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Biomedical subjects

H Albrecht

Publications and source records attributed to H Albrecht.

At least 73 records · Page 4Linked to original sources
PubMed1997

Increased risk for opportunistic infections during chemotherapy in HIV-infected patients with Kaposi's sarcoma.

BACKGROUND: Kaposi's sarcoma (KS) is the most frequent neoplasm in patients with AIDS, responsible for death in about 20-30% of the affected patients. OBJECTIVE: To determine the frequency of opportunistic infections (OI) and change of CD4+ cell counts in patients with KS treated with chemotherapy compared to a group of matched-pair patients without chemotherapy. METHODS: In a prospective study, the clinical courses of 35 HIV-infected patients with KS treated with chemotherapy were compared with 35 matched-pair patients without chemotherapy. RESULTS: During the observation period of 6 months, 11 OI occurred in 10 patients of the chemotherapy group and 5 OI in 5 patients of the control group. With respect to the changes of CD4+ cell counts, no significant differences could be observed. CONCLUSION: The risk for OI in HIV-infected patients with KS is increased while receiving chemotherapy. This should be reflected upon when chemotherapy is taken into consideration.

AIDS-Related Opportunistic Infections↗
PubMed1997

Patterns of mycobacterium avium culture and PCR positivity in immunodeficient HIV-infected patients: progression from localized to systematic disease, German Aids Study Group (GASG/IDKF).

Our aim was to establish the frequency and the longitudinal pattern of MAC culture positivity in late stage HIV-infected patients. Two other aims were to analyse risk factors for progression from localized to systemic disease and the value of PCR diagnosis using blood specimens. A total of 107 patients were recruited to be followed for 32 weeks. Prior MAC treatment and CD4 > 100/microliters were exclusion criteria. A total of 56 patients showed M. avium in at least 1 culture. 10/37 patients with MAC detected by culture first in 'non-sterile' specimens (stool, sputum) and urine progressed to systemic disease as determined by positive blood culture. Risk factors associated with this progression were a high symptom score at baseline, lymphadenopathy, anaemia, and low platelets. PCR was less sensitive than culture in detection of M. avium in blood specimens: Only 7/29 patients with positive blood cultures had a positive PCR at the same time. We conclude that symptomatic patients with advanced HIV-infection have a high frequency of MAC detection. Progression from localized to systemic culture positivity is associated with risk factors. Early 'pre-emptive' therapy is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Epstein-Barr virus--Associated hemophagocytic syndrome. A cause of fever of unknown origin in human immunodeficiency virus infection.

A 26-year-old human immunodeficiency virus-positive man presented with fever of unknown origin, pancytopenia, and elevated liver function tests. Numerous diagnostic tests and empiric therapeutic interventions remained unsuccessful. Splenectomy eventually established the diagnosis of Epstein-Barr virus-associated hemophagocytic syndrome. Treatment with foscarnet, acyclovir, prednisone, and vinblastine resulted in complete recovery. Three months later, Hodgkin's disease, a previously reported complication of the Epstein-Barr virus-associated hemophagocytic syndrome, was diagnosed. Fever, pancytopenia, and hepatic dysfunction are common complication of advanced human immunodeficiency virus infection and can be caused by a variety of opportunistic pathogens. A high index of suspicion is critical for the management of this otherwise fatal disorder because once the diagnosis is made, even patients with advanced disease benefit from aggressive therapeutic intervention, as demonstrated in the case presented.

Adult↗
PubMed1996

Resolution of HIV-associated cystic benign lymphoepithelial lesion of the parotid gland in a patient undergoing chemotherapy for non-Hodgkin's lymphoma.

Cystic benign lymphoepithelial lesion, a previously rare lesion of the parotid gland characterized by multiple cysts accompanied by marked lymphoid hyperplasia, is increasingly reported in patients with human immunodeficiency virus infection. The case of a 59-year-old man without identifiable risk factors for the acquired immunodeficiency syndrome is presented, in whom the development of cystic benign lymphoepithelial lesions led to the diagnosis of the underlying human immunodeficiency virus infection. The lymphoepithelial lesion remained unchanged for 8 years. When chemotherapy was instituted for abdominal non-Hodgkin's lymphoma all cystic lesions resolved completely. This previously undescribed phenomenon strongly supports the concept that the development of the cysts is secondary to the mechanical obstruction of salivary ducts caused by lymphoid hyperplasia and not due to true de novo cyst formation.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Visceral leishmaniasis emerging as an important opportunistic infection in HIV-infected persons living in areas nonendemic for Leishmania donovani.

