2006 in Paroissien Hospital

    Directory of Open Access Journals (Sweden)

    L. S. Mónaco

    2008-12-01

    Full Text Available Se evaluaron en forma retrospectiva las características clínicas, epidemiológicas y microbiológicas de 128 episodios de criptococosis en 106 pacientes VIH positivos internados en el período 1996-2007 en el Hospital Paroissien de La Matanza, Provincia de Buenos Aires. Setenta y cinco fueron varones y 31 mujeres, con una mediana de edad de 34 años y un rango etario de 20-68 años. La conducta de riesgo preponderante para la infección por el VIH fue la adicción a drogas por vía endovenosa, detectada en 55 pacientes (51,9%. La criptococosis se presentó como episodio único en 85 pacientes (80,2% y como recaída en 19 (17,9%. Fue la primera enfermedad marcadora en 36 pacientes (34,0%. El diagnóstico de criptococosis se estableció en 116 episodios por el estudio del LCR (tinta china, cultivo y detección del antígeno, en 9 casos por la recuperación de Cryptococcus sp. del hemocultivo (lisis centrifugación y en 3 casos por la detección del antígeno circulante en el suero de los pacientes con un reactivo de látex. El 89,6% de los pacientes presentó sintomatología neurológica; la cefalea y la fiebre fueron las manifestaciones más frecuentes. El tratamiento de inducción se efectuó en todos los casos con anfotericina B y el de mantenimiento con fluconazol. La mortalidad fue de 35,8% y resultó superior en aquellos pacientes con recaídas (41,3%, en comparación con los que experimentaban el primer episodio de la enfermedad (33,3%.Clinic, epidemiological and microbiological characteristics of 128 episodes of cryptococcosis were retrospectively evaluated in 106 positive HIV patients hospitalized at the Paroissien Hospital on period 1996- 2007. There were 75 male and 31 female patients, with a median age of 34 years, ranging from 20 to 68 years. Addiction to intravenous drugs was the main cause of HIV infection in 55 patients (51.9%. Cryptococcosis was detected as single episode in 85 patients (80.2% and as relapse in 19 (17.9%. It

  18. 艾滋病合并播散性隐球菌病的胸腹部CT表现%The Chest and Abdomen CT Findings of the Disseminated Cryptococcosis in Patients with AIDS

    Institute of Scientific and Technical Information of China (English)

    张烈光; 刘晋新; 江松峰; 陈碧华; 黄德扬

    2013-01-01

    Objective To study the chest and abdomen CT findings of the disseminated cryptococcosis in patients with AIDS.Materials and Methods The chest and abdomen CT imaging features of the disseminated cryptococcosis in 28 patients with AIDS were retro spectively analyzed.Results 28 cases underwent chest CT scan.Pulmonary nodules were seen in 27 (96.43%,27/28) cases.Cavitation in nodule was present in 19 (67.86%,19/28) cases.Ground-glass opacities were seen in 14(50%,14/28) cases.Patch opacities were seen in 2(7.14%,2/28) cases.The enlarged mediastinal and hilar lymph nodes were seen in 11 (40.74%,11/28) cases.Pleural effusion was seen in 6(21.43%,6/28)cases,pericardial effusion was seen in 4(14.29%,4/28) cases.11 of 28 cases underwent abdominal CT scan.Hepatosplenomegaly were seen in 8(72.73%,8/11) cases.Lesions in liver and spleen were found in 2(18.18%,2/11) cases which involved mass and diffused micro-nodules in liver in 1 case and low density node in spleen in 1 case.Abdominal lymph adenopathy were seen in 4(36.36%,4/11)cases and sandwich sign in the small bowel mesentery was seen in 3(27.27%,3/11) cases.Nodule in adrenal gland was seen in 1(9.09%,1/11) case.Ascites were seen in 1(9.09%,1/11) case.Conclusion Pulmonary nodules were the most common CT findings of the disseminated cryptococcosis in patients with AIDS.Cavitation in nodule was characteristic CT findings.Multiple organs can be involved in the abdomen.%目的 探讨艾滋病(Acquired immunodeficiency syndrome,AIDS)合并播散性隐球菌病的胸腹部CT表现.方法 回顾性分析28例艾滋病合并播散性隐球菌病的胸腹部CT表现.结果 28例艾滋病合并播散性隐球菌病胸部CT示肺内结节2 7例(96.43%,27/28),其中19例(67.86%,19/28)结节内可见空洞;肺内磨玻璃样改变14例(50%,14/28);肺内片状实变2例(7.14%,2/28);纵隔肺门淋巴结肿大11例(40.74%,11/28);胸腔积液6例(21.43%,6/28);心包积液4例(14.29%,4/28).11

  19. HIV Suppression Restores the Lung Mucosal CD4+ T-Cell Viral Immune Response and Resolves CD8+ T-Cell Alveolitis in Patients at Risk for HIV-Associated Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Popescu, Iulia; Drummond, M Bradley; Gama, Lucio; Lambert, Allison; Hoji, Aki; Coon, Tiffany; Merlo, Christian A; Wise, Robert A; Keruly, Jeanne; Clements, Janice E; Kirk, Gregory D; McDyer, John F

    2016-11-15

     Lung CD4(+) T-cell depletion and dysfunction, CD8(+) T-cell alveolitis, smoking, and poor control of human immunodeficiency virus (HIV) are features of HIV-associated chronic obstructive pulmonary disease (COPD), but these changes have not been evaluated in smokers at risk for COPD. We evaluated the impact of viral suppression following initiation of antiretroviral therapy (ART) on HIV-specific immunity and the balance of the CD4(+) T-cell to CD8(+) T-cell ratio in the lung.  Using flow cytometry, we assessed the T-cell immune response in lung and blood specimens obtained from 12 actively smoking HIV-positive patients before ART initiation and after ART-associated viral suppression.  HIV suppression resulted in enhanced lung and systemic HIV-specific CD4(+) T-cell immune responses without significant changes in CD8(+) T-cell responses. We observed an increase in lung ratios of CD4(+) T cells to CD8(+) T cells and CD4(+) T-cell frequencies, decreased CD8(+) T-cell numbers, and resolution of CD8(+) T-cell alveolitis after ART in 9 of 12 individuals. Viral suppression reduced Fas receptor and programmed death 1 expression in lung CD4(+) T cells, correlating with enhanced effector function and reduced susceptibility to apoptosis. HIV suppression rescued peripheral but not lung HIV-specific CD4(+) T-cell proliferation, resulting in augmented effector multifunction.  Together, our results demonstrate that HIV suppression restores lung mucosal HIV-specific CD4(+) T-cell multifunctional immunity and balance in the ratio of CD4(+) T cells to CD8(+) T cells, often resolving CD8(+) T-cell alveolitis in active smokers. Peripheral expansion and redistribution of CD4(+) T cells and increased resistance to apoptosis are 2 mechanisms contributing to immunologic improvement following viral suppression in patients at risk for HIV-associated COPD. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For

  20. Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings

    Science.gov (United States)

    Kamerman, Peter R.; Veliotes, Demetri G. A.; Phillips, Tudor J.; Asboe, David; Boffito, Marta; Rice, Andrew S. C.

    2016-01-01

    HIV-associated sensory peripheral neuropathy (HIV-SN) afflicts approximately 50% of patients on antiretroviral therapy, and is associated with significant neuropathic pain. Simple accurate diagnostic instruments are required for clinical research and daily practice in both high- and low-resource setting. A 4-item clinical tool (CHANT: Clinical HIV-associated Neuropathy Tool) assessing symptoms (pain and numbness) and signs (ankle reflexes and vibration sense) was developed by selecting and combining the most accurate measurands from a deep phenotyping study of HIV positive people (Pain In Neuropathy Study–HIV-PINS). CHANT was alpha-tested in silico against the HIV-PINS dataset and then clinically validated and field-tested in HIV-positive cohorts in London, UK and Johannesburg, South Africa. The Utah Early Neuropathy Score (UENS) was used as the reference standard in both settings. In a second step, neuropathic pain in the presence of HIV-SN was assessed using the Douleur Neuropathique en 4 Questions (DN4)-interview and a body map. CHANT achieved high accuracy on alpha-testing with sensitivity and specificity of 82% and 90%, respectively. In 30 patients in London, CHANT diagnosed 43.3% (13/30) HIV-SN (66.7% with neuropathic pain); sensitivity = 100%, specificity = 85%, and likelihood ratio = 6.7 versus UENS, internal consistency = 0.88 (Cronbach alpha), average item-total correlation = 0.73 (Spearman’s Rho), and inter-tester concordance > 0.93 (Spearman’s Rho). In 50 patients in Johannesburg, CHANT diagnosed 66% (33/50) HIV-SN (78.8% neuropathic pain); sensitivity = 74.4%, specificity = 85.7%, and likelihood ratio = 5.29 versus UENS. A positive CHANT score markedly increased of pre- to post-test clinical certainty of HIV-SN from 43% to 83% in London, and from 66% to 92% in Johannesburg. In conclusion, a combination of four easily and quickly assessed clinical items can be used to accurately diagnose HIV-SN. DN4-interview used in the context of bilateral feet

  1. 孤立结节型肺隐球菌病的多排螺旋CT表现%Clinical Features of Pulmonary Cryptococcosis of Solitary Nodular Type as Manifested by Multi-spiral Computed Tomography

    Institute of Scientific and Technical Information of China (English)

    邢维明; 左玉强; 贾丽萍; 苌永利

    2016-01-01

    目的:探讨肺内孤立结节型肺隐球菌病的多排螺旋CT表现,以提高其诊断正确率。方法回顾性分析18例经病理证实的孤立结节型肺隐球菌病患者的螺旋CT表现。结果18例病变中,有13例位于胸膜下,12例位于肺下叶;CT表现为类圆形结节16例、空气支气管征15例、血管集束征8例、宽基底与胸膜相连7例、晕征6例、胸膜反应5例、胸膜凹陷2例、毛刺征4例、分叶征2例。结论孤立结节型肺隐球菌病的多排螺旋CT表现有一定的特征性,认真分析其征象有助于提高该病的诊断正确率。%Objective To investigate the clinical manifestations of pulmonary crytococcosis (PC) of solitary nodular type as illustrated by multi-spiral computed tomography so as to improve the diagnostic accuracy.Methods The CT images of 18 patients diagnosed with pulmonary crytococcosis were reviewed retrospectively, all the diagnoses were pathologically conifrmed.Results Among the 18 cases, 13 nodules were located in subpleural regions and 12 nodules were located in lower lobes. CT images indicated that circular nodules were found in 16 cases, air bronchogram was found in 15 cases, vascular convergence was found in 8 cases, 7 cases clinged to pleura with wide basement, halo sign was found in 6 cases, pleural reaction was found in 5 cases, pleural indentation was found in 2 cases, spicule sign was found in 4 cases, slender spiculation was found in 2 cases.Conclusion As manifested by the multi-spiral computed tomography imaging, the clinical features of pulmonary cryptococcosis of solitary nodular type had certain characteristic idiosyncrasy. Careful analysis of CT imaging of the solitary PC can help improve the diagnostic accuracy.

  2. Value of conventionally fractionated radiotherapy for the local treatment of HIV associated Kaposi`s sarcoma; Wertigkeit konventionell fraktionierter Radiotherapie bei der lokalen Behandlung des HIV-assoziierten Kaposi-Sarkoms

    Energy Technology Data Exchange (ETDEWEB)

    Saran, F. [Abt. fuer Strahlentherapie und Onkologie, Zentrum der Radiologie, Frankfurt Univ. (Germany); Adamietz, I.A. [Abt. fuer Strahlentherapie und Onkologie, Zentrum der Radiologie, Frankfurt Univ. (Germany); Mose, S. [Abt. fuer Strahlentherapie und Onkologie, Zentrum der Radiologie, Frankfurt Univ. (Germany); Thilmann, C. [Abt. fuer Strahlentherapie und Onkologie, Zentrum der Radiologie, Frankfurt Univ. (Germany); Boettcher, H.D. [Abt. fuer Strahlentherapie und Onkologie, Zentrum der Radiologie, Frankfurt Univ. (Germany)

    1995-10-01

    From June 1991 to June 1993, 43 patients with 111 HIV-associated Kaposi`s sarcoma of the skin or oral cavity were treated. Lesions were irradiated with 5 to 12 MeV electrons or 60Co gamma-rays. The fractionation scheme was 5 times 2 Gy/week for skin and enoral lesions with a total reference dosage of up to 20 Gy. Side effects were assessed during therapy and the therapeutic result 6 weeks after end of treatment. Thirty-eight out of 111 lesions were judged as complete response (CR) (34%), 61/111 as partial response (PR) (55%) and 12/111 were judged as no change (NC) (11%). Overall response (CR + PR) was 89%. Two patients with lesions of oral cavity suffered from RTOG grade-IV mucositis after 10 and 14 Gy. In 71/106 skin lesions (67%), radiation induced RTOG grade-I reactions were observed. Conclusion: In patients with HIV associated Kaposi`s sarcoma effective palliation can be achieved by means of radiotherapy with an overall dose of 20 Gy in conventional fractionation. Yet, the fraction of patients with complete responses is with 34 to 47% lower compared with doses above 20 Gy (66 to 100%). With reference to the reported data our results point to a dose-response relationship for Kaposi`s sarcoma. Therefore higher total reference doses, e.g. 30 Gy with weekly 5 times 2 Gy or 24 Gy with 5 times 1.6 Gy for mucous lesions, respectively, are suggested as by this mean the complete response rate can be coubled. (orig./MG) [Deutsch] Von Juni 1991 bis Juni 1993 wurden 43 Patienten mit 111 HIV-assoziierten Kaposi-Sarkomen der Haut oder des Mund- und Rachenraums behandelt. Die Laesionen wurden mit 5- bis 12-MeV-Elektronen oder Co-60-Gammastrahlen bestrahlt. Das Fraktionierungsschema betrug 5mal 2 Gy/Woche bei kutanen und enoralen Laesionen bis zu einer Gesamtreferenzdosis von 20 Gy. Nebenwirkungen wurden waehrend und das Ergebnis sechs Wochen nach Abschluss der Radiotherapie beurteilt. In 38 von 111 Laesionen wurde eine komplette Remission (CR) erzielt (34%), in 61/111 eine

  3. First evidence of overlaps between HIV-Associated Dementia (HAD and non-viral neurodegenerative diseases: proteomic analysis of the frontal cortex from HIV+ patients with and without dementia

    Directory of Open Access Journals (Sweden)

    Kapur Amit

    2010-06-01

    Full Text Available Abstract Background The pathogenesis of HIV-associated dementia (HAD is poorly understood. To date, detailed proteomic fingerprinting directly from autopsied brain tissues of HAD and HIV non-dementia patients has not been performed. Result Here, we have analyzed total proteins from the frontal cortex of 9 HAD and 5 HIV non-dementia patients. Using 2-Dimensional differential in-gel electrophoresis (2-DIGE to analyze the brain tissue proteome, 76 differentially expressed proteins (p 1.25 were identified between HAD and HIV non-dementia patients, of which 36 protein spots (based on 3D appearance of spots on the images were chosen for the mass spectrometry analysis. The large majority of identified proteins were represented in the energy metabolic (mitochondria and signal transduction pathways. Furthermore, over 90% of the protein candidates are common to both HAD and other non-viral neurodegenerative disease, such as Alzheimer's disease. The data was further validated using specific antibodies to 4 proteins (CA2, GS, CKMT and CRMP2 by western blot (WB in the same samples used for 2D-DIGE, with additional confirmation by immunohistochemitsry (IHC using frontal lobe tissue from different HAD and HIV+ non-dementia patients. The validation for all 4 antibodies by WB and IHC was in concordance with the DIGE results, lending further credence to the current findings. Conclusion These results suggest not only convergent pathogenetic pathways for the two diseases but also the possibility of increased Alzheimer's disease (AD susceptibility in HAD patients whose life expectancy has been significantly increased by highly active antiretroviral therapy.

  4. HIV-Associated TB: Facts 2013

    Science.gov (United States)

    ... drug-resistant TB such as multi-drug resistant (MDR-TB) and extensively drug resistant TB (XDR-TB). COLLABORATIVE ... design and costing of expanded TB/HIV and MDR-TB components within the Stop TB Partnership' s Global Plan ...

  5. Sertraline for HIV-associated cryptococcal meningitis

    NARCIS (Netherlands)

    Veringa, Anette; van der Elst, Kim C. M.; Day, Jeremy N.; Thwaites, Guy E.; Alffenaar, Jan-Willem C.

    2016-01-01

    Joshua Rhein and colleagues1 used measurements of sertraline plasma concentrations and the minimum inhibitory concentrations (MICs) for sertraline to determine the probability of achieving therapeutic sertraline concentrations in the brains of patients with cryptococcal meningitis. As mentioned by J

  6. Evolving epidemiology of HIV-associated malignancies.

    Science.gov (United States)

    Shiels, Meredith S; Engels, Eric A

    2017-01-01

    The purpose of this review is to describe the epidemiology of cancers that occur at an elevated rate among people with HIV infection in the current treatment era, including discussion of the cause of these cancers, as well as changes in cancer incidence and burden over time. Rates of Kaposi sarcoma, non-Hodgkin lymphoma and cervical cancer have declined sharply in developed countries during the highly active antiretroviral therapy era, but remain elevated 800-fold, 10-fold and four-fold, respectively, compared with the general population. Most studies have reported significant increases in liver cancer rates and decreases in lung cancer over time. Although some studies have reported significant increases in anal cancer rates and declines in Hodgkin lymphoma rates, others have shown stable incidence. Declining mortality among HIV-infected individuals has resulted in the growth and aging of the HIV-infected population, causing an increase in the number of non-AIDS-defining cancers diagnosed each year in HIV-infected people. The epidemiology of cancer among HIV-infected people has evolved since the beginning of the HIV epidemic with particularly marked changes since the introduction of modern treatment. Public health interventions aimed at prevention and early detection of cancer among HIV-infected people are needed.

  7. Geographically structured populations of Cryptococcus neoformans Variety grubii in Asia correlate with HIV status and show a clonal population structure.

    Directory of Open Access Journals (Sweden)

    Kantarawee Khayhan

    Full Text Available Cryptococcosis is an important fungal disease in Asia with an estimated 140,000 new infections annually the majority of which occurs in patients suffering from HIV/AIDS. Cryptococcus neoformans variety grubii (serotype A is the major causative agent of this disease. In the present study, multilocus sequence typing (MLST using the ISHAM MLST consensus scheme for the C. neoformans/C. gattii species complex was used to analyse nucleotide polymorphisms among 476 isolates of this pathogen obtained from 8 Asian countries. Population genetic analysis showed that the Asian C. neoformans var. grubii population shows limited genetic diversity and demonstrates a largely clonal mode of reproduction when compared with the global MLST dataset. HIV-status, sequence types and geography were found to be confounded. However, a correlation between sequence types and isolates from HIV-negative patients was observed among the Asian isolates. Observations of high gene flow between the Middle Eastern and the Southeastern Asian populations suggest that immigrant workers in the Middle East were originally infected in Southeastern Asia.

  8. Detection of lipoarabinomannan (LAM) in urine is an independent predictor of mortality risk in patients receiving treatment for HIV-associated tuberculosis in sub-Saharan Africa: a systematic review and meta-analysis.

    Science.gov (United States)

    Gupta-Wright, Ankur; Peters, Jurgens A; Flach, Clare; Lawn, Stephen D

    2016-03-23

    Simple immune capture assays that detect mycobacterial lipoarabinomannan (LAM) antigen in urine are promising new tools for the diagnosis of HIV-associated tuberculosis (HIV-TB). In addition, however, recent prospective cohort studies of patients with HIV-TB have demonstrated associations between LAM in the urine and increased mortality risk during TB treatment, indicating an additional utility of urinary LAM as a prognostic marker. We conducted a systematic review and meta-analysis to summarise the evidence concerning the strength of this relationship in adults with HIV-TB in sub-Saharan Africa, thereby quantifying the assay's prognostic value. We searched MEDLINE and Embase databases using comprehensive search terms for 'HIV', 'TB', 'LAM' and 'sub-Saharan Africa'. Identified studies were reviewed and selected according to predefined criteria. We identified 10 studies eligible for inclusion in this systematic review, reporting on a total of 1172 HIV-TB cases. Of these, 512 patients (44 %) tested positive for urinary LAM. After a variable duration of follow-up of between 2 and 6 months, overall case fatality rates among HIV-TB cases varied between 7 % and 53 %. Pooled summary estimates generated by random-effects meta-analysis showed a two-fold increased risk of mortality for urinary LAM-positive HIV-TB cases compared to urinary LAM-negative HIV-TB cases (relative risk 2.3, 95 % confidence interval 1.6-3.1). Some heterogeneity was explained by study setting and patient population in sub-group analyses. Five studies also reported multivariable analyses of risk factors for mortality, and pooled summary estimates demonstrated over two-fold increased mortality risk (odds ratio 2.5, 95 % confidence interval 1.4-4.5) among urinary LAM-positive HIV-TB cases, even after adjustment for other risk factors for mortality, including CD4 cell count. We have demonstrated that detectable LAM in urine is associated with increased risk of mortality during TB treatment, and that this

  9. USCIS My Case Status

    Data.gov (United States)

    Department of Homeland Security — USCIS provide a way for the public who applied for U.S. citizenship to check the status of their application online. To view the status of a case, the application...

  10. Comparison of Montreal cognitive assessment scale and minimental state examination scale in screening HIV-associated neurocognitive disorders in Shenzhen, China%MoCA和MMSE在HIV相关性神经认知损害筛查中的比较

    Institute of Scientific and Technical Information of China (English)

    赵方; 邓永; 孙丽琴; 徐六妹; 李莎西; 王辉; 刘映霞

    2015-01-01

    目的 比较蒙特利尔认知评估量表(MoCA)和简易精神状态量表(MMSE)在筛查HIV相关性神经认知障碍(HAND)中的能力.方法 用MoCA量表和MMSE量表对门诊127例HIV/AIDS患者及60例健康对照进行测试,并对测试结果进行比较和统计分析.结果 MoCA量表得分在HIV +/AIDS组(26.28 ±2.43分)和HIV-对照组(27.33±1.30分)之间差异有统计学意义(P<0.01).MMSE量表得分在HIV +/AIDS组(27.45 ±1.31分)和对照组(27.70±0.89分)之间没有统计学差别(P=0.139).使用MoCA量表,HIV +/AIDS组的HAND患病率明显大于对照组(x2=16.01,P<0.001).使用MMSE量表在筛查HAND患病率,两组之间无差别(x2=2.37,P=0.124).结论 MoCA量表在筛查HIV相关性认知功能损害的敏感性优于MMSE量表,比较适合目前临床上HAND的早期筛查.%Objective To compare the performance of Montreal cognitive assessment scale (MoCA) and minimental state examination scale (MMSE) in screening HIV-associated neurocognitive disorders (HAND).Methods A case-control study of 127 HIV + and 60 HIV-individuals.All the subjects' cognitive functions were assessed using MoCA and MMSE separately.Results Mean MoCA score in cases was 26.28 ± 2.43 compared to 27.33 ± 1.30 in controls (P < 0.01).Mean MMSE score in cases was 27.45 ± 1.31 compared to 27.70 ±0.89 in controls (P =0.139).Using the MoCA screening revealed 43 (33.9%) cases had HAND compared with 6 (6.7 %) controls (x2 =16.01,P < 0.001).Using MMSE,6 (4.7%) cases and 1(1.7%) control had HAND (P=0.124).Conclusion The MoCA scale is more sensitive in deteting HAND than MMSE and is suited for the early cognitive screening of HIV patients in clinic.

