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Biomedical subjects

E L Corbett

Publications and source records attributed to E L Corbett.

28 records · Page 2Linked to original sources

Pneumocystis carinii infection: current treatment and prevention.

Pneumocystis carinii is a common cause of pneumonia in individuals who are immunosuppressed by HIV infection. Use of molecular biological techniques show that P. carinii is a fungus and that infection in man is not a zoonosis. Invasive tests such as sputum induction or bronchoscopy are used to make the diagnosis of P. carinii pneumonia. Life long primary prophylaxis is given to HIV positive individuals with CD4+ lymphocyte counts < 0.20 x 10(9)/L or a CD4: total lymphocyte ratio of < 1.5, constitutional symptoms, or with other AIDS defining diseases. Secondary prophylaxis is given after a first episode to prevent a recurrence. First choice for primary and secondary prophylaxis is oral co-trimoxazole 960 mg od or three times a week. In patients who are intolerant to co-trimoxazole, nebulised pentamidine or dapsone (with or without pyrimethamine) are second and third choices. In a patient with acute PCP disease, severity should be assessed using clinical, radiographic and blood gas criteria as those with moderate or severe disease will benefit from adjuvant glucocorticoids. Co-trimoxazole (120 mg/kg/day in divided doses for 21 days) is first choice therapy for PCP of all degrees of severity. In patients who fail to respond to co-trimoxazole or who are intolerant to it, second line treatment is iv pentamidine in those with severe disease and oral dapsone with trimethoprim, oral clindamycin with primaquine or iv pentamidine in those with mild or moderately severe disease.

Animals↗

Imported mucocutaneous leishmaniasis.

We report a case of mucocutaneous leishmaniasis in a otherwise fit Caucasian man who had traveled in an endemic area. Initial tissue microscopy failed to identify the causative organism, which was only determined by subsequent culture as Leishmania braziliensis. This case illustrates the variability in the presence of Leishman-Donovan (LD) bodies in histopathological studies and emphasizes the need for culture in suspected cases of leishmaniasis, particularly given the ability of certain Leishmania species such as L. braziliensis to cause recalcitrant and destructive infections of the nose and mouth.

Adult↗

Crusted ("Norwegian") scabies in a specialist HIV unit: successful use of ivermectin and failure to prevent nosocomial transmission.

A nosocomial outbreak of scabies in a specialist inpatient HIV unit resulted from a patient admitted with crusted scabies. Treatment of his infestation with topical scabicides alone failed and he remained infectious for several weeks. His infestation was then eradicated with combined topical treatment and oral ivermectin. In total, 14 (88%) out of 19 ward staff became symptomatic, and 4 (21%) had evidence of scabies on potassium hydroxide examination of skin scrapings. The ward infection control policy was changed to distinguish patients with crusted scabies from those with ordinary scabies. A second patient with crusted scabies was treated with combined oral and topical therapy early in his admission and nursed with more stringent isolation procedures. No nosocomial transmission occurred and his infestation responded rapidly to treatment. Patients with crusted scabies require strict barrier nursing if nosocomial transmission is to be avoided. Ivermectin combined with topical scabicides may be a more efficacious treatment than topical scabicides alone in such patients.

Adult↗

Disseminated cutaneous Mycobacterium tuberculosis infection in a patient with AIDS.

Individuals infected with the human immunodeficiency virus (HIV) are at an increased risk of both pulmonary and extrapulmonary tuberculosis. Disseminated cutaneous tuberculosis is rare, but has been reported in four HIV-positive patients, all of whom also had pulmonary infection. In this report we describe an HIV-infected patient with a febrile illness and an abnormal chest radiograph who developed widespread cutaneous tuberculous pustules following a lymph node biopsy on the previous day.

Acquired Immunodeficiency Syndrome↗

Chronic hypothermia and water intoxication associated with a neurodegenerative disease.

We describe a 71 year old man with a neurodegenerative condition who developed chronic inappropriate antidiuretic hormone secretion and hypothermia resulting in recurrent episodes of impaired consciousness. This combination of abnormalities is attributable to hypothalamic disease and has not to our knowledge been previously reported with clearly documented antidiuretic hormone excess.

Aged↗

Raised intracranial pressure and visual complications in AIDS patients with cryptococcal meningitis.

The clinical course of cryptococcal meningitis in AIDS shows some important differences from the features of the illness in non-AIDS patients. Complications such as raised intracranial pressure and visual impairment that are recognised in non-AIDS patients may be less frequent in those with AIDS. Persistent intracranial hypertension should be managed actively to prevent visual impairment. In AIDS patients, in whom ventriculo-peritoneal shunts carry additional risks, acetazolamide can be used successfully to lower the CSF pressure and prevent visual loss.

Acquired Immunodeficiency Syndrome↗

Nutritional status of children with schistosomiasis mansoni in two different areas of Machakos District, Kenya.

A possible association between nutritional status and Schistosoma mansoni infection or morbidity was investigated by comparing anthropometric indices among 362 children from 3 primary schools in Machakos District, Kenya. Matithini was a prosperous school in an area (Kangundo) of moderate intensity of schistosome infection but low associated morbidity. A second area (Kambu) showed more severe schistosome-associated morbidity: in this area, Kitengei school was prosperous and with high intensities of schistosome infection, while Misuuni school was less prosperous and with low intensities of infection. Nutritional status was assessed by measurement and appropriate standardization of height, weight and skinfold thickness and by questionnaires concerning diet. Children in Kangundo were better nourished than those in Kambu. Within Kambu, children from Misuuni showed low mean skinfold thickness and low mean weight-for-height ('wasting'): this was associated with a lack of dietary variety and of intake of animal products. In contrast, those from Kitengei showed low mean height-for-age ('stunting'). The relationship between intensity of schistosome infection and nutritional indices, although significant, was complex and not readily interpretable. However, intensity of infection was also correlated with hepatomegaly, which was more clearly related to nutritional status. Depending on the school, children with hepatomegaly were significantly more stunted and/or wasted than those without, and had less variety in their diet. Possible reasons for the observed associations are discussed and, of various possibilities, the hypothesis is suggested that schistosome-associated morbidity leads to a subsequent nutritional defect. This hypothesis can now be tested by appropriate intervention studies.

Adolescent↗

Tuberculosis in the HIV-positive patient.

HIV infection is the most potent risk factor known for tuberculosis, which results both from reactivation and progression from recent infection. We review the epidemiology, clinical features, differential diagnosis and management of HIV-associated tuberculosis, probably the most important opportunistic infection associated with HIV worldwide, and one that is communicable to other HIV-negative persons.

AIDS-Related Opportunistic Infections↗