BACKGROUND: Visceral leishmaniasis is an important infection in patients infected with human immunodeficiency virus and living in areas endemic for Leishmania sp. Leishmaniasis, however, is rarely suspected in patients residing in nonendemic countries. METHODS: Retrospective case analysis of 15 patients with human immunodeficiency virus infection and leishmaniasis treated at seven German clinics. The clinicopathological features and the diagnostic role of biopsy and/or cytology as compared to serology were evaluated. RESULTS: All patients were severely immunocompromised. One patient was first diagnosed at autopsy. One patient with mucocutaneous disease was diagnosed by nasal biopsy. All others had amastigotes detected in bone marrow (13/13), liver (3/3), and gastrointestinal mucosa (4/4). Serology was positive in only 6 or 13. CONCLUSION: Visceral leishmaniasis is an important opportunistic infection in patients with acquired immunodeficiency syndrome and it must be ruled out in every patient with fever and/or pancytopenia and an appropriate travel history. Because serological diagnosis is often insufficient, pathologists must be aware of the association between human immunodeficiency virus infection and leishmaniasis. Diagnosis depends on detection of the parasite in submitted specimens.

AIDS-Related Opportunistic Infections↗
PubMed1996

Rapid plasma virus and CD4+ T-cell turnover in HIV-1 infection: evidence for an only transient interruption by treatment.

OBJECTIVES: To analyse the short-term kinetics of viral plasma RNA and CD4+ T cells numbers in patients with different initial CD4+ T-cell counts treated with different antiretroviral regimens. METHODS: In 10 HIV-1 positive patients, in vivo kinetics of plasma HIV RNA and CD4+ T cells were studied during antiretroviral treatment. Lymphocyte subpopulation analysis, quantitative polymerase chain reaction (PCR), p24 antigen enzyme immunoassay (EIA) and beta 2-microglobulin EIA were performed at days 0, 3, 7, 10, 14, 21 and 28 of treatment. One additional patient served as a control. The resulting curves were fitted. Half-lives were calculated using the time constant T of decrease or increase [T1/2 = In(2) x T]. Calculations of virus and CD4+ T-cell turnover were multiplied by the total blood volume. RESULTS: Viral plasma RNA half-life ranged from 1.1 to 5.1 days, independent of prior or actual treatment and initial CD4+ T-cell count. The calculated peripheral blood viral plasma RNA turnover varied between 0.02 and 55.8 x 10(8) copies/ml/day and showed some negative correlation with initial CD4+ T-cell counts. CD4+ T-cell turnover estimates ranged from 0.01 to 7.5 x 10(8) cells/day. Most patients showed an immediate reincrease of virus load after the nadir. Changes in HIV p24 antigen paralleled HIV plasma RNA in p24 antigen-positive patients. beta 2-microglobulin decreased until day 7-15 in all but one case and rapidly reincreased to pretreatment values. CONCLUSIONS: The kinetics of virus and CD4+ T-cell turnover are uniformly rapid throughout a wide range of initial CD4+ T-cell counts. The magnitude of virus turnover varies considerably among individuals and appears to be inversely related to the initial CD4+ T-cell count. These data also argue for a rapid resumption of virus production and lymphocyte turnover during treatment.

Adult↗
PubMed1996

[Acute foot drop paralysis in multiple sclerosis. Peroneal nerve compression as differential diagnosis of acute onset].