  11. Heuristic status polling

    Science.gov (United States)

    Archer, Charles J.; Blocksome, Michael A.; Heidelberger, Philip; Kumar, Sameer; Parker, Jeffrey J.; Ratterman, Joseph D.

    2011-06-07

    Methods, compute nodes, and computer program products are provided for heuristic status polling of a component in a computing system. Embodiments include receiving, by a polling module from a requesting application, a status request requesting status of a component; determining, by the polling module, whether an activity history for the component satisfies heuristic polling criteria; polling, by the polling module, the component for status if the activity history for the component satisfies the heuristic polling criteria; and not polling, by the polling module, the component for status if the activity history for the component does not satisfy the heuristic criteria.

  12. 中国大陆地区肺隐球菌病临床表现的Meta分析%Meta-Analysis of Clinical Manifestations of Pulmonary Cryptococcosis in China Mainland

    Institute of Scientific and Technical Information of China (English)

    王葆青; 张含之; 范壁君; 何礼贤

    2013-01-01

    Objective:To investigate the clinical characteristics of pulmonary cryptococcosis(PC) in recent years in China mainland,which can be used as the scientific reference for the diagnosis and treatment of PC.Methods:CNKI website China Knowledge Resource Integrated Database have been digged into to collect the case reports of PC from the domestic statistical source journals from Jan 1981 to Dec 2008 to carry out Meta-analysis.Results:(1)A total of 113 reports have been selected and 728 patients with PC were reported.There were 505 males and 223 females.(2) 86.4 % (506/585) patients had no contact history of bird droppings and soil etc.(3)69.7 % (404/580) patients had no underlying diseases.The common underlying diseases were acquired immune deficiency syndrome(AIDS),diabetes,malignant tumor etc.71.5 % (434/607) patients went to hospital because of cough,expectoration,fever,chest pain etc.Few patients had physical abnormity.(4)The regular laboratory examinations have no specificity.(5)As to the thoracic radiological manifestation,71.8 % (155/216) patients were characterized by nodular lump shadows; 20.8 % (45/216) by flake-like infiltrated shadows,and 7.4 %(16/216) had diffuse mixed lesions.Nodular lump shadows mostly occured in the patients without underlying diseases,while diffuse mixed lesions mostly occured in the patients with underlying diseases.(6)84.3 % (166/197) patients' pathological finding was granulation tumor.(7)56.7 % (310/547) patients got their definite diagnosis by pathological test after the operation.The other ways to make the definite diagnosis were the pathological test results of the percutaneous needle lung biopsy,electron tracheoscope-guided transbronchial lung biopsy and lymph node puncture,the culture results of samples from respiratory tract or other humor etc.Conclusions:In China mainland,most patients with PC have no underlying diseases.The typical clinical manifestations are the symptoms and signs of respiratory system

  13. Service Level Status

    CERN Multimedia

    Lopienski, S

    2007-01-01

    Nowadays, IT departments provide, and people use, computing services of an increasingly heterogeneous nature. There is thus a growing need for a status display that groups these different services and reports status and availability in a uniform way. The Service Level Status (SLS) system addresses these needs by providing a web-based display that dynamically shows availability, basic information and statistics about various IT services, as well as the dependencies between them.

  14. SIS - Status Determination

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Status Determination dataset within the Species Information System (SIS) contains information related to overfishing, overfished, and approaching overfished...

  15. Analysis of clinical and pathological features of HIV associated renal disease%八例HIV感染合并肾脏损害患者的临床病理分析

    Institute of Scientific and Technical Information of China (English)

    马杰; 文煜冰; 郑可; 高瑞通; 蔡建芳; 于阳; 李太生; 李雪梅

    2013-01-01

    病理表现特点及治疗转归.方法 选取2002年至2012年北京协和医院住院的HIV感染合并肾脏损害并接受过肾脏活检的8例患者为研究对象,回顾分析患者的肾脏病理资料和治疗转归情况.结果 8例患者均有不同程度的蛋白尿,6例患者有镜下血尿,2例患者Scr升高.肾脏病理改变:IgA肾病4例,狼疮样肾炎、非特殊型局灶节段性肾小球硬化、膜性肾病、紫癜性肾炎各1例.8例患者均接受了高效联合抗反转录病毒(highlyactive antiretroviral treatment,HAART)治疗,1例患者单用HAART治疗后蛋白尿明显缓解;1例加用血管紧张素转换酶抑制剂和(或)血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)治疗后好转.余6例患者接受了糖皮质激素治疗,2例好转;1例无缓解加用环孢素A治疗,1例ACEI/ARB治疗效果不佳加用糖皮质激素治疗暂无好转;1例肾脏病情加重,因原发病死亡;1例合并IgA肾病患者糖皮质激素治疗肾脏病情稳定,2年后尿蛋白量增加,调整抗病毒治疗后肾脏病情缓解.结论 HIV感染可以合并多种类型的肾脏损害,经典的HIV感染相关肾病(HIV-associated nephropathy,HIVAN)在中国HIV感染者中并不常见.肾脏活检有助于明确诊断,指导治疗.若HAART治疗效果不佳可考虑使用糖皮质激素.

  16. Nuclear proliferation status report. Status report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1992-07-01

    This report contains information concerning the nuclear proliferation status of the following countries: (1) Russia, (2) Ukraine, (3) Belarus, (4) Kazakhstan, (5) Israel, (6) India, (7) Pakistan, (8) South Africa, (9) North Korea, (10) Iraq, (11) Iran, (12) Lybia, (13) Algeria, (14) Syria, (15) Brazil, (16) Argentina, and (17) Taiwan.

  17. Status of APEmille

    CERN Document Server

    Bartoloni, A; Cabibbo, Nicola; Calvayrac, F; Della Morte, M; De Pietri, R; De Riso, P; Carlo, F D; Renzo, F D; Errico, W; Frezzotti, R; Giorgino, T; Heitger, J; Lonardo, A; Loukianov, M; Magazzù, G; Micheli, J; Morénas, V; Paschedag, N; Pène, O; Petronzio, Roberto; Pleiter, D; Rapuano, F; Rolf, J; Rossetti, D; Sartori, L; Simma, H; Schifano, F; Torelli, M; Tripiccione, R; Vicini, P; Wegner, P

    2002-01-01

    This paper presents the status of the APEmille project, which is essentially completed, as far as machine development and construction is concerned. Several large installations of APEmille are in use for physics production runs leading to many new results presented at this conference. This paper briefly summarizes the APEmille architecture, reviews the status of the installations and presents some performance figures for physics codes.

  18. Beauty as Status.

    Science.gov (United States)

    Webster, Murray, Jr.; Driskell, James E., Jr.

    1983-01-01

    Many effects of physical attractiveness can be explained by viewing it as a status characteristic and applying a theory of status characteristics and expectations to it. Tests showed that attractiveness produces predictable differences in expectations and attractiveness characteristics can be modified in combination with additional status…

  19. Adolescent Weight Status

    DEFF Research Database (Denmark)

    Holstein, Bjørn Evald; Due, Pernille; Brixval, Carina Sjöberg;

    2017-01-01

    day) communication with friends through cellphones, SMS messages, or Internet (1.66, 1.03-2.67). In the full population, overweight/obese weight status was associated with not perceiving best friend as a confidant (1.59, 1.11-2.28). No associations were found between weight status and number of close...

  20. Status dystonicus in childhood.

    Science.gov (United States)

    Touati, Nahla; Ben Rhouma, Hanène; Kraoua, Ichraf; Klaa, Hédia; Turki, Ilhem; Gouider-Khouja, Neziha

    2015-12-01

    Status Dystonicus is a rare complication of dystonia. It is a life threatening disorder that needs urgent treatment.The aim of this study is to describe clinical features, management and follow up of children with Status Dystonicus. - We conducted a retrospective study over an 8-year period including all patients diagnosed with Status Dystonicus. Clinical characteristics, etiologies and management were analyzed. - Ten patients were included. Main features of Status Dystonicus were a severe generalized dystonia with vegetative signs. Laryngeal spasm and swallowing disorders were observed in 4 cases. Several treatments such as Levodopa, Anticholinergics, Baclofen, Benzodiazepines and Neuroleptics were tried. Mechanical ventilation was required in 4 cases. Two patients died due to rhabdomyolysis and respiratory failure. Others returned to their pre-Status Dystonicus. - Status Dystonicus is a life threatening condition that needs an urgent management on an intensive care unit. In fact, patients with Status Dystonicus can develop respiratory failure and metabolic complications.On the basis of our experience, we delineated a therapeutic approach in which the patient with Status Dystonicus needs supportive care, specific therapy of dystonia and intravenous sedative treatment.

  1. Fighting status inequalities

    DEFF Research Database (Denmark)

    Nielsen, Morten Ebbe Juul; Landes, Xavier

    2016-01-01

    Status inequalities seem to play a fairly big role in creating inequalities in health. This article assumes that there can be good reasons to fight status inequalities in order to reduce inequalities in health. It examines whether the neorepublican ideal of non-dominance does a better job...

  2. Status epilepticus in adults.

    Science.gov (United States)

    Betjemann, John P; Lowenstein, Daniel H

    2015-06-01

    Status epilepticus is a common neurological emergency with considerable associated health-care costs, morbidity, and mortality. The definition of status epilepticus as a prolonged seizure or a series of seizures with incomplete return to baseline is under reconsideration in an effort to establish a more practical definition to guide management. Clinical research has focused on early seizure termination in the prehospital setting. The approach of early escalation to anaesthetic agents for refractory generalised convulsive status epilepticus, rather than additional trials of second-line anti-epileptic drugs, to avoid neuronal injury and pharmaco-resistance associated with prolonged seizures is gaining momentum. Status epilepticus is also increasingly identified in the inpatient setting as the use of extended electroencephalography monitoring becomes more commonplace. Substantial further research to enable early identification of status epilepticus and efficacy of anti-epileptic drugs will be important to improve outcomes.

  3. STATUS GIZI DAN STATUS KESEHATAN SUKU BADUY

    Directory of Open Access Journals (Sweden)

    Faisal Anwar

    2012-03-01

    Full Text Available 800x600 Normal 0 false false false IN X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} The objectives of the study were: (1 To analyze the socio-economic and demographic characteristics of Baduy people; (2 To analyze the health status and nutritional status of Baduy people and its influential factors. This research is an explorative and descriptive study on the socio-cultural aspects of food system. The data were collected through a direct interview and discussion with respondents as well as a direct observation at the location of respondents. A sample size of 338 households was drawn from the population. To obtain the data on the cultural aspects, history and  socio aspect of food, in-depth interviews was conducted with 19 key persons. The study was last for 12 months. In Outer Baduy, the factors significantly related to nutritional status are age, number of household size, income, nutritional knowledge, and wife’s ability to read. In Moslem Baduy, only age and income are related to the nutritional status of children. In Moslem Baduy and the Outer Baduy, the correlation between age and W/A or W/H is similar: namely, the higher the age, the lower would the Z-score for the W/A or W/H. The income is significantly correlated to the child nutritional status according to Z-score for W/A with a high correlation coefficient, that is, 0.61. This means that the higher the income, the higher would be the Z-score value for the W/A.  The distribution of adults according to BMI classification in Outer Baduy it shows that 12.7% husbands and 17.6% wives are thin (wasted, while the

  4. Aleutian Goose Status Report

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This 1995-96 status report includes the most recent observations of Aleutian Canada geese populations wintering in the El Sobrante and East San Francisco Bay areas...

  5. NAIP Status Maps Gallery

    Data.gov (United States)

    Farm Service Agency, Department of Agriculture — NAIP Status Maps Gallery. These maps illustrate what aerial imagery collection is planned, whats been collected, when it is available and how it is available. These...

  6. Deadline Compliance Status Reports

    Data.gov (United States)

    Department of Housing and Urban Development — These monthly Deadline Compliance Status Reports assist Participating Jurisdictions and HUD Field Offices in monitoring compliance with the 2-year commitment and...

  7. AUTO FIB Current Status

    Science.gov (United States)

    Parry, I.; Sharples, R. M.

    The current status of the automated fibre positioner, Autofib, is reviewed including the positioning performance and the set-up speed. Future plans to build another Autofib for the 4.2 m William Herschel Telescope are also briefly discussed.

  8. Status of ADSW 2005

    DEFF Research Database (Denmark)

    Hartmann, H.; Ahring, Birgitte Kiær

    2006-01-01

    The status of the recent developments in anaerobic digestion of solid waste (ADSW) is outlined on the basis of a selection of papers presented at the 4(th) International Symposium on ADSW 2005.......The status of the recent developments in anaerobic digestion of solid waste (ADSW) is outlined on the basis of a selection of papers presented at the 4(th) International Symposium on ADSW 2005....

  9. Status of numerical relativity

    Indian Academy of Sciences (India)

    Masaru Shibata

    2004-10-01

    I describe the current status of numerical relativity from my personal point of view. Here, I focus mainly on explaining the numerical implementations necessary for simulating general relativistic phenomena such as the merger of compact binaries and stellar collapse, emphasizing the well-developed current status of such implementations that enable simulations for several astrophysical phenomena. Some of our latest results for simulation of binary neutron star mergers are briefly presented.

  10. STATUS EPILEPTICUS: A REVIEW

    Directory of Open Access Journals (Sweden)

    B. Adibeik

    2009-01-01

    Full Text Available ObjectiveStatus Epilepticus (SE has been described as a series of major motor seizure without recovery of consciousness between seizures.SE is a medical emergency that requires prompt diagnosis and appropriate treatment.In this article we shall conclude history, epidemiology, etiology, risk factors, thebest management as well as the prognosis of the condition.Keywords:Status Epilepticus (SE, adults, children, neonates.

  11. Safety system status monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, J.R.; Morgenstern, M.H.; Rideout, T.H.; Cowley, P.J.

    1984-03-01

    The Pacific Northwest Laboratory has studied the safety aspects of monitoring the preoperational status of safety systems in nuclear power plants. The goals of the study were to assess for the NRC the effectiveness of current monitoring systems and procedures, to develop near-term guidelines for reducing human errors associated with monitoring safety system status, and to recommend a regulatory position on this issue. A review of safety system status monitoring practices indicated that current systems and procedures do not adequately aid control room operators in monitoring safety system status. This is true even of some systems and procedures installed to meet existing regulatory guidelines (Regulatory Guide 1.47). In consequence, this report suggests acceptance criteria for meeting the functional requirements of an adequate system for monitoring safety system status. Also suggested are near-term guidelines that could reduce the likelihood of human errors in specific, high-priority status monitoring tasks. It is recommended that (1) Regulatory Guide 1.47 be revised to address these acceptance criteria, and (2) the revised Regulatory Guide 1.47 be applied to all plants, including those built since the issuance of the original Regulatory Guide.

  12. Refractory status epilepticus

    Directory of Open Access Journals (Sweden)

    Sanjay P Singh

    2014-01-01

    Full Text Available Refractory status epilepticus is a potentially life-threatening medical emergency. It requires early diagnosis and treatment. There is a lack of consensus upon its semantic definition of whether it is status epilepticus that continues despite treatment with benzodiazepine and one antiepileptic medication (AED, i.e., Lorazepam + phenytoin. Others regard refractory status epilepticus as failure of benzodiazepine and 2 antiepileptic medications, i.e., Lorazepam + phenytoin + phenobarb. Up to 30% patients in SE fail to respond to two antiepileptic drugs (AEDs and 15% continue to have seizure activity despite use of three drugs. Mechanisms that have made the treatment even more challenging are GABA-R that is internalized during status epilepticus and upregulation of multidrug transporter proteins. All patients of refractory status epilepticus require continuous EEG monitoring. There are three main agents used in the treatment of RSE. These include pentobarbital or thiopental, midazolam and propofol. RSE was shown to result in mortality in 35% cases, 39.13% of patients were left with severe neurological deficits, while another 13% had mild neurological deficits.

  13. STATUS GIZI BATITA

    Directory of Open Access Journals (Sweden)

    Agustina Lubis

    2012-10-01

    Full Text Available Keadaan gizi golongan rawan khususnya anak batita (bawah tiga tahun dapat dipakai sebagai petunjuk keadaan gizi masyarakat. Penentuan status gizi biasanya dilakukan atas dasar pengukuran berat dan tinggi badan dengan menggunakan indeks berat menurut umur, berat menurut tinggi badan atau tinggi menurut umur. Prevalensi kurang gizi yang tinggi pada anak Batita menjadi petunjuk bahwa status gizi masyarakat tersebut masih rendah. Banyak faktor yang diduga mempengaruhi status gizi pada Batita, seperti faktor sosial, lingkungan dan penyakit infeksi. Untuk mengetahui seberapa jauh peran dari faktor-faktor tersebut di atas, dilakukan analisis data ini dengan menggunakan indeks anthropometri berat badan menurut umur.Sumber data yang digunakan adalah hasil Survei Kesejahteraan Keluarga Indonesia 1992 (IFLS. Penelitian ini bersifat cros sectional dan dilakukan di tujuh propinsi di Indonesia. Sebagai unit analisis adalah anak Batita (umur 1-3 tahun, dengan jumlah 1540 populasi.Hasil penelitian menunjukkan ada beberapa faktor yang berperan dalam status gizi anak antara lain adalah urutan kelahiran, pendidikan ibu, diare, panas dan jumlah anggota rumah tangga. Pola makan tidak mempengaruhi status gizi anak laki-laki ataupun anak perempuan. Besarnya anggota rumah tangga walaupun pada analisis bivariat memberikan pengaruh yang bermakna namun pada analisis multivariat tidak memberikan pengaruh yang bermakna, baik pada anak laki-laki ataupun perempuan. pada analisis multivariat untuk anak laki-laki hanya variabel unrutan kelahiran dan pendidikan ibu yang menunjukkan risiko yang bermakna. Sedangkan pada anak perempuan terdapat tiga variabel yang memberikan risiko yang bermakna yaitu urutan keluarga, diare dan panas.

  14. New Service Status Board

    CERN Multimedia

    2013-01-01

    On Monday 14 October, the Service Status Board for GS and IT will change. The new Status Board will be integrated with the CERN Service Portal and with the CERN Service Catalogue.   As of today, the SSB will display “Service Incidents”, “Planned Interventions” and “Service Changes”. References valid from 14 October: CERN SSB at https://cern.ch/ssb Computing SSB (previously IT SSB) at https://cern.ch/itssb   Nicole Cremel, IT and GS Service Management Support

  15. Nutritional Status Assessment

    Science.gov (United States)

    Smith, Scott M.

    2008-01-01

    Nutritional Status Assessment (Nutrition) is the most comprehensive inflight study done by NASA to date of human physiologic changes during long-duration space flight; this includes measures of bone metabolism, oxidative damage, nutritional assessments, and hormonal changes. This study will impact both the definition of nutritional requirements and development of food systems for future space exploration missions to the Moon and Mars. This experiment will also help to understand the impact of countermeasures (exercise and pharmaceuticals) on nutritional status and nutrient requirements for astronauts.

  16. FRIB Cryogenic Plant Status

    Energy Technology Data Exchange (ETDEWEB)

    Dixon, Kelly D. [Thomas Jefferson National Accelerator Facility (TJNAF), Newport News, VA (United States); Ganni, Venkatarao [Thomas Jefferson National Accelerator Facility (TJNAF), Newport News, VA (United States); Knudsen, Peter N. [Thomas Jefferson National Accelerator Facility (TJNAF), Newport News, VA (United States); Casagranda, Fabio [Michigan State Univ., East Lansing, MI (United States)

    2015-12-01

    After practical changes were approved to the initial conceptual design of the cryogenic system for MSU FRIB and an agreement was made with JLab in 2012 to lead the design effort of the cryogenic plant, many activities are in place leading toward a cool-down of the linacs prior to 2018. This is mostly due to using similar equipment used at CHLII for the 12 GeV upgrade at JLab and an aggressive schedule maintained by the MSU Conventional Facilities department. Reported here is an updated status of the cryogenic plant, including the equipment procurement status, plant layout, facility equipment and project schedule.

  17. A parallel genome-wide mRNA and microRNA profiling of the frontal cortex of HIV patients with and without HIV-associated dementia shows the role of axon guidance and downstream pathways in HIV-mediated neurodegeneration

    Directory of Open Access Journals (Sweden)

    Zhou Li

    2012-11-01

    Full Text Available Abstract Background HIV-associated dementia (HAD is the most common dementia type in young adults less than 40 years of age. Although the neurotoxins, oxidative/metabolic stress and impaired activity of neurotrophic factors are believed to be underlying reasons for the development of HAD, the genomic basis, which ultimately defines the virus-host interaction and leads to neurologic manifestation of HIV disease is lacking. Therefore, identifying HIV fingerprints on the host gene machinery and its regulation by microRNA holds a great promise and potential for improving our understanding of HAD pathogenesis, its diagnosis and therapy. Results A parallel profiling of mRNA and miRNA of the frontal cortex autopsies from HIV positive patients with and without dementia was performed using Illumina Human-6 BeadChip and Affymetrix version 1.0 miRNA array, respectively. The gene ontology and pathway analysis of the two data sets showed high concordance between miRNA and mRNAs, revealing significant interference with the host axon guidance and its downstream signalling pathways in HAD brains. Moreover, the differentially expressed (DE miRNAs identified in this study, in particular miR-137, 153 and 218, based on which most correlations were built cumulatively targeted neurodegeneration related pathways, implying their future potential in diagnosis, prognosis and possible therapies for HIV-mediated and possibly other neurodegenerative diseases. Furthermore, this relationship between DE miRNAs and DE mRNAs was also reflected in correlation analysis using Bayesian networks by splitting-averaging strategy (SA-BNs, which revealed 195 statistically significant correlated miRNA-mRNA pairs according to Pearson’s correlation test (P Conclusions Our study provides the first evidence on unambiguous support for intrinsic functional relationship between mRNA and miRNA in the context of HIV-mediated neurodegeneration, which shows that neurologic manifestation in HIV

  18. NASA Armstrong Status

    Science.gov (United States)

    Jacobson, Steven R.

    2014-01-01

    Armstrong (formerly Dryden) Flight Research Center continues it's legacy of exciting work in the area of dynamics and control of advanced vehicle concepts. This status presentation highlights the research and technology development that Armstrong's Control and Dynamics branch is performing in the areas of Control of Flexible Structures and Automated Cooperative Trajectories.

  19. Glueballs: a status report

    Energy Technology Data Exchange (ETDEWEB)

    Scharre, D.L.

    1982-01-01

    It is expected from quantum chromodynamics (QCD) that glueballs, bound states which contain gluons but no valence quarks, should exist. To date, no conclusive evidence for glueballs has been presented. After a brief review of the expected properties and experimental signatures of glueballs the status of some glueball candidate states are discussed.

  20. Amharic. Materials Status Report.

    Science.gov (United States)

    Center for Applied Linguistics, Washington, DC. Language/Area Reference Center.

    The materials status report for Amharic, the dominant language of Ethiopia, is one of a series intended to provide the nonspecialist with a picture of the availability and quality of texts for teaching various languages to English speakers. The report consists of: (1) a brief narrative description of Amharic, the areas where it is spoken, its…

  1. Algeria: Country Status Report.

    Science.gov (United States)

    McFerren, Margaret

    A survey of the status of language usage in Algeria begins with an overview of the usage patterns of Arabic, the Berber languages, and French. The country's return to Arabic as its official language after independence from France in 1962 is discussed along with the resultant language planning, issues of language of instruction at the elementary,…

  2. Status and the brain.

    Directory of Open Access Journals (Sweden)

    Amanda V Utevsky

    2014-09-01

    Full Text Available Social hierarchy is a fact of life for many animals. Navigating social hierarchy requires understanding one's own status relative to others and behaving accordingly, while achieving higher status may call upon cunning and strategic thinking. The neural mechanisms mediating social status have become increasingly well understood in invertebrates and model organisms like fish and mice but until recently have remained more opaque in humans and other primates. In a new study in this issue, Noonan and colleagues explore the neural correlates of social rank in macaques. Using both structural and functional brain imaging, they found neural changes associated with individual monkeys' social status, including alterations in the amygdala, hypothalamus, and brainstem--areas previously implicated in dominance-related behavior in other vertebrates. A separate but related network in the temporal and prefrontal cortex appears to mediate more cognitive aspects of strategic social behavior. These findings begin to delineate the neural circuits that enable us to navigate our own social worlds. A major remaining challenge is identifying how these networks contribute functionally to our social lives, which may open new avenues for developing innovative treatments for social disorders.

  3. Algeria: Country Status Report.

    Science.gov (United States)

    McFerren, Margaret

    A survey of the status of language usage in Algeria begins with an overview of the usage patterns of Arabic, the Berber languages, and French. The country's return to Arabic as its official language after independence from France in 1962 is discussed along with the resultant language planning, issues of language of instruction at the elementary,…

  4. Stellarator status, 1989

    Energy Technology Data Exchange (ETDEWEB)

    Lyon, J.F. (Oak Ridge National Lab., TN (USA)); Grieger, G.; Rau, F. (Max-Planck-Institut fuer Plasmaphysik, Garching (Germany, F.R.)); Iiyoshi, A. (National Inst. for Fusion Science, Nagoya (Japan)); Navarro, A.P. (Centro de Investigaciones Energeticas, Medioambientales y Tecnologicas, Madrid (Spain)); Kovrizhnykh, L.M. (AN SSSR, Moscow (USSR). Inst. Obshchey Fiziki); Pavlichenko, O.S. (AN Ukrain

    1990-07-01

    The present status of stellarator experiments and recent progress in stellarator research (both experimental and theoretical) are reported by groups in the United States, the USSR, Japan, Australia, and the European Community (the Federal Republic of Germany and Spain). Experiments under construction and studies of large, next-generation stellarators are also described. 73 refs., 11 figs., 4 tabs.

  5. Somalia: Country Status Report.

    Science.gov (United States)

    McFerren, Margaret

    A survey of the status of language usage in Somalia begins with an overview of the usage patterns of Somali, the official language, and three languages previously used officially: English, Italian, and Arabic. The cultural context that for many years has supported the usage of a single native language for communication and administration is also…

  6. Current status of DUMAND

    Energy Technology Data Exchange (ETDEWEB)

    Grieder, P.K.F.

    We give a brief description of the scientific aims of the DUMAND project, of the system lay-out and its capabilities, together with some technical details of the detector modules. Subsequently we present the anticipated project schedule and construction strategy, followed by an account of the present project status.

  7. STATUS EPILEPTICUS: A REVIEW

    Directory of Open Access Journals (Sweden)

    B. Adibeik

    2008-10-01

    Full Text Available ObjectiveStatus Epilepticus (SE has been described as a series of major motor seizure without recovery of consciousness between seizures.SE is a medical emergency that requires prompt diagnosis and appropriate treatment.In this article we shall conclude history, epidemiology, etiology, risk factors, thebest management as well as the prognosis of the condition.

  8. Uigur. Materials Status Report.

    Science.gov (United States)

    Center for Applied Linguistics, Washington, DC. Language/Area Reference Center.

    The materials status report for Uigur, a Turkic language spoken in the Sinkiang-Uigur Autonomous Region in northwest China and in the Soviet Socialist Republics of Kazakh and Uzbek, is one of a series intended to provide the nonspecialist with a picture of the availability and quality of texts for teaching various languages to English speakers.…

  9. Angola: Country Status Report.

    Science.gov (United States)

    Bruhn, Thea C.

    A survey of the status of language usage in Angola begins with an overview of the usage and distribution of Portuguese as the official language, and the four most significant native languages and dialects spoken there: Umbundu, Kimbundu, Kikongo, and Lunda-Chokwe. The introduction of Spanish through Cuban trainers, teachers, and military advisors…

  10. Status of memory loss.

    LENUS (Irish Health Repository)

    Iyer, Parameswaran Mahadeva

    2012-01-01

    A 72-year-old woman presented with first onset of seizure with no prior history of cognitive dysfunction. EEG revealed focal non-convulsive status epilepticus. MRI brain showed a left temporal non-enhancing lesion. Temporal pole biopsy showed acute neuronal necrosis and astrocyte hyperplasia together with extensive amyloid plaques and neurofibrillary tangles. Perivascular oligodendroglial hyperplasia was present. Postmortem examination revealed extensive plaque and tangle disease. Perivascular oligodendroglial hyperplasia was limited to the left temporal area. The presence of focal perivascular oligodendroglial hyperplasia in the left temporal cortex, combined with extensive plaque and tangle disease may have contributed to the focal status epilepticus in this patient. Although the presence of focal perivascular oligodendroglial hyperplasia has been reported in cases of temporal lobe epilepsy, it has not been reported as a cause of seizure in patients with Alzheimer\\'s disease previously. Further studies for clinical-pathologic correlation would be required to confirm this hypothesis.

  11. Evolutionary status of Entamoeba

    Institute of Scientific and Technical Information of China (English)

    DONG Jiuhong; WEN Jianfan; XIN Dedong; LU Siqi

    2004-01-01

    In addition to its medical importance as parasitic pathogen, Entamoeba has aroused people's interest in its evolutionary status for a long time. Lacking mitochondrion and other intracellular organelles common to typical eukaryotes, Entamoeba and several other amitochondrial protozoans have been recognized as ancient pre-mitochondriate eukaryotes and named "archezoa", the most primitive extant eukaryotes. It was suggested that they might be living fossils that remained in a primitive stage of evolution before acquisition of organelles, lying close to the transition between prokaryotes and eukaryotes. However, recent studies revealed that Entamoeba contained an organelle, "crypton" or "mitosome", which was regarded as specialized or reductive mitochondrion. Relative molecular phylogenetic analyses also indicated the existence or the probable existence of mitochondrion in Entamoeba. Our phylogenetic analysis based on DNA topoisomerase II strongly suggested its divergence after some mitchondriate eukaryotes. Here, all these recent researches are reviewed and the evolutionary status of Entamoeba is discussed.

  12. Health status of newcomers.

    Science.gov (United States)

    Matuk, L C

    1996-01-01

    This article presents and discusses findings on the health status of newcomers residing in Windsor, Ontario. The data are part of a larger study, which was based on the Ontario Health Survey's questionnaire. Data were collected from 548 newcomers through home visits, focus groups, mail surveys, and telephone interviews. Descriptive multivariate analyses focused on main areas in newcomers' physical and mental health status and their access to health services. The findings identified that most newcomers do not have acute, life-threatening physical problems or chronic illness. They do not experience major problems with access to health care or activity limitations. Men are happier, more satisfied with their health, and less stressed than women. This study has implications for adoption of sensitive transcultural approaches to promote newcomers' health. Special challenges lie in women's health and mental health.

  13. ATLAS construction status

    CERN Document Server

    Jenni, P

    2006-01-01

    The ATLAS detector is being constructed at the LHC, in view of a data-taking start-up in 2007. This report concentrates on the progress and the technical challenges of the detector construction, and summarizes the status of the work as of August 2004. The project is on track to allow the highly motivated ATLAS collaboration to enter into a new exploratory domain of high-energy physics in 2007.

  14. QCDSP A status report

    CERN Document Server

    Chen, D; Christ, N H; Edwards, R G; Fleming, G R; Gara, A; Hansen, S; Jung, C; Kähler, A L; Kennedy, A D; Kilcup, G W; Luo, Y; Malureanu, C I; Mawhinney, Robert D; Parsons, H; Sexton, J C; Sui, C Z; Vranas, P M; Chen, Dong; Chen, Ping; Christ, Norman H.; Edwards, Robert G.; Fleming, George R.; Gara, Alan; Hansen, Sten; Jung, Chulwoo; Kaehler, Adrian L.; Kennedy, Anthony D.; Kilcup, Gregory W.; Luo, Yubing; Malureanu, Catalin I.; Mawhinney, Robert D.; Parsons, John; Sexton, James C.; Sui, ChengZhong; Vranas, Pavlos M.

    1997-01-01

    The QCDSP machine at Columbia University has grown to 2,048 nodes achieving a peak speed of 100 Gigaflops. Software for quenched and Hybrid Monte Carlo (HMC) evolution schemes has been developed for staggered fermions, with support for Wilson and clover fermions under development. We provide an overview of the runtime environment, the current status of the QCDSP construction program and preliminary results not presented elsewhere in these proceedings.

  15. Experimental status of physics

    Indian Academy of Sciences (India)

    H Yamamoto

    2000-07-01

    In a short period of time, we will have a large amount of results from -factories including ones on CP violation. In this talk, we briefly review the current experimental status of -physics. After a quick description of -facilities, we divide this vast field into two categories: (1) weak interaction and QCD, (2) unitarity triangle and CP violation. Only a few critical items are selected in each category for the sake of time and space.

  16. SalSA status

    Energy Technology Data Exchange (ETDEWEB)

    Connolly, Amy [Department of Physics and Astronomy, University College London, Gower Street, London WC1E 6BT (United Kingdom)], E-mail: amyc@hep.ucl.ac.uk

    2009-06-01

    I review the status of SalSA, a proposed antenna array in a large volume salt formation for detecting ultra-high energy neutrinos. We report on measurements taken in 2007 of attenuation lengths in the 125-900 MHz frequency range at the Cote Blanche salt mine near New Iberia, Louisiana, which is the most precise in situ measurement of attenuation lengths in salt to date. We comment on the impact of these measurements on the feasibility of SalSA.

  17. The status of GALLEX

    Energy Technology Data Exchange (ETDEWEB)

    Cribier, M. (CEA Centre d' Etudes Nucleaires de Saclay, 91 - Gif-sur-Yvette (France). Dept. de Physique des Particules Elementaires)

    1990-01-01

    The present status of the Gallium Solar Neutrino Experiment performed by the GALLEX Collaboration in the Gran Sasso Underground Laboratory is described. The implementation phase of this experiment is now completed, the whole gallium is at hand and data taking starts now. After a short introduction and an outline of the basic experimental procedure, details will be given on different parts of the experiment and on some background. 14 refs., 2 figs.

  18. DUMAND II status report

    Energy Technology Data Exchange (ETDEWEB)

    Aoki, T. (ICRR, University of Tokyo, Japan (JP)); Becker-Szendy, R.; Bosetti, P.; Boynton, P.E.; Bradner, H.; Camerini, U.; Clem, J.; Commichau, V.; Dau, D.; Dye, S.; Grieder, P.K.F.; Hayashino, T.; Hazen, E.; Jaworski, M.; Kitamura, T.; Kobayakawa, K.; Koske, P.; Learned, J.G.; Ley, C.; Lord, J.J.; March, R.; Matsuno, S.; Minkowski, P.; Mitsui, K.; O' Connor, D.; Ohashi, Y.; Okada, A.; Peterson, V.Z.; Rathlev, J.; Roberts, A.; Roos, C.E.; Sakuda, M.; Samm, D.; Stenger, V.J.; Tanaka, S.; Uehara, S.; Webster, M.; Wilkins, G.; Wilkes, R.J.; Yamaguchi, A.; Yamamoto, I.; Young, K.K. (University of Bern, Switzerland (CH) Boston University, (USA) University of Hawaii, (USA) University of Kiel, Germany (DE) Kobe University, Japan (JP) Kinki University, Japan (JP) Okayama Science University, Japan (JP) Scripps Institute of Oceanography, (USA) Tohoku University, Japan (JP) ICRR, University of tokyo, Japan (JP) NLHEP Tsukuba, Japan (JP) Vanderbilt University, (USA) University of Washington, (US

    1991-04-05

    The scientific goals, design, capabilities, and status of the DUMAND II detector system are described. In June, 1989, the High Energy Physics Advisory Panel recommended support for construction of DUMAND II to the U.S. Department of Energy. Funding began in 1990, and prototype development for various detector subsystems is under way. Current plans include deployment of the shore cable, junction box and three strings of optical detector modules in 1992, and expansion to the full 9-string configuration in 1993.

  19. DUMAND II status report

    Science.gov (United States)

    Aoki, T.; Becker-Szendy, R.; Bosetti, P.; Boynton, P. E.; Bradner, H.; Camerini, U.; Clem, J.; Commichau, V.; Dau, D.; Dye, S.; Grieder, P. K. F.; Hayashino, T.; Hazen, E.; Jaworski, M.; Kitamura, T.; Kobayakawa, K.; Koske, P.; Learned, J. G.; Ley, C.; Lord, J. J.; March, R.; Matsuno, S.; Minkowski, P.; Mitsui, K.; O'Connor, D.; Ohashi, Y.; Okada, A.; Peterson, V. Z.; Rathlev, J.; Roberts, A.; Roos, C. E.; Sakuda, M.; Samm, D.; Stenger, V. J.; Tanaka, S.; Uehara, S.; Webster, M.; Wilkins, G.; Wilkes, R. J.; Yamaguchi, A.; Yamamoto, I.; Young, K. K.

    1991-04-01

    The scientific goals, design, capabilities, and status of the DUMAND II detector system are described. In June, 1989, the High Energy Physics Advisory Panel recommended support for construction of DUMAND II to the U.S. Department of Energy. Funding began in 1990, and prototype development for various detector subsystems is under way. Current plans include deployment of the shore cable, junction box and three strings of optical detector modules in 1992, and expansion to the full 9-string configuration in 1993.

  20. Supersymmetry: Experimental Status

    CERN Document Server

    Ulmer, Keith A

    2016-01-01

    This talk presents results from the CMS and ATLAS Collaborations from searches for physics beyond the Standard Model motivated by supersymmetry from Run 1 of the LHC. Representative searches are described to illustrate the diverse nature of the search program in both background estimation techniques and final state topologies. The status of preparation for Run 2 searches at 13 TeV is also presented.

  1. Status of MARS Code

    Energy Technology Data Exchange (ETDEWEB)

    N.V. Mokhov

    2003-04-09

    Status and recent developments of the MARS 14 Monte Carlo code system for simulation of hadronic and electromagnetic cascades in shielding, accelerator and detector components in the energy range from a fraction of an electronvolt up to 100 TeV are described. these include physics models both in strong and electromagnetic interaction sectors, variance reduction techniques, residual dose, geometry, tracking, histograming. MAD-MARS Beam Line Build and Graphical-User Interface.

  2. [Civil status and suicide].

    Science.gov (United States)

    Gaxiola-Robles, Ramón; Bitzer-Quintero, Oscar Kurt; García-González, Adolfo; Celis-de la Rosa, Alfredo

    2009-01-01

    To determine if civil status acts as a risk factor in suicide and how it modifies according to gender, age and population size. A retrospective study which analyzes information from the mortality data from the National Institute of Statistics, Geography and Information, from 1998 to 2002. Variables like suicides age, sex, cause of death, federal entity, population size and civil status were registered. Single men showed twofold risk for committing suicide. Women did not show any associated risk for suicide according to civil status. The risk of married men for committing suicide increased gradually with age. Medium-sized communities with less than 19,999 habitants presented the highest risk for habitants to commit suicide. Suicide is associated to gender especially to men who are not married and living in small and medium-sized communities. One explanation could be the lack of integrated behavior as defined by Emile Durkheim, where the physical density of society will determine behavior and ideas. This social structure phenomenon is called the "moral cocoon." This works around the individual being less individualistic and granting him/her the feeling of belonging to a group.

  3. Women Status and their Discrimination

    OpenAIRE

    PEŠKOVÁ, Pavlína

    2008-01-01

    My work deal with women status and their discrimination. Chapter one contains women status in different historical periods and development of their status to bigger equal with men. There is also written about present feminist trends. Chapter two is about women discrimination. There is about women´ job discrimination, job segregation according to gender and inequality in payment. There is also written about women status at home and unequal duties at home among family mates. Chapter three is ab...

  4. Sibling Status Effects: Adult Expectations.

    Science.gov (United States)

    Baskett, Linda Musun

    1985-01-01

    This study attempted to determine what expectations or beliefs adults might hold about a child based on his or her sibling status alone. Ratings on 50 adjective pairs for each of three sibling status types, only, oldest, and youngest child, were assessed in relation to adult expectations, birth order, and parental status of rater. (Author/DST)

  5. Mental Representations of Social Status

    Science.gov (United States)

    Chiao, Joan Y.; Bordeaux, Andrew R.; Ambady, Nalni

    2004-01-01

    How do people think about social status? We investigated the nature of social status and number representations using a semantic distance latency test. In Study 1, 21 college students compared words connoting different social status as well as numbers, which served as a control task. Participants were faster at comparing occupations and numbers…

  6. Convulsive status epilepticus in children

    Directory of Open Access Journals (Sweden)

    Redžek-Mudrinić Tatjana

    2010-01-01

    Full Text Available Introduction. Convulsive status epilepticus is the most urgent neurological medical emergency in children. Generalized convulsive status epilepticus is the most common and life-threatening type of status epilepticus. It is not a syndrome in the same sense as febrile convulsions, benign rolandic epilepsy, and infantile polymorphic epilepsy. These latter disorders have a tight age frame, seizure semiology, and a reasonably predictable outcome. Episodes of convulsive status epilepticus can occur in each: occasionally in symptomatic and febrile convulsions, and Lennox Gastaut syndrome, rarely in benign rolandic epilepsy, and West syndrome. Etiology of convulsive status epilepticus. Status epilepticus has many causes, which vary depending on the age and patient population. Convulsive status epileptucus continues to be associated with significant neurological morbidity and mortality, with different hazards and outcome. Although the outcome is dependent on etiology, it is known that appropriate early management may reduce mortality and some of the morbidity associated with convulsive status epilepticus. Discussion. Status epilepticus is a disorder in which the mechanisms attempting at terminating the seizure fail. Continued convulsive activity in convulsive status epilepticus results in decompensation of all organs and systems, thus being life threatening. Seizure activity in convulsive status epilepticus is associated with neuronal damage. The aim should be to halt this activity urgently, using, ideally, a 100% effective drug, administered quickly, without compromising the consciousness level or producing other negative effects on cardiovascular, respiratory function or other unexpected effects.

  7. Status of the LHC

    CERN Document Server

    Gourber, J P

    1999-01-01

    Since the approval of the Large Hadron Collider (LHC) by the CERN Council in December 1994, considerable progress has been made in the assessment of the beam parameters and the refining of the design of the machine components and experimental areas. Thanks to the strong support from a number of countries outside the Member States, the machine will be constructed in one single stage with first physics in 2005. The first large calls for tenders are being launched. The status of the project and the future plans are presented.

  8. Status of Wheeler Reservoir

    Energy Technology Data Exchange (ETDEWEB)

    1990-09-01

    This is one in a series of status reports prepared by the Tennessee Valley Authority (TVA) for those interested in the conditions of TVA reservoirs. This overview of Wheeler Reservoir summarizes reservoir purposes and operation, reservoir and watershed characteristics, reservoir uses and use impairments, and water quality and aquatic biological conditions. The information presented here is from the most recent reports, publications, and original data available. If no recent data were available, historical data were summarized. If data were completely lacking, environmental professionals with special knowledge of the resource were interviewed. 12 refs., 2 figs.

  9. Model Validation Status Review

    Energy Technology Data Exchange (ETDEWEB)

    E.L. Hardin

    2001-11-28

    The primary objective for the Model Validation Status Review was to perform a one-time evaluation of model validation associated with the analysis/model reports (AMRs) containing model input to total-system performance assessment (TSPA) for the Yucca Mountain site recommendation (SR). This review was performed in response to Corrective Action Request BSC-01-C-01 (Clark 2001, Krisha 2001) pursuant to Quality Assurance review findings of an adverse trend in model validation deficiency. The review findings in this report provide the following information which defines the extent of model validation deficiency and the corrective action needed: (1) AMRs that contain or support models are identified, and conversely, for each model the supporting documentation is identified. (2) The use for each model is determined based on whether the output is used directly for TSPA-SR, or for screening (exclusion) of features, events, and processes (FEPs), and the nature of the model output. (3) Two approaches are used to evaluate the extent to which the validation for each model is compliant with AP-3.10Q (Analyses and Models). The approaches differ in regard to whether model validation is achieved within individual AMRs as originally intended, or whether model validation could be readily achieved by incorporating information from other sources. (4) Recommendations are presented for changes to the AMRs, and additional model development activities or data collection, that will remedy model validation review findings, in support of licensing activities. The Model Validation Status Review emphasized those AMRs that support TSPA-SR (CRWMS M&O 2000bl and 2000bm). A series of workshops and teleconferences was held to discuss and integrate the review findings. The review encompassed 125 AMRs (Table 1) plus certain other supporting documents and data needed to assess model validity. The AMRs were grouped in 21 model areas representing the modeling of processes affecting the natural and

  10. Status of GENEUS

    Directory of Open Access Journals (Sweden)

    Srdinko Th.

    2012-05-01

    Full Text Available The current status of the nuclear data evaluation tool GENEUS (General Nuclear Data Evaluation and Uncertainty System is discussed. Especially, recent improvements of the implemented algorithms concerning smoothness and stability of the evaluated data. These modifications include an improved extrapolation algorithm for the model defect covariance matrices, the inclusion of uncertainties in level densities and charged particle optical model parameters and the employment of a regularization procedure to restore positive semidefiniteness of the prior covariance matrices. The impact of these improvements is studied for the example of neutron-induced cross sections of 55Mn for which preliminary evaluation results are also provided.