We report on ten patients with clinically definite multiple sclerosis (MS) and acute weakness during dorsiflexion of the foot and toes. Assuming an attack, two patients were treated with corticosteroids, but without any effect. Since there were very few clinical hints (hyposensitivity in the area of distribution of n. peronaeus superficialis in one, positive Hoffmann-Tinel signs in two cases) only detailed neurophysiological examinations finally resulted in locating circumscribed lesions of the peroneal nerves (mainly localized at the head of the fibula), which consequently ended up in peripheral paresis of the dorsiflexion muscles. In six cases the peroneal lesion was caused by direct pressure on the nerve (hard crossing of the legs in five patients, pressing the caput fibulae against the wheelchair in one), and in the other three cases by stretching of the nerve due to genu recurvatum. Seven patients forced this posture with the intention of compensating for ataxia of the trunk and/or gait. After a period of avoiding these mechanisms, we saw five patients for follow-up examinations with evident improvements in the clinical and neurophysiological aspects.

Acute Disease↗
PubMed1995

Expression of type A and B tumor necrosis factor (TNF) receptors on melanoma cells can be regulated by dbc-AMP and IFN gamma.

Local administration of high-dose r-TNF alpha with IFN gamma in the limbs of melanoma patients has proved to be a very promising treatment. To understand the role played by the effect of TNF on melanoma cells in tumor destruction, we have investigated the expression of TNF-receptors in melanoma cells using monoclonal antibodies specific for the type-A (75-kDa) and the type-B (55-kDa) TNF receptors. Flow cytometric analysis of cultured melanoma cells indicated the presence of both types of receptor. Quantificative differences in the relative levels of receptors were observed for different cells lines, although the type-B receptor was generally more strongly expressed. Similar results were obtained by immunohistochemistry on cryosections from tumor samples. Positive staining of variable intensity was observed for the type-B TNF-receptor in a high percentage of tumor cells. The type-A TNF-receptor was also detected, but with a weaker staining. The total TNF-binding activity of cultured melanoma cells, as measured by binding of 125I-labeled TNF alpha, was up-regulated between 2- and 4-fold by incubation of cells with activators of protein kinase A or IFN gamma. Treatment of cultured melanoma cells with dbc-AMP resulted in a selective induction of type-A TNF-receptors, without affecting the type-B receptor level. In contrast, IFN gamma was able to induce either type of receptor in a cell-line-dependent fashion. Addition of TNF alpha to melanoma cells induced the activation of the nuclear transcription factor kappa B, as measured in an electrophoretic mobility shift assay, thus indicating the biological significance of the TNF-receptors on these cells.

Base Sequence↗
PubMed1995

A case of disseminated Mycobacterium bovis infection in an AIDS patient.

The first case of disseminated Mycobacterium bovis infection with meningitis in an AIDS patient is reported. A 54-year-old male HIV-positive patient was admitted for evaluation of fever, weight loss, inappetence, fatigue and malaise. Mycobacterium bovis (non-BCG) was isolated from blood, bone marrow, stool, urine, sputum, abdominal lymph nodes and cerebrospinal fluid. Antituberculous therapy using a five-drug regimen plus steroids resulted in complete recovery.

AIDS-Related Opportunistic Infections↗
PubMed1995

Disseminated Encephalitozoon (Septata) intestinalis infection in a patient with AIDS: novel diagnostic approaches and autopsy-confirmed parasitological cure following treatment with albendazole.

Encephalitozoon intestinalis is a recently described microsporidian which causes intestinal and disseminated infections in severely immunocompromised patients with AIDS. Preliminary data suggest that albendazole can be an effective therapy for patients with E. intestinalis infection. However, relapses have been reported following treatment in some cases. These results were based upon examination of cytologic, biopsy, or stool samples with an inherent sampling bias. This report documents the first postmortem evaluation of a patient with E. intestinalis infection treated with albendazole. Antemortem microsporidial diagnosis was performed on nasal mucosal smear and duodenal biopsy specimens by electron microscopy and a newly developed indirect fluorescent-antibody method based upon in vitro cultivation of the organism. This case represents the initial report of using nasal cytologic specimens for ultrastructural and antibody-based species-level diagnosis of microsporidiosis. Following successful treatment of this infection with albendazole, the patient died of other causes. A thorough autopsy examination failed to reveal the presence of E. intestinalis in any tissue, providing confirmatory evidence for a complete parasitological cure with albendazole.

Acquired Immunodeficiency Syndrome↗