  11. NESTOR: A status report

    CERN Document Server

    Anassontzis, E G; Barone, M; Foudas, C; Grammatikakis, G; Katsanevas, S; Kourkoumelis, C; Manousakis-Katsikakis, A; Resvanis, L K; Siotis, I; Sotiriou, S A; Voulgaris, G; Minkowski, P; Grieder, P K F; Ball, A E; Bottai, S; Cartacci, A M; Monteleoni, B; Naumov, Vadim A; Trasatti, L; Fahrun, E; Keusen, U; Koske, P; Rathlev, J; Schmidt, N P; Voight, G; Bezrukov, Leonid B; Butkevich, A V; Dedenko, L G; Karaevsky, S K; Mironovich, A A; Zakharov, L M; Zheleznykh, I M; Zhukov, V A; Demidova, T A; Deineko, A O; Eremeev, A P; Paka, V T; Permyakov, A A; Platonov, M N; Rukol, V Kh; Sheremet, N A; Surin, N M; Albul, V I; Ledenev, V V

    2000-01-01

    NESTOR is an underwater neutrino astrophysics laboratory to be located in the international waters of the southwest of Greece. The first phase of this experiment is the construction and deployment of one hexagonal tower consisting of 168 optical modules, with effective are of 20000m2 for E ⩾ TeV neutrinos. Over the past few years detailed studies of the site have been carried out while many tests have been performed. The current status of the preparation of the experiment and the future plans will be presented.

  12. Status epilepticus in scleromyxedema

    Institute of Scientific and Technical Information of China (English)

    Soifa Markoula; Soifa Zouroudi; Soitrios Giannopoulos; Kimon Tsoukanelis; Ananstasia Zikou; Athanassios P Kyritsis

    2016-01-01

    Scleromyxedema is a rare dermatologic disorder, characterized by erythematous or yelowish lichenoid waxy papules. Neurological manifestations are rare but wel-recognized. A 51-year-old woman, diagnosed with scleromyxedema, was admitted to the hospital with status epilepticus, caused by brain lesions, as disclosed in a brain magnetic resonance imaging (MRI). The patient was treated with anticonvulsants and corticosteroids and gradualy recovered fuly. A complete remission of the lesions was shown in a folow-up brain MRI. In cases with scleromyxedema and the presence of neurological manifestations, we need to pay attention to central nervous system involvement, especialy when combined with brain MRI lesions, and treat the patient appropriately.

  13. NESTOR: a status report

    Science.gov (United States)

    Bottai, S.; Anassontzis, E. G.; Athanasopoulos, C.; Barone, M.; Grammatikakis, G.; Katsanevas, S.; Kourkoumelis, C.; Manousakis-Katsikakis, A.; Resvanis, L. K.; Siotis, I.; Sotiriou, S. A.; Voulgaris, C. G.; Minkowski, P.; Grieder, P. K. F.; Ball, A. E.; Cartacci, A. M.; Monteleoni, B.; Naumov, V. A.; Trasatti, L.; Fahrun, E.; Keusen, U.; Koske, P.; Rathlev, J.; Schmidt, N. P.; Voigt, G.; Bezrukov, L. B.; Butkevich, A. V.; Dedenko, L. G.; Karaevsky, S. K.; Mironovich, A. A.; Zakharov, L. M.; Zheleznykh, I. M.; Zhukov, V. A.; Demidova, T. A.; Deineko, A. O.; Eremeev, A. P.; Paka, V. T.; Permyakov, A. A.; Platonov, M. N.; Rukol, V. Kh.; Sheremet, N. A.; Surin, N. M.; Albul, V. I.; Ledenev, V. V.

    2000-05-01

    NESTOR is an underwater neutrino astrophysics laboratory to be located in the international waters of the southwest of Greece. The first phase of this experiment is the construction and deployment of one hexagonal tower consisting of 168 optical modules, with effective area of 20000m2 for E >= TeV neutrinos. Over the past few years detailed studies of the site have been carried out while many tests have been performed. The current status of the preparation of the experiment and the future plans will be presented

  14. NESTOR: a status report

    Energy Technology Data Exchange (ETDEWEB)

    Bottai, S.; Anassontzis, E.G; Athanasopoulos, C.; Barone, M.; Grammatikakis, G.; Katsanevas, S.; Kourkoumelis, C.; Manousakis-Katsikakis, A.; Resvanis, L.K.; Siotis, I.; Sotiriou, S. A.; Voulgaris, C G.; Minkowski, P.; Grieder, P.K.F.; Ball, A.E.; Cartacci, A.M.; Monteleoni, B.; Naumov, V.A.; Trasatti, L.; Fahrun, E.; Keusen, U.; Koske, P.; Rathlev, J.; Schmidt, N.P.; Voigt, G.; Bezrukov, L.B.; Butkevich, A. V.; Dedenko, L.G.; Karaevsky, S.K.; Mironovich, A.A.; Zakharov, L.M.; Zheleznykh, I.M.; Zhukov, V.A.; Demidova, T.A.; Deineko, A.O.; Eremeev, A.P.; Paka, V.T.; Permyakov, A.A.; Platonov, M.N.; Rukol, V.Kh.; Sheremet, N.A.; Surin, N.M.; Albul, V.I.; Ledenev, V.V

    2000-05-01

    NESTOR is an underwater neutrino astrophysics laboratory to be located in the international waters of the southwest of Greece. The first phase of this experiment is the construction and deployment of one hexagonal tower consisting of 168 optical modules, with effective area of 20000m{sup 2} for E {>=} TeV neutrinos. Over the past few years detailed studies of the site have been carried out while many tests have been performed. The current status of the preparation of the experiment and the future plans will be presented.

  15. The status of gallex

    Science.gov (United States)

    Kirsten, Till; Bellotti, E.; Anselmann, P.; Breitenbach, M.; Hampel, W.; Heusser, G.; Kiko, J.; Kirsten, T.; Lenzing, A.; Pernicka, E.; Plaga, R.; Povh, B.; Schlosser, C.; Völk, H.; Wink, R.; Wójcik, M.; Ammon, R. V.; Balata, M.; Ebert, K.; Fritsch, T.; Hellriegel, K.; Henrich, E.; Stieglitz, L.; Weyrich, F.; Cremonesi, O.; Fiorini, E.; Ragazzi, S.; Zanotti, L.; Feilitzsch, F. V.; Mößbauer, R.; Schanda, U.; Berthomieu, G.; Schatzman, E.; Carmi, I.; Dostrovsky, I.; D'Angelo, S.; Bacci, C.; Belli, P.; Bernabei, R.; Paoluzi, L.; Cribier, M.; Dupont, G.; Gosset, L.; Pichard, B.; Rich, J.; Spiro, M.; Stolarczyk, T.; Tao, C.; Vignaud, D.; Friedlander, G.; Hahn, R. L.; Hartmann, F. X.; Rowley, J. K.; Stoenner, R. W.; Weneser, J.

    1991-04-01

    A radiochemical Gallium-Solar-Neutrino Detector has been set up at the Gran Sasso Underground Laboratory. All major installations are implemented and the target, 53.5 m3 of galliumchloride solution containing 30.3 tons of gallium, has been brought underground after removing cosmogenic Ge-isotopes through nitrogen purge. This final implementation status and the achieved parameters characterizing the experiment are described in this report. Full scale performance tests and optimalization of the operating conditions of the extraction system are presently under way.

  16. The status of GALLEX

    Energy Technology Data Exchange (ETDEWEB)

    Kirsten, T.; Anselmann, P.; Breitenbach, M.; Hampel, W.; Heusser, G.; Kiko, J.; Kirsten, T.; Lenzing, A.; Pernicka, E.; Plaga, R.; Povh, B.; Schlosser, C.; Voelk, H.; Wink, R.; Wojcik, M. (Max-Planck-Institut fuer Kernphysik, Heidelberg (Germany, F.R.)); Bellotti, E. (Laboratori Nazionali del Gran Sasso (Italy)); Ammon, R. v.; Balata, M.; Ebert, K.; Fritsch, T.; Hellriegel, K.; Henrich, E.; Stieglitz, L.; Weyrich, F. (Kernforschungszentrum Karlsruhe GmbH (Germany, F.R.)); Cremonesi, O.; Fiorini, E.; Ragazzi, S.; Zanotti, L. (Milan Univ. (Italy). Dipt. di Fisica); Feilitzsch, F. v.; Moessbauer, R.; Schanda, U. (Technische Univ. Muenchen, Garching (Germany, F.R.). Fakultaet fuer Physik); Berthomieu, G.; Schatzmann, E. (Nice Univ., 06 (France). Observatoire); Carmi, I.; Dostrovsky, I. (Weizmann Inst. of Science, Rehovoth (Israel)); D' Angelo, S.; Bacci, C.; Belli, P.; Bernabei, R.; Paoluzi, L. (Rome-2 Univ. (Italy)); Cribier, M.; Dupont, G.; Gosset, L.; Pichard, B.; Rich, J.; Spiro; GALLEX Collaboration

    1991-04-01

    A radiochemical Gallium-Solar-Neutrino Detector has been set up at the Gran Sasso Underground Laboratory. All major installations are implemented and the target, 53,5 m{sup 3} of galliumchloride solution containing 30.3 tons of gallium, has been brought underground after removing cosmogenic Ge-isotopes through nitrogen purge. This final implementation status and the achieved parameters characterizing the experiment are described in this report. Full scale performance tests and optimalization of the operating conditions of the extraction system are presently under way. (orig.).

  17. Age, relationship status, and the planning status of births

    Directory of Open Access Journals (Sweden)

    Sarah Hayford

    2010-08-01

    Full Text Available In the United States historically, births to older mothers have been more likely to be planned than births to younger mothers, and births to unmarried women have been less likely to be planned than births to married women. As the average age of mothers has increased and more births have occurred outside of marriage in the United States, the intersection of these trends may have weakened the traditional linkage between age and birth planning status. In this article, we examine differences by maternal age in planning status of births using The 2002 National Survey of Family Growth. We find that age is strongly associated with planning status, but the association is reduced in magnitude when controlling for relationship status and is stronger for first and second births than for higher-parity births. Further, the association between union status and the planning status of births varies by race-ethnicity.

  18. Treatment intensification with maraviroc (CCR5 antagonist) leads to declines in CD16-expressing monocytes in cART-suppressed chronic HIV-infected subjects and is associated with improvements in neurocognitive test performance: implications for HIV-associated neurocognitive disease (HAND).

    Science.gov (United States)

    Ndhlovu, Lishomwa C; Umaki, Tracie; Chew, Glen M; Chow, Dominic C; Agsalda, Melissa; Kallianpur, Kalpana J; Paul, Robert; Zhang, Guangxiang; Ho, Erika; Hanks, Nancy; Nakamoto, Beau; Shiramizu, Bruce T; Shikuma, Cecilia M

    2014-12-01

    HIV-associated neurocognitive disorders (HAND) continues to be prevalent (30-50%) despite plasma HIV-RNA suppression with combination antiretroviral therapy (cART). There is no proven therapy for individuals on suppressive cART with HAND. We have shown that the degree of HIV reservoir burden (HIV DNA) in monocytes appear to be linked to cognitive outcomes. HIV infection of monocytes may therefore be critical in the pathogenesis of HAND. A single arm, open-labeled trial was conducted to examine the effect of maraviroc (MVC) intensification on monocyte inflammation and neuropsychological (NP) performance in 15 HIV subjects on stable 6-month cART with undetectable plasma HIV RNA (10 copies/10(6) cells). MVC was added to their existing cART regimen for 24 weeks. Post-intensification change in monocytes was assessed using multiparametric flow cytometry, monocyte HIV DNA content by PCR, soluble CD163 (sCD163) by an ELISA, and NP performance over 24 weeks. In 12 evaluable subjects, MVC intensification resulted in a decreased proportion of circulating intermediate (median; 3.06% (1.93, 6.45) to 1.05% (0.77, 2.26)) and nonclassical (5.2% (3.8, 7.9) to 3.2% (1.8, 4.8)) CD16-expressing monocytes, a reduction in monocyte HIV DNA content to zero log10 copies/10(6) cells and in levels of sCD163 of 43% by 24 weeks. This was associated with significant improvement in NP performance among six subjects who entered the study with evidence of mild to moderate cognitive impairment. The results of this study suggest that antiretroviral therapy with potency against monocytes may have efficacy against HAND.

  19. Quimiotipagem do Cryptococcus neoformans. Revisão da literatura. Novos dados epidemiológicos sobre a criptococose. Nossa experiência com o emprego do meio de C.G.B. no estudo daquela levedura Biotyping of Cryptococcus neoformans. Review of the literature. New epidemiologic informations about cryptococcosis. Our experience with the utilization of C.G.B medium in this yeast

    Directory of Open Access Journals (Sweden)

    Natalina Takahashi de Melo

    1993-10-01

    about the biotyping of Cryptococcus neoformans. The more up-to date research concerning the epidemiology of cryptococcosis comprising quite a few articles, mainly after the advent of AIDS, was also reviewed. The Cryptococcus neoformans varieties neoformans and gattii are well defined biochemically nowadays chiefly through the C.G.B. medium, according to KWON-CHUNG et al. (198224. The isolation of C. neoformans var. gattii from flowers and leaves of Eucalyptus camaldulensis and Eucalyptus tereticornis, specially in Australia, through the works of ELLIS & PFEIFFER (1990 16 and PFEIFFER & ELLIS (1992 41 permitted very interesting epidemiological investigations on C. neoformans, a capsulaled yeast by which SANFELICE 50, 51, in Italy (1894; 1895 attracted attention of medical class. BUSSE 8, in 1894, described the first human case of cryptococcosis under the presentation of a bone lesion simulating sarcoma. In this paper, the Brazilian researchers focused on this subject were pointed out, followed by the Author's experience with the C.G.B medium (L - canavanine, glycin and bromothymol blue proposed by KWON-CHUNG et al. (1982 24 with very good results. It was possible with such medium the study of 50 C.N.S. liquor samples, being 39 from AIDS patients (78% and 11 from non-AIDS ones (22%. Thirty-seven out of the 39 HIV- positive patients (74% were identified as C. neoformans var. neoformans and 2 (4% as C. neoformans var. gattii. From the negative HIV, 8 (16% were classified as C. neoformans var. neoformans and 3 (6% as C. neoformans var. gattii. We could not perform the serotyping of the above referred samples. It is evident anyway that in Brazil there exist both varieties gattii and neoformans, agents of neurocryptococcosis, including AIDS patients. The importance of neurocryptococcosis, mainly among AIDS patients, is stressed here, showing once more the value of C.G.B. medium in the typing of C. neoformans in its two varieties. Also, it is of relevant importance the

  20. Contribution of intestinal barrier damage, microbial translocation and HIV-1 infection status to an inflammaging signature.

    Directory of Open Access Journals (Sweden)

    Amanda K Steele

    Full Text Available Systemic inflammation is a characteristic of both HIV-1 infection and aging ("inflammaging". Intestinal epithelial barrier damage (IEBD and microbial translocation (MT contribute to HIV-associated inflammation, but their impact on inflammaging remains unclear.Plasma biomarkers for IEBD (iFABP, MT (LPS, sCD14, T-cell activation (sCD27, and inflammation (hsCRP, IL-6 were measured in 88 HIV-1 uninfected (HIV(neg and 83 treated, HIV-1-infected (HIV(pos adults from 20-100 years old.Age positively correlated with iFABP (r = 0.284, p = 0.008, sCD14 (r = 0.646, p = <0.0001 and LPS (r = 0.421, p = 0.0002 levels in HIV(neg but not HIV(pos subjects. Age also correlated with sCD27, hsCRP, and IL-6 levels regardless of HIV status. Middle-aged HIV(pos subjects had elevated plasma biomarker levels similar to or greater than those of elderly HIV(neg subjects with the exception of sCD14. Clustering analysis described an inflammaging phenotype (IP based on iFABP, sCD14, sCD27, and hsCRP levels in HIV(neg subjects over 60 years of age. The IP in HIV(neg subjects was used to develop a classification model that was applied to HIV(pos subjects to determine whether HIV(pos subjects under 60 years of age were IP+. HIV(pos IP+ subjects were similar in age to IP- subjects but had a greater risk of cardiovascular disease (CVD based on Framingham risk score (p =  0.01.We describe a novel IP that incorporates biomarkers of IEBD, MT, immune activation as well as inflammation. Application of this novel IP in HIV-infected subjects identified a group at higher risk of CVD.

  1. Clinical and laboratory peculiarities of cryptococcal meningoencephalitis in patients with hiv-negative status

    Directory of Open Access Journals (Sweden)

    Елена Леонидовна Панасюк

    2015-09-01

    microscopically detected microorganisms (yeast cells that are morphologically similar to cryptococcous including actively budding forms. In CSF of 3 patients (in one case at the negative microscopy antigens Cryptococcus neoformans was detected by the method of latex-agglutination (CALAS®system.Conclusions: The risk group on development of cryptococcal meningoencephalitis on the background of HIV-negative status is patients with oncopathology (especially of ENT-organs and brain, chronic somatic pathology at the stage of decompensation, tuberculosis. The negative results of microscopic and culture study of CSF for Cryptococcus neoformans are not the reason for excluding the diagnosis cryptococcal ME at primary examination and in the course of treatment it not always indicate recovery (the end of pathologic process. The combined intensive care with intrathecal methods allow carry out monitoring of intracranial pressure (ICP, CSF, to rise an efficiency of intensive care and the survival rate of patients in first 3-4 months. The lethality at cryptococcosis of CNS is as before the one of the highest and reaches 42,9 %

  2. [The national health status].

    Science.gov (United States)

    Afek, Arnon

    2010-04-01

    During the Golden Age of Medicine (20th Century), scientific and technological breakthroughs enabled physicians to treat diseases that were previously incurable. The idealist, romantic approach of medical practice believed in the right of every human being to receive the best treatment possible, regardless of cost. However, the rise in health care expenditure at the end of the last century made this approach impossible to follow. The growing health expenses are due to the increased percentage of chronically sick patients and elderly population, costs of novel technologies and public expectations. Israel spends 7.9% of its GDP on health, a figure which has not changed in the last fifteen years, while other western countries spend a considerably higher and increasing percentage of their GDP on health. Public resources must be allocated in order to maintain the health of the population and to decrease inequities. A data-based demonstration of the population health status and health care system is therefore mandated. in this issue of the Harefuah, three articles are presented which try to show different aspects of the measurement of Israeli heath status. The data accumulated is used to improve the health status of the Israeli people. The Israel Medical Association (IMA) has assumed responsibility for the creation of an objective index for the measurement and evaluation of the public state of health and the healthcare system. The goal of the IMA National Health Index is to promote discussions regarding medicine and health in Israel, and to serve as a tool to be used by relevant policy makers. Prof. Israeli et al discuss the merits of the National Health Index as well as delineate the difficulties regarding the methodology and choice of parameters. They suggest methods for its improvement. Dr Cohen and his colleagues of Clalit Health Services present the Quality Health indicator program in the community. In effect over the past fifteen years, this program is based on

  3. TAROT A status report

    CERN Document Server

    Boër, M; Bringer, M; Klotz, A H; Peignot, C; Malina, R F; Sánchez, P G; Pedersen, H J; Calvet, G; Eysseric, J; Leroy, A; Meissonier, M; Pollas, C; De Pacheco, J A F; Boër, Michel

    1997-01-01

    TAROT-1 is an automatic, autonomous ground based observatory whose primary goal is the rapid detection of the optical counterparts of cosmic gamma-ray burst sources. It will be able to begin imaging any GRB localization 8 seconds after receipt of an alert from CGRO/BATSE or HETE-2. TAROT-1 will reach the 17th V magnitude in 10 seconds, at a 10$\\sigma$ confidence level. TAROT will be able to observe GRB positions given by Beppo-SAX or RXTE, EUV transients from ALEXIS alerts, etc. TAROT will also study a wide range of secondary objectives and will feature a complete automatic data analysis system, and a powerful scheduling software. TAROT will be installed this fall on the Plateau du Calern, 1200m above sea level. We report on the status of the project.

  4. Status of French reactors

    Energy Technology Data Exchange (ETDEWEB)

    Ballagny, A. [Commissariat a l`Energie Atomique, Saclay (France)

    1997-08-01

    The status of French reactors is reviewed. The ORPHEE and RHF reactors can not be operated with a LEU fuel which would be limited to 4.8 g U/cm{sup 3}. The OSIRIS reactor has already been converted to LEU. It will use U{sub 3}Si{sub 2} as soon as its present stock of UO{sub 2} fuel is used up, at the end of 1994. The decision to close down the SILOE reactor in the near future is not propitious for the start of a conversion process. The REX 2000 reactor, which is expected to be commissioned in 2005, will use LEU (except if the fast neutrons core option is selected). Concerning the end of the HEU fuel cycle, the best option is reprocessing followed by conversion of the reprocessed uranium to LEU.

  5. Status of Advanced LIGO

    Science.gov (United States)

    Landry, Michael

    2012-10-01

    Installation of Advanced LIGO, a second-generation interferometric gravitational wave observatory, began in earnest in October of 2010. Initial LIGO instrumentation was de-installed, vacuum chambers and envelope modified, and the installation of scientific payloads begun. At LIGO Hanford Observatory, optics and suspensions comprising one of two 4km Fabry-Perot arms have been deployed and commissioned, resonating green light in an experiment to test and understand the process of controlling cavity lengths (``lock acquisition''). At LIGO Livingston, cornerstation optic and seismic isolation installation has matured such that the primary infrared laser and a suspended mode cleaner cavity (employed to spacially clean the interferometer input beam) are locked and under commissioning test. In this talk we present the status of Advanced LIGO installation and integration, and sketch the promising future of gravitational wave observation and astronomy.

  6. Refractory status epilepticus.

    Science.gov (United States)

    Fernandez, Andres; Claassen, Jan

    2012-04-01

    Refractory status epilepticus (RSE) has a high morbidity and mortality. There are currently no definitive data to guide both the optimal choice of therapy and treatment goals. This review focuses on RSE diagnosis and outcome and discusses both commonly used and anecdotal therapies for RSE. The challenges in performing randomized controlled trials (RCTs) in neurocritical care and more specifically for the treatment of RSE are illustrated by the early termination of the first RCT of RSE due to low recruitment that compared propofol to barbiturates. Recent case series include the successful treatment of recurrent RSE with ketamine, intravenous lacosamide as an add-on treatment, the use of combination antiepileptics (phenytoin, levetiracetam, and pregabalin), and surgical treatments (vagal nerve and deep brain stimulation) for the control of RSE. A number of different therapeutic options are available for the treatment of RSE but none have been shown to be superior to others at this point.

  7. Media Challenging Status Quo

    DEFF Research Database (Denmark)

    Sandvik, Kjetil

    structures and thus – along with a variety of both historical and socio-political conditions (Zizek 2011) – both enabling and shaping the protests against the financial powers of the world and their role in the global financial crisis. References: Christakis, N. & J. Fowler (2010): Connected. The amazing...... and dystopian trends in contemporary culture (Turner 2006). On that note, this paper examines the Occupy Wall Street-movement as an example on how social media may rock the status quo of today’s global power structures putting to use its democratic potential and its modes of communication through network......, New York: Perseus Books Group Rheingold, H. (2004). Smart Mobs. The Next Social Revolution. Cambridge MA: Basic Books Turner, F. (2006): From counterculture to cyberculture, University of Chicago Press. Zizek, S. (2011): “Dagen efter oprøret [The day after the riot]”, Dagbladet Information 26.10.12...

  8. Status of Standardization Projects

    Science.gov (United States)

    1991-12-31

    PENTAERYTHRITOL MB DM F4 A 911 921 921 A MD MS 03 N C 6505 5486 A-A-XXX PENICILLIN G SUS MB DM F4 A 911 921 921 A MD MS 03 N C 6505 5489 A-A-XXX DEXAMETHASONE ... PHENYLBUTAZONE TABS MB DM H5 914 924 924 A MD MS 03 N 6605 TOTAL- 19. DELINQUENT- 4, STATUS CODES: A- 8, G- 1, Y- 0, Z- 10 6610 F119 MIL A 38138 AMP IND...921 921 A MD MS 03 N C 6505 5486 A-A-XXX PENICILLIN G SUS MB DM F4 A 911 921 921 A MD MS 03 N C 6505 5489 A-A-XXX DEXAMETHASONE SODIUM MB DM F4 A 911

  9. ALSSAT Development Status

    Science.gov (United States)

    Yeh, H. Y. Jannivine; Brown, Cheryl B.; Jeng, Frank F.; Anderson, Molly; Ewert, Michael K.

    2009-01-01

    The development of the Advanced Life Support (ALS) Sizing Analysis Tool (ALSSAT) using Microsoft(Registered TradeMark) Excel was initiated by the Crew and Thermal Systems Division (CTSD) of Johnson Space Center (JSC) in 1997 to support the ALS and Exploration Offices in Environmental Control and Life Support System (ECLSS) design and studies. It aids the user in performing detailed sizing of the ECLSS for different combinations of the Exploration Life support (ELS) regenerative system technologies. This analysis tool will assist the user in performing ECLSS preliminary design and trade studies as well as system optimization efficiently and economically. The latest ALSSAT related publication in ICES 2004 detailed ALSSAT s development status including the completion of all six ELS Subsystems (ELSS), namely, the Air Management Subsystem, the Biomass Subsystem, the Food Management Subsystem, the Solid Waste Management Subsystem, the Water Management Subsystem, and the Thermal Control Subsystem and two external interfaces, including the Extravehicular Activity and the Human Accommodations. Since 2004, many more regenerative technologies in the ELSS were implemented into ALSSAT. ALSSAT has also been used for the ELS Research and Technology Development Metric Calculation for FY02 thru FY06. It was also used to conduct the Lunar Outpost Metric calculation for FY08 and was integrated as part of a Habitat Model developed at Langley Research Center to support the Constellation program. This paper will give an update on the analysis tool s current development status as well as present the analytical results of one of the trade studies that was performed.

  10. Biomarkers of Selenium Status

    Directory of Open Access Journals (Sweden)

    Gerald F. Combs, Jr.

    2015-03-01

    Full Text Available The essential trace element, selenium (Se, has multiple biological activities, which depend on the level of Se intake. Relatively low Se intakes determine the expression of selenoenzymes in which it serves as an essential constituent. Higher intakes have been shown to have anti-tumorigenic potential; and very high Se intakes can produce adverse effects. This hierarchy of biological activities calls for biomarkers informative at different levels of Se exposure. Some Se-biomarkers, such as the selenoproteins and particularly GPX3 and SEPP1, provide information about function directly and are of value in identifying nutritional Se deficiency and tracking responses of deficient individuals to Se-treatment. They are useful under conditions of Se intake within the range of regulated selenoprotein expression, e.g., for humans <55 μg/day and for animals <20 μg/kg diet. Other Se-biomarkers provide information indirectly through inferences based on Se levels of foods, tissues, urine or feces. They can indicate the likelihood of deficiency or adverse effects, but they do not provide direct evidence of either condition. Their value is in providing information about Se status over a wide range of Se intake, particularly from food forms. There is need for additional Se biomarkers particularly for assessing Se status in non-deficient individuals for whom the prospects of cancer risk reduction and adverse effects risk are the primary health considerations. This would include determining whether supranutritional intakes of Se may be required for maximal selenoprotein expression in immune surveillance cells. It would also include developing methods to determine low molecular weight Se-metabolites, i.e., selenoamino acids and methylated Se-metabolites, which to date have not been detectable in biological specimens. Recent analytical advances using tandem liquid chromatography-mass spectrometry suggest prospects for detecting these metabolites.

  11. SCIENTIFIC STATUS OF DIDACTICS

    Directory of Open Access Journals (Sweden)

    I. M. Osmolovskaya

    2015-03-01

    Full Text Available The research is aimed at scientific justification of didactics referred to the social and humanitarian field of knowledge. The author deals with the scientific character criteria (verity, inter-subjectivity, systemacity and validity taking into account different scientific rationality types (classical and nonclassical and identifying post-modernism influence on didactics. Objectives and results of research. Attempts are made to systematize the didactic knowledge and identify its components and structure. Didactic concepts are classified in accordance with its objects: teaching process by the whole, its individual components or educative process aspects that enable to form definite teaching views, studying it from the specific positions. The author singles out holistic-didactic, component and aspect concepts; and specifies the concept of didactic systems and models with its hierarchy. The author highlights the didactic knowledge increment. Apart from traditional empirical theoretical researches, the author’s attention is drawn to the academic pursuit such as a scientific project based on the didactic object specificity of the teaching process which is fully human controlled and realized and doesn’texist without human being. It is shown that basic theoretical ideas of scientific projects are itemized, concretized and enlarged during co-current educative practice, i.e. an adhesion of theory and practice occurs.It is stressed that there are two special directions of didactic development multidimensionality: 1. extension of its semantic field in the context of modern socio-cultural conditions; 2. increase of scientific status related to a conceptual framework improvement, empirically accumulated information arrangement, new hypotheses, theories and concepts’ development. Scientific novelty. The research findings demonstrate well-reasoned statement of the didactics’ scientific status, its particular components and structure

  12. SCIENTIFIC STATUS OF DIDACTICS

    Directory of Open Access Journals (Sweden)

    I. M. Osmolovskaya

    2014-01-01

    Full Text Available The research is aimed at scientific justification of didactics referred to the social and humanitarian field of knowledge. The author deals with the scientific character criteria (verity, inter-subjectivity, systemacity and validity taking into account different scientific rationality types (classical and nonclassical and identifying post-modernism influence on didactics. Objectives and results of research. Attempts are made to systematize the didactic knowledge and identify its components and structure. Didactic concepts are classified in accordance with its objects: teaching process by the whole, its individual components or educative process aspects that enable to form definite teaching views, studying it from the specific positions. The author singles out holistic-didactic, component and aspect concepts; and specifies the concept of didactic systems and models with its hierarchy. The author highlights the didactic knowledge increment. Apart from traditional empirical theoretical researches, the author’s attention is drawn to the academic pursuit such as a scientific project based on the didactic object specificity of the teaching process which is fully human controlled and realized and doesn’texist without human being. It is shown that basic theoretical ideas of scientific projects are itemized, concretized and enlarged during co-current educative practice, i.e. an adhesion of theory and practice occurs.It is stressed that there are two special directions of didactic development multidimensionality: 1. extension of its semantic field in the context of modern socio-cultural conditions; 2. increase of scientific status related to a conceptual framework improvement, empirically accumulated information arrangement, new hypotheses, theories and concepts’ development. Scientific novelty. The research findings demonstrate well-reasoned statement of the didactics’ scientific status, its particular components and structure

  13. HIV-associated multicentric Castleman’s disease

    Directory of Open Access Journals (Sweden)

    Fauzia de Fátima Naime

    2012-09-01

    Full Text Available Multicentric Castleman’s disease (MCD is a rare lymphoproliferative disorder. It is found with higher frequency in patients with HIV infection, with systemic symptoms and poor prognosis. We present the case of a 32-year old man with HIV disease, Kaposi’s sarcoma, lymphadenopathy, fever and hemolytic anemia. A diagnosis of Castleman’s disease is confirmed through biopsy and treatment is often based only on published case reports. Systemic treatments for MCD have included chemotherapy, anti-herpes virus, highly active antiretroviral therapy and, more recently, monoclonal antibodies against both IL6 and CD20.

  14. The kidney in HIV infection: beyond HIV-associated nephropathy.

    Science.gov (United States)

    Wyatt, Christina M

    2012-01-01

    Acute kidney injury (AKI) and chronic kidney disease (CKD) are more common in HIV-infected persons than in the general population. AKI is associated with poor health outcomes, including increased risk of heart failure, cardiovascular events, end-stage renal disease (ESRD), and mortality. The most common causes of AKI in HIV-infected persons are systemic infections and adverse drug effects. The prevalence of CKD is rising in the HIV-infected population and CKD is increasingly likely to be caused by comorbid conditions, such as diabetes and hypertension, that frequently cause CKD in the general population. Guidelines for CKD screening in HIV-infected patients are being revised. It is currently recommended that all patients be screened for creatinine-based estimates of glomerular filtration rate and for urine protein at the time of HIV diagnosis. Annual screening is recommended for high-risk patients. Hemodialysis, peritoneal dialysis, and kidney transplantation are all options for treating ESRD in HIV-infected patients. Hemodialysis and peritoneal dialysis offer similar survival in HIV-infected patients with ESRD. In selected patients with well-controlled HIV infection, kidney transplantation is associated with survival intermediate between that in the overall transplant population and that among transplant recipients older than 65 years. This article summarizes a presentation by Christina M. Wyatt, MD, at the IAS-USA continuing medical education program held in Chicago in May 2012, describing AKI and CKD using case illustrations.

  15. HIV-associated TB syndemic: A growing clinical challenge worldwide

    Directory of Open Access Journals (Sweden)

    Maria Theresa Montales

    2015-12-01

    Full Text Available The association of tuberculosis (TB with human immunodeficiency virus (HIV infection and acquired immune deficiency syndrome (AIDS over the past several years has become an emerging syndemic. Approximately 10% of people living with HIV (PLHIV with latent TB infection will develop active TB disease each year. In this review, we highlight that this phenomenon is not limited to high endemic regions like Afro-Asian nations, but globalization/migration is causing increased case detection even in developed nations such as the United States (US. Active screening should be performed for tuberculosis in PLHIV. A high degree of clinical suspicion for tuberculosis is warranted in PLHIV presenting with fever, cough and unintentional weight loss. HIV-Mycobacterium tuberculosis (MTB coinfection is often paucibacillary, precluding diagnosis by conventional diagnostics and/or smear-microscopy/culture. Improved detection of pulmonary and extrapulmonary tuberculosis is now possible by incorporation of the GeneXPERT MTB/RIF assay (Cepheid Inc, Sunnyvale, USA. The World Health Organization (WHO recommends instituting immediate therapy for Mycobacterium tuberculosis, in conjunction with ongoing or newly introduced antiretroviral therapy (ART. Vigilance is required to detect drug-induced organ injuries, and early-treatment induced immune reconstitution inflammatory syndrome (IRIS. Collaborating MTB and HIV activities in concentrated HIV epidemic settings should become a high public health priority.

  16. Susac's syndrome as HIV-associated immune reconstitution inflammatory syndrome.

    Science.gov (United States)

    Ferretti, Francesca; Gerevini, Simonetta; Colombo, Bruno; Testa, Manuela; Guffanti, Monica; Franciotta, Diego; Bernardi, Gaetano; Lazzarin, Adriano; Cinque, Paola

    2013-09-03

    Susac's Syndrome (SS) is an autoimmune endotheliopathy of cerebral, retinal and cochlear arterioles. We report of an HIV-infected woman who developed a first SS episode following a spontaneous reduction of plasma viral load and several relapses six years later, following initiation of combined antiretroviral therapy (cART). Corticosteroids and intravenous immunoglobulins alone did not control the disease, which improved after combined treatment with acyclovir and ganciclovir. SS onset in HIV infection and relapses during cART-induced immune reconstitution are consistent with the dysimmune nature of the disease. The response to anti-herpes drugs suggests a viral contribute in this case of SS.

  17. What's in a Name? AIDS Dementia Complex, HIV-associated ...

    African Journals Online (AJOL)

    of HIV recommend initiating ARVs in people with stage four disease irrespective of CD4 ... language; abstraction- executive; complex motor; memory and sensory perceptual/motor .... immunity is well understood by the lay public. The current.

  18. HIV associated deep vein thrombosis: Case reports from Jos, Nigeria

    Directory of Open Access Journals (Sweden)

    C A Daniyam

    2011-01-01

    Full Text Available Deep vein thrombosis (DVT has been reported to be 2-10 times commoner in HIV infected patients than in the general population. We report two cases of extensive unilateral deep vein thrombosis involving the lower limb in HIV infected patients on highly active antiretroviral therapy (HAART. Doppler ultrasound in the two patients revealed evidence of venous thrombosis from the femoral vein down to the posterior tibial veins. None of the patients had a history of acquired risk factors for DVT. Both patients responded well to anti-coagulants. A high index of suspicion may therefore be required to make the diagnosis and institute adequate management for this condition which has potentially life threatening consequences.

  19. Antiretroviral treatment uptake in patients with HIV- associated TB ...

    African Journals Online (AJOL)

    Models of integrated care in resource-limited countries include: efficient referrals between ..... transport money for additional clinic appointments.16,24 These factors ... operational research fellow by the International Union Against Tuberculosis.

  20. Diagnosis and treatment of HIV-associated manifestations in otolaryngology

    Directory of Open Access Journals (Sweden)

    Emily Iacovou

    2012-01-01

    Full Text Available Almost 30 years after its first description, HIV still remains a global pandemic. The present paper aims to review the current knowledge on the ear, nose and throat (ENT manifestations of HIV infection, and present the available diagnostic and treatment options. A literature review was conducted in Medline and other available database sources. Information from related books was also included in the data analysis. It is well acknowledged that up to 80% of HIV-infected patients eventually develop ENT manifestations; among which, oral disease appears to be the most common. Oro-pharyngeal manifestations include candidiasis, periodontal and gingival disease, HSV and HPV infection, oral hairy leucoplakia, Kaposi’s sarcoma, and non- Hodgkin’s lymphoma. ENT manifestations in the neck can present as cervical lymphadenopathy or parotid gland enlargement. Respective nasal manifestations include sinusitis (often due to atypical bacteria, and allergic rhinitis. Finally, otological manifestations include otitis (externa, or media, inner ear involvement (sensorineural hearing loss, disequilibrium, and facial nerve palsy (up to 100 times more frequently compared to the general population. Although ENT symptoms are not diagnostic of the disease, they might be suggestive of HIV infection, or related to its progression and the respective treatment failure. ENT doctors should be aware of the ENT manifestations associated with HIV disease, and the respective diagnosis and treatment. A multi-disciplinary approach may be required to provide the appropriate level of care to HIV patients.

  1. Marital Status, Happiness, and Anomia.

    Science.gov (United States)

    Ryan, John

    1981-01-01

    Survey data indicates that neither marital status nor marital happiness is related to anomia. Suggests a moderately strong negative relationship exists between education and anomia with a weak negative relationship between overall life satisfaction and anomia. Results indicate socioeconomic status remains the primary determinant of anomia for most…

  2. Status of VIRGO

    CERN Document Server

    Freise, A; Amico, P; Arnaud, N; Avino, S; Babusci, D; Barille, R; Barone, F; Barsotti, L; Barsuglia, M; Beauville, F; Bizouard, M A; Boccara, C; Bondu, F; Bosi, L; Bradaschia, C; Braccini, S; Brillet, A; Brisson, V; Brocco, L; Buskulic, Damir; Calamai, G; Calloni, E; Campagna, E; Cavalier, F; Cella, G; Chassande-Mottin, E; Cleva, F; Cokelaer, T; Coulon, J P; Cuoco, E; Dattilo, V; Davier, M; De Rosa, R; Di Fiore, L; Di Virgilio, A; Dujardin, B; Eleuteri, A; Enard, D; Ferrante, I; Fidecaro, F; Fiori, I; Flaminio, R; Fournier, J D; Frasca, S; Frasconi, F; Gammaitoni, L; Gennai, A; Giazotto, A; Giordano, G; Giordano, L; Guidi, G; Heitmann, H; Hello, P; Heusse, P; Holloway, L; Kreckelbergh, S; La Penna, P; Loriette, V; Loupias, M; Losurdo, G; Mackowski, J M; Majorana, E; Man, C N; Marchetti, E; Marion, F; Martelli, F; Masserot, A; Massonnet, Louis; Mazzoni, M; Milano, L; Moreau, J; Moreau, F; Morgado, N; Mornet, F; Mours, B; Pacheco, J; Pai, A; Palomba, C; Paoletti, F; Pardi, S; Passaquieti, R; Passuello, D; Perniola, B; Pinard, L; Poggiani, R; Punturo, M; Puppo, P; Qipiani, K; Ramonet, J; Rapagnani, P; Reita, V; Remillieux, A; Ricci, F; Ricciardi, I; Russo, G; Solimeno, S; Stanga, R; Tournefier, E; Travasso, F; Trinquet, H; Verkindt, D; Vetrano, F; Veziant, O; Viceré, A; Vinet, J Y; Vocca, H; Yvert, M

    2003-01-01

    The French-Italian interferometric gravitational wave detector VIRGO is currently being commissioned. Its principal instrument is a Michelson interferometer with 3 km long optical cavities in the arms and a power-recycling mirror. This paper gives an overview of the present status of the system. We report on the presently attained sensitivity and the system's performance during the recent commissioning runs. After a sequence of intermediate stages, the interferometer is now being used in the so-called recombined configuration. The input laser beam is spatially filtered by a 144 m long input mode-cleaner before being injected to the main interferometer. The main optics are suspended from so-called \\sa s, which provide an excellent seismic isolation. The two 3 km long Fabry-Perot arm cavities are kept in resonance with the laser light, and the Michelson interferometer is held on the dark fringe. An automatic mirror alignment system based on the Anderson technique has been implemented for the arm cavities. The l...

  3. Biosimilar drugs: Current status.

    Science.gov (United States)

    Kumar, Rajiv; Singh, Jagjit

    2014-07-01

    Biologic products are being developed over the past three decades. The expiry of patent protection for many biological medicines has led to the development of biosimilars in UK or follow on biologics in USA. This article reviews the literature on biosimilar drugs that covers the therapeutic status and regulatory guidelines. Appraisal of published articles from peer reviewed journals for English language publications, search from PubMed, and guidelines from European Medicines Agency, US Food Drug Administration (FDA) and India were used to identify data for review. Literature suggest that biosimilars are similar biological products, i.e., comparable but not identical to the reference product, are not generic version of innovator product and do not ensure therapeutic equivalence. Biosimilars present more challenges than conventional generics and marketing approval is also more complicated. To improve access, US Congress passed the Biologics Price Competition and Innovation act 2009 and US FDA allowed "abbreviated pathway" for their approval. U.S law has defined new standards and terms and EMA scientific guidelines have also set detailed approval standards. India being one of the most preferred manufacturing destinations of biosimilars, there is a need for stringent safety and regulatory guidelines. The New India Guidelines "Draft Guidelines on Similar Biologics were announced in June 2012, by Department of Biotechnology at Boston bio and available online.

  4. Solar Orbiter Status Report

    Science.gov (United States)

    Gilbert, Holly; St. Cyr, Orville Chris; Mueller, Daniel; Zouganelis, Yannis; Velli, Marco

    2017-08-01

    With the delivery of the instruments to the spacecraft builder, the Solar Orbiter mission is in the midst of Integration & Testing phase at Airbus in Stevenage, U.K. This mission to “Explore the Sun-Heliosphere Connection” is the first medium-class mission of ESA’s Cosmic Vision 2015-2025 program and is being jointly implemented with NASA. The dedicated payload of 10 remote-sensing and in-situ instruments will orbit the Sun as close as 0.3 A.U. and will provide measurments from the photosphere into the solar wind. The three-axis stabilized spacecraft will use Venus gravity assists to increase the orbital inclination out of the ecliptic to solar latitudes as high as 34 degrees in the extended mission. The science team of Solar Orbiter has been working closely with the Solar Probe Plus scientists to coordinate observations between these two highly-complementary missions. This will be a status report on the mission development; the interested reader is referred to the recent summary by Müller et al., Solar Physics 285 (2013).

  5. ANAIS: Status and prospects

    CERN Document Server

    Amaré, Julio; Cuesta, Clara; García, Eduardo; Ginestra, Carlos; Martínez, María; Oliván, Miguel A; Ortigoza, Ysrael; de Solórzano, Alfonso Ortíz; Pobes, Carlos; Puimedón, Jorge; Sarsa, María Luisa; Villar, José Ángel; Villar, Patricia

    2015-01-01

    ANAIS experiment will look for dark matter annual modulation with large mass of ultra-pure NaI(Tl) scintillators at the Canfranc Underground Laboratory (LSC), aiming to confirm the DAMA/LIBRA positive signal in a model-independent way. Two 12.5 kg each NaI(Tl) crystals provided by Alpha Spectra are currently taking data at the LSC. Present status of ANAIS detectors background and general performance is summarized; in particular, thanks to the high light collection efficiency prospects of lowering the threshold down to 1 keVee are reachable. Crystal radiopurity goals are fulfilled for $^{232}$Th and $^{238}$U chains and $^{40}$K activity, although higher than original goal, could be accepted; however, high $^{210}$Pb contamination out-of-equilibrium has been identified. More radiopure detectors are being built by Alpha Spectra. The ongoing high quantum efficiency PMT tests and muon veto characterization are also presented. Finally, the sensitivity of the experiment for the annual modulation in the WIMP signal,...

  6. TESLA Test Facility. Status

    Energy Technology Data Exchange (ETDEWEB)

    Aune, B. [Deutsches Elektronen-Synchrotron (DESY), Hamburg (Germany); TESLA Collaboration

    1996-01-01

    The TESLA Test Facility (TTF), under construction at DESY by an international collaboration, is an R and D test bed for the superconducting option for future linear e+/e-colliders. It consists of an infrastructure to process and test the cavities and of a 500 MeV linac. The infrastructure has been installed and is fully operational. It includes a complex of clean rooms, an ultra-clean water plant, a chemical etching installation and an ultra-high vacuum furnace. The linac will consist of four cryo-modules, each containing eight 1 meter long nine-cell cavities operated at 1.3 GHz. The base accelerating field is 15 MV/m. A first injector will deliver a low charge per bunch beam, with the full average current (8 mA in pulses of 800 {mu}s). A more powerful injector based on RF gun technology will ultimately deliver a beam with high charge and low emittance to allow measurements necessary to qualify the TESLA option and to demonstrate the possibility of operating a free electron laser based on the Self-Amplified-Spontaneous-Emission principle. Overview and status of the facility will be given. Plans for the future use of the linac are presented. (R.P.). 19 refs.

  7. MARS: a status report

    Energy Technology Data Exchange (ETDEWEB)

    Tribble, R.E.; Gagliardi, C.A.; Liu, W. (Cyclotron Inst., Texas A and M Univ., College Station (USA))

    1991-05-01

    We are building a momentum achromat recoil spectrometer (MARS) for use with the new K500 superconducting cyclotron at Texas A and M University. MARS uses a unique optical design utilizing two dispersive planes to combine a momemtum achromat with a recoil mass spectrometer. This configuration makes MARS applicable to a broad range of nuclear reaction studies utilizing inverse kinematics. It also leads to a system that is well matched to the range of secondary particle energies that will be produced in reactions with K500 beam. MARS will have a typical mass resolution of {delta}M/M{approx equal}1/300, with an energy acceptance of {+-}9% {Delta}E/E and a geometric solid angle of up to 9 msr. A beam swinger system will alow reaction products in the angular range 0deg to 30deg to be studied. MARS will be used to study both the excited states and decay properties of very proton- and neutron-rich nuclei. MARS will also be used to provide a reaction mechanism filter to assist investigations of the dynamics of heavy ion collisions and to produce secondary radioactive beams for reaction and spectroscopic studies of particular interest for nuclear astrophysics. We briefly describe the design of MARS, give a status report on its construction and an overview of the scientific program planned for it. (orig.).

  8. Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry

    Energy Technology Data Exchange (ETDEWEB)

    Mhlanga, Joyce C.; Durand, Daniel; Leal, Jeffrey P. [Johns Hopkins University School of Medicine, Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Sciences, Baltimore, MD (United States); Tsai, Hua-Ling; Wang, Hao [Johns Hopkins University School of Medicine, Department of Oncology Biostatistics Division, Baltimore, MD (United States); Durand, Christine M.; Moore, Richard [Johns Hopkins University School of Medicine, Maryland Infectious Diseases Department, Baltimore, MD (United States); Wahl, Richard L. [Johns Hopkins University School of Medicine, Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Sciences, Baltimore, MD (United States); Johns Hopkins University School of Medicine, Department of Oncology, Baltimore, MD (United States)

    2014-04-15

    To determine the diagnostic accuracy of a semiautomated {sup 18}F-FDG PET/CT measurement of total lesion glycolysis (TLG), maximum and peak standardized uptake value at lean body mass (SUL-Max and SUL-Peak), qualitative estimates of left/right nodal symmetry and FDG uptake for differentiating lymphoma from reactive adenopathy in HIV-infected patients. We retrospectively analyzed 41 whole-body {sup 18}F-FDG PET/CT studies performed in HIV-infected patients for clinical reasons. The study received institutional review board approval. Of the 41 patients, 19 had biopsy-proven untreated lymphoma, and 22 with reactive adenopathy without malignancy on follow-up were used as controls. Nodal and extranodal visual qualitative metabolic scores, SUL-Max, SUL-Peak, CT nodal size, and PERCIST 1.0 threshold-based TLG and metabolic tumor volume (MTV) were determined. The qualitative intensity of nodal involvement and symmetry of uptake were compared using receiver operator curve (ROC) analysis. HIV plasma viral RNA measurements were also obtained. All of the quantitative PET metrics performed well in differentiating lymphoma from reactive adenopathy and performed better than qualitative visual intensity scores. The areas under the ROC curves (AUC) were significantly higher for TLG = 0.96, single SUL-Peak = 0.96, single SUL-Max = 0.97, and MTV = 0.96, compared to 0.67 for CT nodal size (p < 0.001). These PET metrics performed best in separating the two populations in aviremic patients, with AUCs of 1 (AUC 0.91 for CT nodal size). TLG, MTV, SUL-Peak and SUL-Max were more reliable markers among viremic individuals, with AUCs between 0.84 and 0.93, compared to other metrics. PET metrics were significantly correlated with plasma viral load in HIV-reactive adenopathy controls. Asymmetrical FDG uptake had an accuracy of 90.4 % for differentiating lymphoma from reactive adenopathy in HIV-infected patients. Quantitative PET metabolic metrics as well as the qualitative assessment of symmetry of nodal uptake appear to be valuable tools for differentiating lymphoma from reactive adenopathy in HIV-infected patients using FDG PET. These parameters appear more robust in aviremic patients. (orig.)

  9. Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry.

    Science.gov (United States)

    Mhlanga, Joyce C; Durand, Daniel; Tsai, Hua-Ling; Durand, Christine M; Leal, Jeffrey P; Wang, Hao; Moore, Richard; Wahl, Richard L

    2014-04-01

    To determine the diagnostic accuracy of a semiautomated (18)F-FDG PET/CT measurement of total lesion glycolysis (TLG), maximum and peak standardized uptake value at lean body mass (SUL-Max and SUL-Peak), qualitative estimates of left/right nodal symmetry and FDG uptake for differentiating lymphoma from reactive adenopathy in HIV-infected patients. We retrospectively analyzed 41 whole-body (18)F-FDG PET/CT studies performed in HIV-infected patients for clinical reasons. The study received institutional review board approval. Of the 41 patients, 19 had biopsy-proven untreated lymphoma, and 22 with reactive adenopathy without malignancy on follow-up were used as controls. Nodal and extranodal visual qualitative metabolic scores, SUL-Max, SUL-Peak, CT nodal size, and PERCIST 1.0 threshold-based TLG and metabolic tumor volume (MTV) were determined. The qualitative intensity of nodal involvement and symmetry of uptake were compared using receiver operator curve (ROC) analysis. HIV plasma viral RNA measurements were also obtained. All of the quantitative PET metrics performed well in differentiating lymphoma from reactive adenopathy and performed better than qualitative visual intensity scores. The areas under the ROC curves (AUC) were significantly higher for TLG = 0.96, single SUL-Peak = 0.96, single SUL-Max = 0.97, and MTV = 0.96, compared to 0.67 for CT nodal size (p < 0.001). These PET metrics performed best in separating the two populations in aviremic patients, with AUCs of 1 (AUC 0.91 for CT nodal size). TLG, MTV, SUL-Peak and SUL-Max were more reliable markers among viremic individuals, with AUCs between 0.84 and 0.93, compared to other metrics. PET metrics were significantly correlated with plasma viral load in HIV-reactive adenopathy controls. Asymmetrical FDG uptake had an accuracy of 90.4 % for differentiating lymphoma from reactive adenopathy in HIV-infected patients. Quantitative PET metabolic metrics as well as the qualitative assessment of symmetry of nodal uptake appear to be valuable tools for differentiating lymphoma from reactive adenopathy in HIV-infected patients using FDG PET. These parameters appear more robust in aviremic patients.

  10. Therapie des Status epilepticus

    Directory of Open Access Journals (Sweden)

    Trinka E

    2009-01-01

    Full Text Available Der Status epilepticus (SE ist nach dem Schlaganfall der häufigste neurologische Notfall. Er stellt als generaliserter konvulsiver SE (GKSE die schwerste Ausprägung eines epileptischen Anfalls dar, der mit einer signifikanten Morbidität und einer ca. 20%igen Letalität verbunden ist. Nur bei der Hälfte der Patienten mit SE besteht zuvor eine Epilepsie; die meisten Fälle sind symptomatisch, wobei Schädel- Hirn-Traumata, zerebrovaskuläre Erkrankungen, ZNS-Infektionen und metabolische Ursachen führend sind. Bei Patienten mit vorbestehender Epilepsie lässt sich eine frühe Phase des GKSE erkennen, in der die Anfälle crescendoartig zunehmen, bis sie in kontinuierliche Anfallsaktivität münden (etablierte Phase. Das Management eines GKSE verlangt rasches und beherztes Vorgehen. Neben der sofort einzuleitenden Therapie muss gleichzeitig die artdiagnostische Zuordnung des SE und die Ursache erkannt und behandelt werden. Als Therapie der ersten Wahl sind Benzodiazepine etabliert, wobei intravenösem (i.v. Lorazepam gegenüber Diazepam der Vorzug zu geben ist. Versagt die Therapie mit Benzodiazepinen, muss rasch und konsequent nach einem Stufenschema vorgegangen werden. Phenytoin/Fosphenytoin, Valproinsäure, Levetiracetam und Lacosamid sind als i.v. Formulierung erhältliche Antiepileptika. Obwohl Vergleichsstudien hier fehlen, wird Phenytoin bevorzugt. Valproat und Levetiracetam sind nicht sedierend und kardiovaskulär gut verträglich, sodass hier Alternativen zu Phenytoin vorhanden sind. Lacosamid ist eine neue Therapieoption, deren Stellenwert erst bestimmt werden muss. Versagt auch die zweite Therapiestufe, so muss der Patient intubiert und in Allgemeinanästhesie intensivmedizinisch behandelt werden. Dafür stehen Thiopental, Propofol oder hoch dosiertes Midazolam zu Verfügung. Durch den eklatanten Mangel an randomisierten Studien bleibt die Therapie des GKSE empirisch und durch den Off-label-Einsatz gekennzeichnet.

  11. Reducing status quo bias in choice experiments

    DEFF Research Database (Denmark)

    Bonnichsen, Ole; Ladenburg, Jacob

    2015-01-01

    to be superior, i.e. a status quo effect. However, in the stated preference literature, the tendency to choose the alternative representing the status quo situation seems to exceed real life status quo effects. Accordingly, status quo bias can be a problem. In the Choice Experiment literature, status quo bias...

  12. Treatment of Established Status Epilepticus

    Science.gov (United States)

    Falco-Walter, Jessica J.; Bleck, Thomas

    2016-01-01

    Status epilepticus is the most severe form of epilepsy, with a high mortality rate and high health care costs. Status epilepticus is divided into four stages: early, established, refractory, and super-refractory. While initial treatment with benzodiazepines has become standard of care for early status epilepticus, treatment after benzodiazepine failure (established status epilepticus (ESE)) is incompletely studied. Effective treatment of ESE is critical as morbidity and mortality increases dramatically the longer convulsive status epilepticus persists. Phenytoin/fosphenytoin, valproic acid, levetiracetam, phenobarbital, and lacosamide are the most frequently prescribed antiseizure medications for treatment of ESE. To date there are no class 1 data to support pharmacologic recommendations of one agent over another. We review each of these medications, their pharmacology, the scientific evidence in support and against each in the available literature, adverse effects and safety profiles, dosing recommendations, and limitations of the available evidence. We also discuss future directions including the established status epilepticus treatment trial (ESETT). Substantial further research is urgently needed to identify these patients (particularly those with non-convulsive status epilepticus), elucidate the most efficacious antiseizure treatment with head-to-head randomized prospective trials, and determine whether this differs for convulsive vs. non-convulsive ESE. PMID:27120626

  13. Treatment of Established Status Epilepticus

    Directory of Open Access Journals (Sweden)

    Jessica J. Falco-Walter

    2016-04-01

    Full Text Available Status epilepticus is the most severe form of epilepsy, with a high mortality rate and high health care costs. Status epilepticus is divided into four stages: early, established, refractory, and super-refractory. While initial treatment with benzodiazepines has become standard of care for early status epilepticus, treatment after benzodiazepine failure (established status epilepticus (ESE is incompletely studied. Effective treatment of ESE is critical as morbidity and mortality increases dramatically the longer convulsive status epilepticus persists. Phenytoin/fosphenytoin, valproic acid, levetiracetam, phenobarbital, and lacosamide are the most frequently prescribed antiseizure medications for treatment of ESE. To date there are no class 1 data to support pharmacologic recommendations of one agent over another. We review each of these medications, their pharmacology, the scientific evidence in support and against each in the available literature, adverse effects and safety profiles, dosing recommendations, and limitations of the available evidence. We also discuss future directions including the established status epilepticus treatment trial (ESETT. Substantial further research is urgently needed to identify these patients (particularly those with non-convulsive status epilepticus, elucidate the most efficacious antiseizure treatment with head-to-head randomized prospective trials, and determine whether this differs for convulsive vs. non-convulsive ESE.

  14. Sentinel-2 Mission status

    Science.gov (United States)

    Hoersch, Bianca; Colin, Olivier; Gascon, Ferran; Arino, Olivier; Spoto, Francois; Marchese, Franco; Krassenburg, Mike; Koetz, Benjamin

    2016-04-01

    Copernicus is a joint initiative of the European Commission (EC) and the European Space Agency (ESA), designed to establish a European capacity for the provision and use of operational monitoring information for environment and security applications. Within the Copernicus programme, ESA is responsible for the development of the Space Component, a fully operational space-based capability to supply earth-observation data to sustain environmental information Services in Europe. The Sentinel missions are Copernicus dedicated Earth Observation missions composing the essential elements of the Space Component. In the global Copernicus framework, they are complemented by other satellites made available by third-parties or by ESA and coordinated in the synergistic system through the Copernicus Data-Access system versus the Copernicus Services. The Copernicus Sentinel-2 mission provides continuity to services relying on multi-spectral high-resolution optical observations over global terrestrial surfaces. Sentinel-2 capitalizes on the technology and the vast experience acquired in Europe and the US to sustain the operational supply of data for services such as forest monitoring, land cover changes detection or natural disasters management. The Sentinel-2 mission offers an unprecedented combination of the following capabilities: ○ Systematic global coverage of land surfaces: from 56°South to 84°North, coastal waters and Mediterranean sea; ○ High revisit: every 5 days at equator under the same viewing conditions with 2 satellites; ○ High spatial resolution: 10m, 20m and 60m; ○ Multi-spectral information with 13 bands in the visible, near infra-red and short wave infra-red part of the spectrum; ○ Wide field of view: 290 km. The data from the Sentinel-2 mission are available openly and freely for all users with online easy access since December 2015. The presentation will give a status report on the Sentinel-2 mission, and outlook for the remaining ramp-up Phase, the

  15. Association of HIV Status With Local Immune Response to Anal Squamous Cell Carcinoma: Implications for Immunotherapy.

    Science.gov (United States)

    Yanik, Elizabeth L; Kaunitz, Genevieve J; Cottrell, Tricia R; Succaria, Farah; McMiller, Tracee L; Ascierto, Maria L; Esandrio, Jessica; Xu, Haiying; Ogurtsova, Aleksandra; Cornish, Toby; Lipson, Evan J; Topalian, Suzanne L; Engels, Eric A; Taube, Janis M

    2017-07-01

    The programmed cell death protein 1 (PD-1) and programmed death-ligand 1 (PD-L1) pathway play an important immunosuppressive role in cancer and chronic viral infection, and have been effectively targeted in cancer therapy. Anal squamous cell carcinoma (SCC) is associated with both human papillomavirus and HIV infection. To date, patients with HIV have been excluded from most trials of immune checkpoint blocking agents, such as anti-PD-1 and anti-PD-L1, because it was assumed that their antitumor immunity was compromised compared with immunocompetent patients. To compare the local tumor immune microenvironment (TME) in anal SCCs from HIV-positive and HIV-negative patients. Anal SCC tumor specimens derived from the AIDS and Cancer Specimen Resource (National Cancer Institute) and Johns Hopkins Hospital included specimens. Tumors were subjected to immunohistochemical analysis for immune checkpoints (PD-L1, PD-1, LAG-3) and immune cell (IC) subsets (CD3, CD4, CD8, CD68). Expression profiling for immune-related genes was performed on select HIV-positive and HIV-negative cases in PD-L1+ tumor areas associated with ICs. Programmed death-ligand 1 expression on tumor cells and ICs, PD-L1 patterns (adaptive vs constitutive), degree of IC infiltration, quantified densities of IC subsets, and gene expression profiles in anal SCCs from HIV-positive vs HIV-negative patients. Approximately half of 40 tumor specimens from 23 HIV-positive and 17 HIV-negative patients (29 men and 11 women; mean [SD] age, 51 [9.9] years) demonstrated tumor cell PD-L1 expression, regardless of HIV status. Median IC densities were not significantly decreased in HIV-associated tumors for any cellular subset studied. Both adaptive (IC-associated) and constitutive PD-L1 expression patterns were observed. Immune cell PD-L1 expression correlated with increasing intensity of IC infiltration (r = 0.52; 95% CI, 0.26-0.78; P anal SCCs (fold change, 12.69; P anal SCC. These findings demonstrate an immune

  16. HIV相关神经认知紊乱患者配对组织来源的HIV-1 env基因特征分析%Analysis of genetic characteristics in paired tissue-derived HIV-1 env from patients with HIV associated neurocognitive disorders

    Institute of Scientific and Technical Information of China (English)

    欧阳雅博; 刘利锋; 张玉林; 袁霖; 刘志英; 杨素芳; 魏飞力; 乔录新; 陈德喜

    2014-01-01

    Objective To investigate the evolutionary genetic characteristics of different tissue-derived HIV-1 env from patients with HIV associated neurocognitive disorders (HAND). Methods HIV-1 infected patients were retrospec-tively included and then identified using international HIV dementia scale score as HAND. HIV-1 env sequences that de-rived from plasma and cerebrospinal fluid (CSF) were collected to study the characteristics and differences of quasispecies diversity, amino acid length, numbers of potential N-linked glycosylation sites (PNGS) and signature pattern between the two tissues. Results Four HAND patients with 57 HIV-1 V3-C4 sequences were included in this study (plasma-de-rived:29;CSF-derived:28). A higher diversity was noted for the variants in CSF(mean diversity:0.053) than that in plasma (mean diversity: 0.007, P= 0.043). All viral quasispecies from three patients used CCR5 as the coreceptor in both tissues, and two patients had a longer viral amino acid length in CSF (patient D:158 bp vs. 156 bp, P= 0.017; patient F: 158 bp vs. 157 bp, P= 0.003). Sixteen CSF-specific genetic signatures of V3-C4 region were identified in HAND patients, and most of them belonged to V4 region (10/16, 62.5%). Conclusion Genetic characteristics are found between the two tissue-specific HIV-1 quasispecies from HAND patients, which exhibit high quasispecies diversity in CSF-derived strains.%目的:探讨人类免疫缺陷病毒相关神经认知紊乱(HIV associated neurocognitive disorder, HAND)患者不同组织中HIV-1 env基因的变异进化特征。方法通过国际HIV痴呆量表筛选出HAND患者,获得其血浆及脑脊液来源的HIV-1 env基因核苷酸序列,回顾性分析遗传多样性、氨基酸长度、潜在糖基化位点(PNGS)、辅助受体利用以及特征性氨基酸的特点及组织间差异。结果本研究纳入4例HAND患者共57条HIV-1 env基因V3-C4序列(血浆来源29条,脑脊液来源28条)。脑脊液中的HIV-1遗

  17. Coagulation Status in Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Miller, Iben Marie; Johansen, Maria Egede; Mogensen, Ulla B

    2015-01-01

    BACKGROUND: Chronic inflammatory diseases other than hidradenitis suppurativa (HS) have been associated with prothrombotic/hypercoagulable status. OBJECTIVE: To investigate a possible association between the chronic inflammatory skin disease HS and prothrombotic/hypercoagulable state. METHODS: We...

  18. Refugee status determination: three challenges

    Directory of Open Access Journals (Sweden)

    Martin Jones

    2009-04-01

    Full Text Available Refugee status determination (RSD, which is vital to the protection of so many asylum seekers worldwide, is at best an imperfect, haphazard and challenging process. It merits greater attention and appropriate reform.

  19. Socioeconomic Status, IQ, and Delinquency.

    Science.gov (United States)

    Moffitt, Terrie E.; And Others

    1981-01-01

    Results from two Danish prospective longitudinal studies are presented to support the view that IQ bears a causal relationship to delinquency that is independent of the effects of socioeconomic status (SES). (CL)

  20. Current status of pulmonary metastasectomy

    DEFF Research Database (Denmark)

    Hornbech, Kåre; Ravn, Jesper; Steinbrüchel, Daniel Andreas

    2011-01-01

    for unresected patients. In this article, we discuss the current status on pulmonary metastasectomy. Preoperative assessment and selection of surgical candidates is covered. The different surgical strategies including surgical approach, unilateral versus bilateral exploration, lymph node dissection, and repeat...

  1. of nutritional status of women

    African Journals Online (AJOL)

    A structured questionnaire was administered to pregnant women, lactating ..... Authority. Ethiopia .Demographic and Health Survey 2000. Central Statistics Authority, Addis Ababa. 2001. Tuazan, M.A.. ... Parental Care, and Nutritional. Status of.

  2. Current status of natural fibres

    CSIR Research Space (South Africa)

    Anandjiwala, RD

    2006-12-01

    Full Text Available , automotive, aerospace, marine, electronic, leisure and household uses. This paper will provide an overview of the current status of research and development. It will also deal with future drivers for the growth and competitiveness of natural fibres...

  3. Enhance the Team Status Meeting

    Science.gov (United States)

    2014-12-01

    collection and analysis tool chosen by the team : the Process Dashboard © 1998-2014 Tuma Solutions, LLC. Using this format , the PRT teams are now getting...status meetings of those teams coached by the NAVAIR PRT have evolved into more relevant, easier to understand, and more visually interesting formats ...support, this submission to Open Forum highlights the team status meeting. These meetings help keep a team aware, engaged, and on-track. Their content

  4. Health psychology: status and trends.

    Science.gov (United States)

    Blancarte, A L; Murphy, K J; Reilley, R R

    1991-08-01

    This study investigated the present status and suggested trends in health psychology as reported by American Psychological Association Division 38 (Health Psychology) members. A 25-item mail-in survey was developed to obtain these data from a randomly selected sample of 300. Information includes a demographic description of the respondents, their selection of influential books, journals, and individuals, and their opinions regarding the current status and desirable future trends in the field of health psychology.

  5. Status report, canister fabrication

    Energy Technology Data Exchange (ETDEWEB)

    Andersson, Claes-Goeran; Eriksson, Peter; Westman, Marika [Swedish Nuclear Fuel and Waste Management Co., Stockholm (Sweden); Emilsson, Goeran [CSM Materialteknik AB, Linkoeping (Sweden)

    2004-06-01

    The report gives an account of the development of material and fabrication technology for copper canisters with cast inserts during the period from 2000 until the start of 2004. The engineering design of the canister and the choice of materials in the constituent components described in previous status reports have not been significantly changed. In the reference canister, the thickness of the copper shell is 50 mm. Fabrication of individual components with a thinner copper thickness is done for the purpose of gaining experience and evaluating fabrication and inspection methods for such canisters. As a part of the development of cast inserts, computer simulations of the casting processes and techniques used at the foundries have been performed for the purpose of optimizing the material properties. These properties have been evaluated by extensive tensile testing and metallographic inspection of test material taken from discs cut at different points along the length of the inserts. The testing results exhibit a relatively large spread. Low elongation values in certain tensile test specimens are due to the presence of poorly formed graphite, porosities, slag or other casting defects. It is concluded in the report that it will not be possible to avoid some presence of observed defects in castings of this size. In the deep repository, the inserts will be exposed to compressive loading and the observed defects are not critical for strength. An analysis of the strength of the inserts and formulation of relevant material requirements must be based on a statistical approach with probabilistic calculations. This work has been initiated and will be concluded during 2004. An initial verifying compression test of a canister in an isostatic press has indicated considerable overstrength in the structure. Seamless copper tubes are fabricated by means of three methods: extrusion, pierce and draw processing, and forging. It can be concluded that extrusion tests have revealed a

  6. Social Carrying Capacity as Status Group Convention.

    Science.gov (United States)

    West, Patrick C.

    A sociological study investigating the relationship between perception of crowding and social status was conducted in a rural camping setting. Results indicate that higher social status groups and groups aspiring to higher social status are more likely to perceive crowding than are lower status groups, but more research is suggested prior to the…

  7. Reducing status quo bias in choice experiments

    DEFF Research Database (Denmark)

    Bonnichsen, Ole; Ladenburg, Jacob

    In stated preference literature, the tendency to choose the alternative representing the status quo situation seems to exceed real life status quo effects. Accordingly, status quo bias can be a problem. In Choice Experiments, status quo bias is found to be strongly correlated with protest attitudes...

  8. Social Carrying Capacity as Status Group Convention.

    Science.gov (United States)

    West, Patrick C.

    A sociological study investigating the relationship between perception of crowding and social status was conducted in a rural camping setting. Results indicate that higher social status groups and groups aspiring to higher social status are more likely to perceive crowding than are lower status groups, but more research is suggested prior to the…

  9. ANTIOXIDANT STATUS IN DIABETIC NEPHROPATHY

    Directory of Open Access Journals (Sweden)

    Giriraja

    2015-12-01

    Full Text Available BACKGROUND Hyperglycemia and dislipidemia in DM induce increased lipid peroxdation and free radical formation. This is an important mechanism of microangiopathy. AIM To measure the antioxidant status in type 2 DM with nephropathy and compared with nondiabetic control group. MATERIALS AND METHODS 50 type 2 DM patients aged between 50 to 70 years according to national diabetes data group criteria with nephropathy diagnosed on the basis of history, physical examination and biochemical parameters were included. 50 age and sex matched apparently healthy individuals with normal plasma glucose, normal renal parameters and with no symptoms suggestive of DM were taken as controls. RESULTS Antioxidant status was significantly less in patients with diabetic nephropathy. CONCLUSION Data suggests that alteration in antioxidant status may help predict the risk of diabetic nephropathy.

  10. Association between Periodontal Status, Oral Hygiene Status and ...

    African Journals Online (AJOL)

    developed by Ainamo, et al., (1982),[1] healthy periodontium means no gingival ... hygiene status and tooth wear among the adult male population in Benin City, Nigeria. Subjects and ... 95% at the pre‑testing stage. The intra‑examiner ...

  11. The treatment of status epilepticus.

    Science.gov (United States)

    Riviello, James J; Holmes, Gregory L

    2004-06-01

    Status epilepticus (SE) is a life-threatening emergency that requires prompt treatment, including basic neuroresuscitation principles (the ABCs), antiepileptic drugs to stop the seizure, and identification of etiology. Symptomatic SE is more common in younger children. Treating the precipitating cause may prevent ongoing neurologic injury and facilitates seizure control. A systematic treatment regimen, planned in advance, is needed, including one for refractory status epilepticus (RSE). Here we emphasize definitions, clinical and electroencephalography stages, early treatment, special circumstances that may require immediate seizure control, and treatment of RSE. Because much clinical research in SE has been done in adults, we indicate the patient population studied.

  12. The Medicina Station Status Report

    Science.gov (United States)

    Orfei, Alessandro; Orlati, Andrea; Maccaferri, Giuseppe

    2013-01-01

    General information about the Medicina Radio Astronomy Station, the 32-m antenna status, and the staff in charge of the VLBI observations is provided. In 2012, the data from geodetic VLBI observations were acquired using the Mark 5A recording system with good results. Updates of the hardware were performed and are briefly described.

  13. Health status of hostel dwellers

    African Journals Online (AJOL)

    the cumulative effects on nutritional status of circular migration as a process over time ... infant mortality rates.3 In Cape Town, the infant mortality rate for the hostel .... The research team comprised a nursing sister, a nurse/social anthropologist ...

  14. Present status of processing method

    Energy Technology Data Exchange (ETDEWEB)

    Kosako, Kazuaki [Sumitomo Atomic Energy Industries Ltd., Tokyo (Japan)

    1998-11-01

    Present status of processing method for a high-energy nuclear data file was examined. The NJOY94 code is the only one available to the processing. In Japan, present processing used NJOY94 is orienting toward the production of traditional cross section library, because a high-energy transport code using a high-energy cross section library is indistinct. (author)

  15. 2010 Chemical Working Group Status

    Science.gov (United States)

    Reid, Concha M.

    2010-01-01

    The Steering Group for the Interagency Advanced Power Group (IAPG) held their business meeting on November 30-December 1st in McLean, Virginia. Status reports were presented from each of the IAPG's Working Groups. These charts contain a brief summary of the IAPG Chemical Working Group's activities during 2010 and its plans for 2011.

  16. The Epistemic Status of Intelligence

    DEFF Research Database (Denmark)

    Rønn, Kira Vrist; Høffding, Simon

    2012-01-01

    We argue that the majority of intelligence definitions fail to recognize that the normative epistemic status of intelligence is knowledge and not an inferior alternative. We refute the counter-arguments that intelligence ought not to be seen as knowledge because of 1) its action-oriented scope...... and robustness of claims to intelligence-knowledge can be assessed....

  17. Status of the QCDOC project

    CERN Document Server

    Boyle, P A; Christ, N H; Cristian, C; Dong, Z; Gara, A; Joó, B; Kim, C; Levkova, L; Liao, X; Liu, G; Mawhinney, Robert D; Ohta, S; Wettig, T; Yamaguchi, A

    2002-01-01

    A status report is given of the QCDOC project, a massively parallel computer optimized for lattice QCD using system-on-a-chip technology. We describe several of the hardware and software features unique to the QCDOC architecture and present performance figures obtained from simulating the current VHDL design of the QCDOC chip with single-cycle accuracy.

  18. Ethiopia: Country Status Report (Revision).

    Science.gov (United States)

    McFerren, Margaret

    A survey of the status of language usage in Ethiopia begins with an overview of the distribution of Amharic, the sole official language and medium of elementary instruction, and Tigrinya, Oromo, Wolayto, Somali, Sidamo, Hadiyya, and English, the medium of secondary and higher education instruction. The relationship of language usage patterns to…

  19. Ivory Coast: Country Status Report.

    Science.gov (United States)

    Bruhn, Thea C.

    A survey of the status of language usage in the Ivory Coast begins with an overview of the usage patterns of French, the official language, and the five most commonly used native languages: Jula, Anyi-Baoule, Senoufo, Bete, and Dan. Recent Ivorian efforts at language planning, development, and research are also highlighted. A matrix follows that…

  20. Boiling liquid cauldron status report

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, M.A.

    1980-12-28

    The progress made over the past year in assessing the feasibility of the high-temperature, boiling cauldron blanket concept for the tanden mirror reactor is reviewed. The status of the proposed experiments and recently revised estimates of the vapor void fraction in the boiling pool are discussed.

  1. NIE Planning Status, July 1972.

    Science.gov (United States)

    Silberman, Harry F.

    This paper summarizes the current status of the National Institute of Education (NIE) plans for programs and organization as of the beginning of the 1973 fiscal year. The author considers the purpose of NIE as outlined in the NIE enabling legislation, lists the goals of education, and examines the problems that arise in trying to achieve those…

  2. Ownership as a Social Status

    Science.gov (United States)

    Kalish, Charles W.; Anderson, Craig D.

    2011-01-01

    The authors suggest that ownership may be one of the critical entry points into thinking about social constructions, a kind of laboratory for understanding status. They discuss the features of ownership that make it an interesting case to study developmentally. In particular, ownership is a consequential social fact that is alterable by an…

  3. Targeted Advertising and Social Status

    NARCIS (Netherlands)

    N. Vikander (Nick)

    2010-01-01

    textabstractThis paper shows how a firm can use non-targeted advertising to exploit consumers' desire for social status. A monopolist sells multiple varieties of a good to consumers who each care about what others believe about his wealth. Advertising allows consumers both to buy different varieties

  4. IEC Research Status at MSFC

    Science.gov (United States)

    Hrbud, Ivana; Dobson, Chris

    2001-01-01

    This viewgraph presentation gives an overview of the Inertial Electrostatic Confinement (IEC) research status at Marshall Space Flight Center. Details are given on the experiment setup (hardware characteristics, diagnostic equipment, propellant feed system, and planned pulse mode operation), grid manufacturing (identified manufacturing techniques, such as metal deposition, negative template mold, and machining), and grid for IEC operation (negative template technique and electrochemical technique).

  5. HEALTH STATUS OF INDIAN WOMEN

    OpenAIRE

    Mohan

    2014-01-01

    Health status of women still is one of the most serious issues affecting the community particularly in developing countries. Community life is meant to include not only social, economic and nutritional conditions, however additionally the cultural systems of values, aspirations and satisfaction that influence mental and family behavior under reproductive habits.

  6. Ivory Coast: Country Status Report.

    Science.gov (United States)

    Bruhn, Thea C.

    A survey of the status of language usage in the Ivory Coast begins with an overview of the usage patterns of French, the official language, and the five most commonly used native languages: Jula, Anyi-Baoule, Senoufo, Bete, and Dan. Recent Ivorian efforts at language planning, development, and research are also highlighted. A matrix follows that…

  7. European Solar Telescope: Progress status

    NARCIS (Netherlands)

    Collados, M.; Bettonvil, F.C.M.; Cavaller, L.; Ermolli, I.; Gelly, B.; Pérez, A.; Socas-Navarro, H.; Soltau, D.; Volkmer, R.

    2010-01-01

    In this paper, the present status of the development of the design of the European Solar Telescope is described. The telescope is devised to have the best possible angular resolution and polarimetric performance, maximizing the throughput of the whole system. To that aim, adaptive optics and multi-c

  8. Status of Fermilab E-710

    Energy Technology Data Exchange (ETDEWEB)

    Rubinstein, R.; E-710 Collaboration

    1993-08-01

    This report give the current status of E-710, an experiment at the Fermilab {bar p}p Tevatron Collider to measure elastic scattering, total cross sections and diffraction dissociation up to {radical}s = 1.8 TeV.

  9. The status of cold fusion

    Science.gov (United States)

    Storms, E.

    This report attempts to update the status of the phenomenon of cold fusion. The new field is continuing to grow as a variety of nuclear reactions are discovered to occur in a variety of chemical environments at modest temperatures. However, it must be cautioned that most scientists consider cold fusion as something akin to UFO's, ESP, and numerology.

  10. Status of spallation neutron source

    Energy Technology Data Exchange (ETDEWEB)

    Oyama, Yukio [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

    1997-03-01

    Existing and planned facilities using proton accelerator driven spallation neutron source are reviewed. These include new project of neutron science proposed from Japan Atomic Energy Research Institute. The present status of facility requirement and accelerator technology leads us to new era of neutron science such as neutron scattering research and nuclear transmutation study using very intense neutron source. (author)

  11. The Current Status of CLASS

    NARCIS (Netherlands)

    Helbig, P

    2000-01-01

    Abstract: I give a brief overview of the current status of some aspects of the Cosmic Lens All-Sky Survey (CLASS): description of the survey, current list of lens systems, cosmological parameters from lensing statistics, H_0 from time delays, dark lenses, wide-separation lenses.

  12. Status over revisionforskningen i Danmark

    DEFF Research Database (Denmark)

    Seehausen, Jesper; Holm, Claus

    Aalborg Universitet og lektor, ph.d. Claus Holm fra Handelshøjskolen i Århus status over revisionsforskningen i Danmark. Der fokuseres på den forskning, som gennemføres og publiceres i form af ph.d.-afhandlinger. Således giver forfatterne blandt andet en oversigt over indholdet i de hidtidige danske ph...

  13. Ownership as a Social Status

    Science.gov (United States)

    Kalish, Charles W.; Anderson, Craig D.

    2011-01-01

    The authors suggest that ownership may be one of the critical entry points into thinking about social constructions, a kind of laboratory for understanding status. They discuss the features of ownership that make it an interesting case to study developmentally. In particular, ownership is a consequential social fact that is alterable by an…

  14. STATUS TAKSONOMI, DISTRIBUSI DAN KATEGORI STATUS KONSERVASI MAGNOLIACEAE DI INDONESIA

    Directory of Open Access Journals (Sweden)

    Andes Hamuraby Rozak

    2012-07-01

    Full Text Available The Family of Magnoliaceae is one of the most primitive taxa in the world.  Knowledge of this family is essential for studies on the origin, evolution and systematics of Angiosperms.  There are 223 species belongs to this family in the world and 25 of them are found in Indonesia. This paper explains taxonomy, distribution, and conservation status of the family Magnoliaceae in Indonesia.

  15. Status of TRANSP/PTRANSP

    Science.gov (United States)

    McCune, Douglas; Andre, Rob; Feibush, Eliot; Gorelenkova, Marina; Ludescher-Furth, Christiane; Yuan, Xingqiu

    2011-10-01

    This poster summarizes the status of TRANSP/PTRANSP code development and run production operations. Production system utilization rates, particularly for MPI jobs, continue to climb. The poster will show production system utilization history and describe status and plans for production facilities and supporting software, as well as the major areas of physics code development. The major physics areas are: simulation using free boundary MHD equilibrium (ISOLVER); neutral beam and fusion product fast ion heating and current drive (NUBEAM); RF heating and current drive (TORIC, GENRAY, and other codes); and predictive transport modeling (PTRANSP and associated modular solvers). In addition, there have been promising advances in capabilities for post-processing and analysis of TRANSP results, based on the SWIM Plasma State software; these too will be described.

  16. Present status of solar distillation

    Energy Technology Data Exchange (ETDEWEB)

    Tiwari, G.N.; Singh, H.N.; Tripathi, R. [Indian Inst. of Technology, New Delhi (India). Centre for Energy Studies

    2003-11-01

    In this communication an attempt has been made to review, in brief, work on solar distillation, its present status in the world today and its future perspective. The review also includes water sources, water demand, availability of potable water and purification methods including the state of art and historical background. The classification of distillation units has been done on the basis of literature survey till today. The basic heat and mass transfer relation responsible for developing, testing procedure for various designs of solar stills have also been discussed. The present status of solar distillation units in India, economics of single and double slope fibre reinforced plastic on the basis of long-term performance and recommendations for future have been discussed in brief. (author)

  17. Status of the VERITAS Observatory

    CERN Document Server

    Holder, J; Aliu, E; Arlen, T; Beilicke, M; Benbow, W; Bradbury, S M; Buckley, J H; Bugaev, V; Butt, Y; Byrum, K L; Cannon, A; Celik, O; Cesarini, A; Ciupik, L; Chow, Y C K; Cogan, P; Colin, P; Cui, W; Daniel, M K; Ergin, T; Falcone, A D; Fegan, S J; Finley, J P; Finnegan, G; Fortin, P; Fortson, L F; Furniss, A; Gillanders, G H; Grube, J; Guenette, R; Gyuk, G; Hanna, D; Hays, E; Horan, D; Hui, C M; Humensky, T B; Imran, A; Kaaret, Philip; Karlsson, N; Kertzman, M; Kieda, D B; Kildea, J; Konopelko, A; Krawczynski, H; Krennrich, F; Lang, M J; Le Bohec, S; Maier, G; McCann, A; McCutcheon, M; Moriarty, P; Mukherjee, R; Nagai, T; Niemiec, J; Ong, R A; Pandel, D; Perkins, J S; Pohl, M; Quinn, J; Ragan, K; Reyes, L C; Reynolds, P T; Rose, H J; Schroedter, M; Sembroski, G H; Smith, A W; Steele, D; Swordy, S P; Toner, J A; Valcarcel, L; Vasilev, V V; Wagner, R; Wakely, S P; Ward, J E; Weekes, T C; Weinstein, A; White, R J; Williams, D A; Wissel, S A; Wood, M; Zitzer, B

    2008-01-01

    VERITAS, an Imaging Atmospheric Cherenkov Telescope (IACT) system for gammma-ray astronomy in the GeV-TeV range, has recently completed its first season of observations with a full array of four telescopes. A number of astrophysical gamma-ray sources have been detected, both galactic and extragalactic, including sources previously unknown at TeV energies. We describe the status of the array and some highlight results, and assess the technical performance, sensitivity and shower reconstruction capabilities.

  18. Happiness and Sexual Minority Status.

    Science.gov (United States)

    Thomeer, Mieke Beth; Reczek, Corinne

    2016-10-01

    We used logistic regression on nationally representative data (General Social Survey, N = 10,668 and N = 6680) to examine how sexual minority status related to happiness. We considered two central dimensions of sexual minority status-sexual behavior and sexual identity. We distinguished between same-sex, both-sex, and different-sex-oriented participants. Because individuals transition between sexual behavior categories over the life course (e.g., from both-sex partners to only same-sex partners) and changes in sexual minority status have theoretical associations with well-being, we also tested the associations of transitions with happiness. Results showed that identifying as bisexual, gay, or lesbian, having both male and female partners since age 18, or transitioning to only different-sex partners was negatively related to happiness. Those with only same-sex partners since age 18 or in the past 5 years had similar levels of happiness as those with only different-sex partners since age 18. Additional tests showed that the majority of these happiness differences became non-significant when economic and social resources were included, indicating that the lower happiness was a product of structural and societal forces. Our findings clearly and robustly underscored the importance of taking a multi-faceted approach to understanding sexuality and well-being, demonstrating that not all sexual minority groups experience disadvantaged happiness. Our study calls for more attention to positive aspects of well-being such as happiness in examinations of sexual minorities and suggests that positive psychology and other happiness subfields should consider the role of sexual minority status in shaping happiness.

  19. Atmospheric neutrinos: Status and prospects

    OpenAIRE

    2016-01-01

    We present an overview of the current status of neutrino oscillation studies at atmospheric neutrino experiments. While the current data gives some tentalising hints regarding the neutrino mass hierarchy, octant of $\\theta_{23}$ and $\\delta_{CP}$, the hints are not statistically significant. We summarise the sensitivity to these sub-dominant three-generation effects from the next-generation proposed atmospheric neutrino experiments. We next present the prospects of new physics searches such a...

  20. Drug-induced status epilepticus.

    Science.gov (United States)

    Cock, Hannah R

    2015-08-01

    Drug-induced status epilepticus (SE) is a relatively uncommon phenomenon, probably accounting for less than 5% of all SE cases, although limitations in case ascertainment and establishing causation substantially weaken epidemiological estimates. Some antiepileptic drugs, particularly those with sodium channel or GABA(γ-aminobutyric acid)-ergic properties, frequently exacerbate seizures and may lead to SE if used inadvertently in generalized epilepsies or less frequently in other epilepsies. Tiagabine seems to have a particular propensity for triggering nonconvulsive SE sometimes in patients with no prior history of seizures. In therapeutic practice, SE is most commonly seen in association with antibiotics (cephalosporins, quinolones, and some others) and immunotherapies/chemotherapies, the latter often in the context of a reversible encephalopathy syndrome. Status epilepticus following accidental or intentional overdoses, particularly of antidepressants or other psychotropic medications, has also featured prominently in the literature: whilst there are sometimes fatal consequences, this is more commonly because of cardiorespiratory or metabolic complications than as a result of seizure activity. A high index of suspicion is required in identifying those at risk and in recognizing potential clues from the presentation, but even with a careful analysis of patient and drug factors, establishing causation can be difficult. In addition to eliminating the potential trigger, management should be as for SE in any other circumstances, with the exception that phenobarbitone is recommended as a second-line treatment for suspected toxicity-related SE where the risk of cardiovascular complications is higher anyways and may be exacerbated by phenytoin. There are also specific recommendations/antidotes in some situations. The outcome of drug-induced status epilepticus is mostly good when promptly identified and treated, though less so in the context of overdoses. This article is

  1. The TEMPIS Project: Current Status,

    Science.gov (United States)

    1987-06-19

    GRA&I 9 [ Valiente 19871 jC A 10 [Aba 1986AJ tnannounced ŕ [Ahn~ 1986B] oation- Table 1: Status of Subtasks Distribut on/ ____ Avail and/or 3 WkM On...W ~~ -tt-,u Rr ~~ n~ m1 Nn VJs -W r a -VW uS ru-p-urp-Vf U, 8 39. [ Valiente 19871 Valiente , J. Implementing TQuel Aggregates (in progress). Master’s

  2. Renewables 2013. Global Status Report

    Energy Technology Data Exchange (ETDEWEB)

    Sawin, J.L. (ed.) [and others

    2013-07-01

    Renewable energy markets, industries, and policy frameworks have evolved rapidly in recent years. The Renewables Global Status Report provides a comprehensive and timely overview of renewable energy market, industry, investment, and policy developments worldwide. It relies on the most recent data available, provided by many contributors and researchers from around the world, all of which is brought together by a multi-disciplinary authoring team. The report covers recent developments, current status, and key trends; by design, it does not provide analysis or forecasts. This latest Renewables Global Status Report saw: a shift in investment patterns that led to a global decrease in clean energy investment; continuing growth in installed capacity due to significant technology cost reductions and increased investment in developing countries; renewables progressively supplementing established electricity systems, demonstrating that the implementation of suitable policies can enable the successful integration of higher shares of variable renewables; and the emergence of integrated policy approaches that link energy efficiency measures with the implementation of renewable energy technologies.

  3. Timing of Anticonvulsant Administration in Status Epilepticus

    Directory of Open Access Journals (Sweden)

    Juan A Piantino

    2015-06-01

    Full Text Available Investigators from the Pediatric Status Epilepticus Research Group studied the time elapsed from onset of pediatric convulsive status epilepticus (SE to administration of antiepileptic drugs (AED.

  4. US Forest Service Land Status and Encumbrance

    Data.gov (United States)

    US Forest Service, Department of Agriculture — A map service designed to portray US Forest Service Land Status Record System data. The map service is for querying and displaying Land Status Record System...

  5. Nonconvulsive status epilepticus after electroconvulsive therapy

    DEFF Research Database (Denmark)

    Povlsen, Uffe Juul; Wildschiødtz, Gordon; Høgenhaven, Hans;

    2003-01-01

    SUMMARY: We describe three cases of nonconvulsive status epilepticus induced by electroconvulsive therapy (ECT). Nonconvulsive status epilepticus is an important differential diagnosis in patients who develop prolonged confusion after ECT. The present cases exemplify the difficulty in defining...

  6. Nonconvulsive status epilepticus disguising as hepatic encephalopathy.

    Science.gov (United States)

    Jo, Yong Min; Lee, Sung Wook; Han, Sang Young; Baek, Yang Hyun; Ahn, Ji Hye; Choi, Won Jong; Lee, Ji Young; Kim, Sang Ho; Yoon, Byeol A

    2015-04-28

    Nonconvulsive status epilepticus has become an important issue in modern neurology and epileptology. This is based on difficulty in definitively elucidating the condition and its various clinical phenomena and on our inadequate insight into the intrinsic pathophysiological processes. Despite nonconvulsive status epilepticus being a situation that requires immediate treatment, this disorder may not be appreciated as the cause of mental status impairment. Although the pathophysiology of nonconvulsive status epilepticus remains unknown, this disorder is thought to lead to neuronal damage, so its identification and treatment are important. Nonconvulsive status epilepticus should be considered in the differential diagnosis of patients with liver cirrhosis presenting an altered mental status. We report a case of a 52-year-old male with liver cirrhosis presenting an altered mental status. He was initially diagnosed with hepatic encephalopathy but ultimately diagnosed with nonconvulsive status epilepticus by electroencephalogram.

  7. Why do nominal characteristics acquire status value? A minimal explanation for status construction.

    Science.gov (United States)

    Mark, Noah P; Smith-Lovin, Lynn; Ridgeway, Cecilia L

    2009-11-01

    Why do beliefs that attach different amounts of status to different categories of people become consensually held by the members of a society? We show that two microlevel mechanisms, in combination, imply a system-level tendency toward consensual status beliefs about a nominal characteristic. (1) Status belief diffusion: a person who has no status belief about a characteristic can acquire a status belief about that characteristic from interacting with one or more people who have that status belief. (2) Status belief loss: a person who has a status belief about a characteristic can lose that belief from interacting with one or more people who have the opposite status belief. These mechanisms imply that opposite status beliefs will tend to be lost at equal rates and will tend to be acquired at rates proportional to their prevalence. Therefore, if a status belief ever becomes more prevalent than its opposite, it will increase in prevalence until every person holds it.

  8. Iron Status of Deployed Military Members

    Science.gov (United States)

    2017-01-04

    iron status indicators, as Hb concentration and serum ferritin were higher in women reporting amenorrhea as compared to those without...associated with diminished iron status. In female volunteers, menstruation affected iron status indicators, as Hb concentration and serum ferritin were...Participants were categorized as ID if they presented with >2 of the following 3 indicators of abnormal iron status: serum ferritin < 12 ng/mL,

  9. 27 CFR 28.30 - Export status.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Export status. 28.30... Export status. (a) Distilled spirits and wines manufactured, produced, bottled in bottles packed in... such purposes are considered to be exported. Export status is not acquired until application on Form...

  10. Social Status Identity: Antecedents and Vocational Outcomes

    Science.gov (United States)

    Thompson, Mindi N.; Subich, Linda M.

    2011-01-01

    This study extended the literature on potential antecedents and outcomes of perceived social status, or differential status identity (DSI). Fouad and Brown's DSI was used as a conceptual lens for examining the relation of supports and barriers to an individual's perceived social status and subsequent career indecisiveness and career decision…

  11. Management of Status Epilepticus in Children

    Directory of Open Access Journals (Sweden)

    Douglas M. Smith

    2016-04-01

    Full Text Available Status epilepticus is a common pediatric neurological emergency. Management includes prompt administration of appropriately selected anti-seizure medications, identification and treatment of seizure precipitant(s, as well as identification and management of associated systemic complications. This review discusses the definitions, classification, epidemiology and management of status epilepticus and refractory status epilepticus in children.

  12. 5 Assessment of fertility status.cdr

    African Journals Online (AJOL)

    Administrator

    coconut yield is generally related to the fertility status of the soil, a study was conducted to evaluate the fertility status of soils supporting ... Mean organic matter status 22.1 1.9 gkg was moderate. ... surface moisture drains down slope, which.

  13. Overseas Contingency Operations Funding: Background and Status

    Science.gov (United States)

    2017-02-07

    Operations Funding: Background and Status Congressional Research Service Summary The Department of Defense (DOD) estimates that through FY2016...Contingency Operations Funding: Background and Status Congressional Research Service Contents Introduction...Contingency Operations Funding: Background and Status Congressional Research Service 2 budget to which government financiers increasingly turn to

  14. The Retinal Readout System: a status report A Status Report

    CERN Document Server

    Litke, A M

    1999-01-01

    The 'Retinal Readout System' is being developed to study the language the eye uses to send information about the visual world to the brain. Its architecture is based on that of silicon microstrip detectors. An array of 512 microscopic electrodes picks up the signals generated by the output neurons of live retinal tissue in response to a dynamic image focused on the input neurons. These signals are amplified, filtered and multiplexed by a set of eight custom-designed VLSI readout chips, and digitized and recorded by a data acquisition system. This report describes the goals, design, and status of the system. (author)

  15. Socio-Economic Status and Occupational Status Projections of Southern Youth, By Race and Sex.

    Science.gov (United States)

    Lever, Michael F.; Kuvlesky, William P.

    The purpose of this study was to examine selected occupational status projections and the relationship between these projections and socioeconomic status (SES). Occupational status projections referred to predictive statements about the future lifetime job of the respondents. The occupational status projections included in the analysis were: (1)…

  16. Preference for High Status Predicts Implicit Outgroup Bias among Children from Low-Status Groups

    Science.gov (United States)

    Newheiser, Anna-Kaisa; Dunham, Yarrow; Merrill, Anna; Hoosain, Leah; Olson, Kristina R.

    2014-01-01

    Whereas members of high-status racial groups show ingroup preference when attitudes are measured implicitly, members of low-status racial groups--both adults and children--typically show no bias, potentially reflecting awareness of the ingroup's low status. We hypothesized that when status differences are especially pronounced, children from…

  17. Reducing status quo bias in choice experiments

    DEFF Research Database (Denmark)

    Bonnichsen, Ole; Ladenburg, Jacob

    In stated preference literature, the tendency to choose the alternative representing the status quo situation seems to exceed real life status quo effects. Accordingly, status quo bias can be a problem. In Choice Experiments, status quo bias is found to be strongly correlated with protest attitudes...... toward the cost attribute. If economic values are to be elicited, this problem is difficult to remedy. In a split sample framework we test a novel ex-ante entreaty aimed specifically at the cost attribute and find that it effectively reduces status quo bias and improves the internal validity...

  18. Global conservation status of sponges.

    Science.gov (United States)

    Bell, James J; McGrath, Emily; Biggerstaff, Andrew; Bates, Tracey; Cárdenas, César A; Bennett, Holly

    2015-02-01

    Sponges are important for maintaining ecosystem function and integrity of marine and freshwater benthic communities worldwide. Despite this, there has been no assessment of their current global conservation status. We assessed their status, accounting for the distribution of research effort; patterns of temporal variation in sponge populations and assemblages; the number of sponges on threatened species lists; and the impact of environmental pressures. Sponge research effort has been variable; marine sponges in the northeastern Atlantic and Mediterranean and freshwater sponges in Europe and North America have received the most attention. Although sponge abundance has increased in some locations since 1990, these were typically on coral reefs, in response to declines in other benthic organisms, and restricted to a few species. Few data were available on temporal trends in freshwater sponge abundance. Despite over 8500 described sponge species, only 20 are on threatened species lists, and all are marine species from the northeastern Atlantic and Mediterranean. Of the 202 studies identified, the effects of temperature, suspended sediment, substratum loss, and microbial pathogens have been studied the most intensively for marine sponges, although responses appear to be variable. There were 20 studies examining environmental impacts on freshwater sponges, and most of these were on temperature and heavy metal contamination. We found that most sponges do not appear to be threatened globally. However, little information is available for most species and more data are needed on the impacts of anthropogenic-related pressures. This is a critical information gap in understanding sponge conservation status. © 2015 Society for Conservation Biology.

  19. Top Quark Current Experimental Status

    CERN Document Server

    Juste, A

    2006-01-01

    Ten years after its discovery at the Tevatron collider, we still know little about the top quark. Its large mass suggests it may play a key role in the mechanism of Electroweak Symmetry Breaking (EWSB), or open a window of sensitivity to new physics related to EWSB and preferentially coupled to it. To determine whether this is the case, precision measurements of top quark properties are necessary. The high statistics samples being collected by the Tevatron experiments during Run II start to incisively probe the top quark sector. This report summarizes the experimental status of the top quark, focusing in particular on the recent measurements from the Tevatron.

  20. Status of LLNL granite projects

    Energy Technology Data Exchange (ETDEWEB)

    Ramspott, L.D.

    1980-12-31

    The status of LLNL Projects dealing with nuclear waste disposal in granitic rocks is reviewed. This review covers work done subsequent to the June 1979 Workshop on Thermomechanical Modeling for a Hardrock Waste Repository and is prepared for the July 1980 Workshop on Thermomechanical-Hydrochemical Modeling for a Hardrock Waste Repository. Topics reviewed include laboratory determination of thermal, mechanical, and transport properties of rocks at conditions simulating a deep geologic repository, and field testing at the Climax granitic stock at the USDOE Nevada Test Site.

  1. Status epilepticus and cluster seizures.

    Science.gov (United States)

    Patterson, Edward Ned E

    2014-11-01

    Status epilepticus (SE) is a medical emergency for companion animals, with significant associated morbidity and mortality. Therapy in companion animals and people has been largely with sedatives and anesthetics, many of which have gamma-aminobutyric acid receptor-mediated mechanisms. Early aggressive treatment includes staged first-line therapy with benzodiazepines, and second- and third-line protocols when needed. Recently, intravenous levetiracetam has also been used in for SE in dogs and people, and there are other human intravenous drug preparations that may hold promise for future use in companion animals.

  2. LHC Status and Upgrade Challenges

    Science.gov (United States)

    Smith, Jeffrey

    2009-11-01

    The Large Hadron Collider has had a trying start-up and a challenging operational future lays ahead. Critical to the machine's performance is controlling a beam of particles whose stored energy is equivalent to 80 kg of TNT. Unavoidable beam losses result in energy deposition throughout the machine and without adequate protection this power would result in quenching of the superconducting magnets. A brief overview of the machine layout and principles of operation will be reviewed including a summary of the September 2008 accident. The current status of the LHC, startup schedule and upgrade options to achieve the target luminosity will be presented.

  3. Renewables 2012. Global Status Report

    Energy Technology Data Exchange (ETDEWEB)

    Sawin, J.L. (ed.) [and others

    2012-08-15

    Renewable energy markets and policy frameworks have evolved rapidly in recent years. This report provides a comprehensive and timely overview of renewable energy market, industry, investment, and policy developments worldwide. It relies on the most recent data available, provided by a network of more than 400 contributors and researchers from around the world, all of which is brought together by a multi-disciplinary authoring team. The report covers recent developments, current status, and key trends; by design, it does not provide analysis or forecast the future.

  4. Mobile satellite plans and status

    Science.gov (United States)

    Anderson, Roy E.

    1987-03-01

    A method for implementing a mobile satellite system (MSS) in the U.S. and Canada, and the services such a system would provide are described. The MSS is to provide mobile communications that are unlimited in range and unaffected by local terrain features. The system's communications can be either voice or digital, and the small, automatic transponders located in vehicles will respond automatically with the data needed to determine the location of the vehicle. Surveys reveal that there are markets for radio telephones and data and dispatch services. Consideration is given to the regulatory status of the MSS.

  5. Renewables 2005. Global status report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-01

    This report provides an overview of the status of renewable energy worldwide in 2005. It covers markets, investments, industries, policies, and rural (off-grid) renewable energy in developing countries. By design, the report does not provide analysis, recommendations, or conclusions. An extensive research and review process over several months involving more than 100 researchers and contributors has kept inaccuracies to a minimum. REN21 sees this report as the beginning of an active exchange of views and information. This report reveals some surprising facts about renewable energy, many reflecting strong growth trends and increasing significance relative to conventional energy. (au)

  6. Probe Project Status and Accomplishments

    Energy Technology Data Exchange (ETDEWEB)

    Burris, RD

    2001-05-07

    The Probe project has completed its first full year of operation. In this document we will describe the status of the project as of December 31, 2000. We will describe the equipment configuration, then give brief descriptions of the various projects undertaken to date. We will mention first those projects performed for outside entities and then those performed for the benefit of one of the Probe sites. We will then describe projects that are under consideration, including some for which initial actions have been taken and others which are somewhat longer-term.

  7. SEEDS Moving Group Status Update

    Science.gov (United States)

    McElwain, Michael

    2011-01-01

    I will summarize the current status of the SEEDS Moving Group category and describe the importance of this sub-sample for the entire SEEDS survey. This presentation will include analysis of the sensitivity for the Moving Groups with general a comparison to other the other sub-categories. I will discuss the future impact of the Subaru SCExAO system for these targets and the advantage of using a specialized integral field spectrograph. Finally, I will present the impact of a pupil grid mask in order to produce fiducial spots in the focal plane that can be used for both photometry and astrometry.

  8. LP-80 IMU program status

    Science.gov (United States)

    Jackson, Edward N.

    Development history, system design features, performance, and hardware status are reviewed for the fourth-generation LP-80 strapdown inertial measurement unit (IMU) which is currently in full-scale development to meet the design objectives required for missiles, torpedoes, drones, and range instrumentation system applications. The LP-80 is fully self-contained and operates at all attitudes, providing digital processed outputs of angular rate and linear acceleration measured in the body axis frame. For range applications, the LP-80 is designed to provide linear velocities with respect to a space stabilized coordinate frame.

  9. State building energy codes status

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-09-01

    This document contains the State Building Energy Codes Status prepared by Pacific Northwest National Laboratory for the U.S. Department of Energy under Contract DE-AC06-76RL01830 and dated September 1996. The U.S. Department of Energy`s Office of Codes and Standards has developed this document to provide an information resource for individuals interested in energy efficiency of buildings and the relevant building energy codes in each state and U.S. territory. This is considered to be an evolving document and will be updated twice a year. In addition, special state updates will be issued as warranted.

  10. Atmospheric Neutrinos: Status and Prospects

    CERN Document Server

    Choubey, Sandhya

    2016-01-01

    We present an overview of the current status of neutrino oscillation studies at atmospheric neutrino experiments. While the current data gives some tentalising hints regarding the neutrino mass hierarchy, octant of $\\theta_{23}$ and $\\delta_{CP}$, the hints are not statistically significant. We summarise the sensitivity to these sub-dominant three-generation effects from the next-generation proposed atmospheric neutrino experiments. We next present the prospects of new physics searches such as non-standard interactions, sterile neutrinos and CPT violation studies at these experiments.

  11. Atmospheric neutrinos: Status and prospects

    Science.gov (United States)

    Choubey, Sandhya

    2016-07-01

    We present an overview of the current status of neutrino oscillation studies at atmospheric neutrino experiments. While the current data gives some tantalising hints regarding the neutrino mass hierarchy, octant of θ23 and δCP, the hints are not statistically significant. We summarise the sensitivity to these sub-dominant three-generation effects from the next-generation proposed atmospheric neutrino experiments. We next present the prospects of new physics searches such as non-standard interactions, sterile neutrinos and CPT violation studies at these experiments.

  12. Status of the GRANIT facility

    CERN Document Server

    Roulier, Damien; Baessler, Stefan; Clément, Benoît; Morton, Daniel; Nesvizhevsky, Valery; Pignol, Guillaume; Rebreyend, Dominique

    2014-01-01

    The GRANIT facility is a follow-up project, which is motivated by the recent discovery of gravitational quantum states of ultracold neutrons. The goal of the project is to approach the ultimate accuracy in measuring parameters of such quantum states and also to apply this phenomenon and related experimental techniques to a broad range of applications in particle physics as well as in surface and nanoscience studies. We overview the current status of this facility, the recent test measurements and the nearest prospects.

  13. Status of RDMS CMS computing

    Science.gov (United States)

    Gavrilov, V.; Golutvin, I.; Kodolova, O.; Korenkov, V.; Levchuk, L.; Shmatov, S.; Tikhonenko, E.; Zhiltsov, V.

    2016-09-01

    The Compact Muon Solenoid (CMS) is a high-performance general-purpose detector at the Large Hadron Collider (LHC) at CERN. More than twenty institutes from Russia and Joint Institute for Nuclear Research (JINR) are involved in Russia and Dubna Member States (RDMS) CMS Collaboration. A proper computing grid-infrastructure has been constructed at the RDMS institutes for the participation in the running phase of the CMS experiment. Current status of RDMS CMS computing and plans of its development to the next LHC start are presented.

  14. Status of the QUAD Experiment

    Science.gov (United States)

    Church, Sarah

    2006-12-01

    The QUaD (QUEST at DASI) experiment comprises a 31-pixel polarization-sensitive bolometric camera mounted on a 2.6m telescope at the South Pole. QUaD has completed two seasons of observations designed to measure the polarization of the Cosmic Microwave Background (CMB). I will report on the status of QUaD data analysis and interpretation. QUaD is a collaboration between institutions in the US, the UK and Ireland and is funded by the NSF, PPARC and Enterprise Ireland.

  15. Sensors for observing ecosystem status

    Directory of Open Access Journals (Sweden)

    S. Kröger

    2009-04-01

    Full Text Available This paper aims to review the availability and application of sensors for observing marine ecosystem status. It gives a broad overview of important ecosystem variables to be investigated, such as biogeochemical cycles, primary and secondary production, species distribution, animal movements, habitats and pollutants. Some relevant legislative drivers are listed, as they provide one context in which ecosystem studies are undertaken. In addition to literature cited within the text the paper contains some useful web links to assist the reader in making an informed instrument choice, as the authors feel that the topic is so broad, it is impossible to discuss all relevant systems or to provide appropriate detail for those discussed. This is therefore an introduction to how and why ecosystem status is currently observed, what variables are quantified, from what platforms, using remote sensing or in-situ measurements, and gives examples of useful sensor based tools. Starting with those presently available, to those under development and also highlighting sensors not yet realised but desirable for future studies.

  16. Sensors for observing ecosystem status

    Directory of Open Access Journals (Sweden)

    S. Kröger

    2009-11-01

    Full Text Available This paper aims to review the availability and application of sensors for observing marine ecosystem status. It gives a broad overview of important ecosystem variables to be investigated, such as biogeochemical cycles, primary and secondary production, species distribution, animal movements, habitats and pollutants. Some relevant legislative drivers are listed, as they provide one context in which ecosystem studies are undertaken. In addition to literature cited within the text the paper contains some useful web links to assist the reader in making an informed instrument choice, as the authors feel that the topic is so broad, it is impossible to discuss all relevant systems or to provide appropriate detail for those discussed. It is therefore an introduction to how and why ecosystem status is currently observed, what variables are quantified, from what platforms, using remote sensing or in-situ measurements, and gives examples of useful sensor based tools. Starting with those presently available, to those under development and also highlighting sensors not yet realised but desirable for future studies.

  17. Status of the CBM experiment

    Science.gov (United States)

    Heuser, Johann M.

    2015-05-01

    The Compressed Baryonic Matter (CBM) experiment at the Facility for Anti-Proton and Ion Research (FAIR) will explore the phase diagram of strongly interacting matter at highest net baryon densities and moderate temperatures. The CBM physics program will be started with beams delivered by the SIS 100 synchrotron, providing energies from 2 to 11 GeV/nucleon for heavy nuclei, up to 14 GeV/nucleon for light nuclei, and 29 GeV for protons. The highest net baryon densities will be explored with ion beams up to 45 GeV/nucleon energy delivered by SIS 300 in the next stage of FAIR. Collision rates up to 107 per second are required to produce very rare probes with unprecedented statistics in this energy range. Their signatures are complex. These conditions call for detector systems designed to meet the extreme requirements in terms of rate capability, momentum and spatial resolution, and a novel DAQ and trigger concept which is not limited by latency but by throughput. The article discusses the development status of the CBM sub-systems for charged particle tracking, vertex detection, electron/muon identification, hadron/time-of-flight measurement, electromagnetic and zero-degree calorimetry, in terms of prototypes and expected physics performance. The concept and development status of CBM's central detector, the Silicon Tracking System STS are presented in somewhat more detail.

  18. MENA Renewables Status Report 2013

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-06-15

    The MENA Renewables Status Report is an outcome of ADIREC, the Abu Dhabi International Renewable Energy Conference. The report provides a status overview of renewable energy markets, industry, policy and investment trends in the region, drawing on the most recent data available. It is produced in cooperation with over 50 contributors and researchers in the region and reveals massive growth in the renewable energy markets of the Middle East and North Africa (MENA). Regional investment topped US$2.9 billion in 2012, up 40% from 2011 and 650% from 2004. With over 100 projects under development, the region could see a 450% increase in non-hydro renewable energy generating capacity in the next few years. For the report, the 21 MENA countries were clustered into two sub-groups: Net Oil-Exporting Countries (NOEC) -- Algeria, Bahrain, Egypt, Iran, Iraq, Kuwait, Libya, Oman, Qatar, Saudi Arabia, Syria, United Arab Emirates, and Yemen; and Net Oil-Importing Countries (NOIC) -- Djibouti, Israel, Jordan, Lebanon, Malta, Morocco, Palestine, and Tunisia.

  19. Status of the CBM experiment

    Directory of Open Access Journals (Sweden)

    Heuser Johann M.

    2015-01-01

    Full Text Available The Compressed Baryonic Matter (CBM experiment at the Facility for Anti-Proton and Ion Research (FAIR will explore the phase diagram of strongly interacting matter at highest net baryon densities and moderate temperatures. The CBM physics program will be started with beams delivered by the SIS 100 synchrotron, providing energies from 2 to 11 GeV/nucleon for heavy nuclei, up to 14 GeV/nucleon for light nuclei, and 29 GeV for protons. The highest net baryon densities will be explored with ion beams up to 45 GeV/nucleon energy delivered by SIS 300 in the next stage of FAIR. Collision rates up to 107 per second are required to produce very rare probes with unprecedented statistics in this energy range. Their signatures are complex. These conditions call for detector systems designed to meet the extreme requirements in terms of rate capability, momentum and spatial resolution, and a novel DAQ and trigger concept which is not limited by latency but by throughput. The article discusses the development status of the CBM sub-systems for charged particle tracking, vertex detection, electron/muon identification, hadron/time-of-flight measurement, electromagnetic and zero-degree calorimetry, in terms of prototypes and expected physics performance. The concept and development status of CBM’s central detector, the Silicon Tracking System STS are presented in somewhat more detail.

  20. Repository development status in Spain

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez Beceiro, Alvaro; Zuloaga, Pablo [ENRESA (Spain)

    2009-06-15

    The paper describes the status of repository development for the different waste categories. Low and Intermediate Waste Disposal facility of El Cabril was commissioned in 1992 and is in normal operation. The major modifications and activities during the last years are the adaptation to waste streams not initially foreseen such as some decommissioning waste or waste from steel industry, and the improvement of its performance assessment, supported by a R and D and refined models. As part of this facility, a new disposal facility specifically intended for very low activity waste has been constructed and commissioned in July 2008. Its design is based on the European Directive for hazardous waste disposal. National policy for Nuclear Spent Fuel and High-Level waste is focused on the development of a centralized storage facility of the vault type, whose site location would be selected through a volunteering process. Meanwhile, with the aim of solving specific problems, three individual storage facilities are in different status at reactor sites. Research on final solution, including some repository aspects as well as separation and transmutation are being carried out in accordance to ENRESA's R and D program. ENRESA has developed conceptual designs for non site specific repositories, both in granite and clay, and has carried out their corresponding performance assessment exercises. (authors)