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Biomedical subjects

M J Wiselka

Publications and source records attributed to M J Wiselka.

At least 19 recordsLinked to original sources
PubMed2006

Progressive symptoms and signs following institution of highly active antiretroviral therapy and subsequent antituberculosis therapy: immune reconstitution syndrome or infection?

A 36 year old man presented with weight loss, cough, fever, and exertional dyspnoea shortly after a diagnosis of HIV infection. Symptoms and initial radiological abnormalities worsened after highly active antiretroviral therapy was started. An eventual diagnosis was established but multiple problems occurred throughout the treatment period. Differentiation between immune reconstitution inflammatory syndrome and an infective cause was problematic.

AIDS-Related Opportunistic Infections↗
PubMed2005

Disseminated Sporothix schenckii in a patient with AIDS.

Sporothrix schenckii is a widespread dimorphic fungus which can cause cutaneous infection following local implantation. Disseminated sporotrichosis may occur in immunodeficient individuals but meningitis remains a rare complication. Diagnosis is usually difficult, requiring isolation of the organism from the CSF or skin so appropriate treatment can be promptly initiated. We present the first case of S. schenckii meningitis reported in the UK in a patient with AIDS. He presented with insidious features of meningoencephalitis, hydrocephalus and multiple cutaneous lesions and failed to respond to therapy.

AIDS-Related Opportunistic Infections↗
PubMed2002

New World leishmaniasis from Spain.

A 69 year old man living in Spain contracted mucocutaneous leishmaniasis involving the nose. The infecting organism was Leishmania infantum, which only rarely causes the New World form of the disease. The source of infection was probably a neighbour's dog. The patient began treatment with liposomal amphotericin B but died of pneumonia two months later.

Amphotericin B↗
PubMed2000

Extensive psoriasis induced by interferon alfa treatment for chronic hepatitis C.

A 47 year old man with chronic hepatitis C was treated with interferon alfa, 3 million units three times a week, and developed widespread plaque psoriasis within weeks of starting interferon therapy. There was no previous history of psoriasis. The psoriasis was characterised by extensive nail involvement and plaques at the interferon injection sites. The patient relapsed after a total of 12 months of interferon and was subsequently treated with interferon and tribavirin (ribavirin) with recurrence of the psoriasis.

Antiviral Agents↗
PubMed1999

Cytomegalovirus viraemia has poor predictive value for the development of cytomegalovirus disease in patients with advanced HIV-infection.

OBJECTIVE: Cytomegalovirus (CMV) continues to be one of the most important opportunistic infections associated with human immunodeficiency virus (HIV) infection. This study investigated the value of CMV-viraemia in predicting the development of clinical CMV disease in patients with advanced HIV infection. METHODS: This was a prospective observational study performed over a 2-year period between 1994-96 in the Department of Infection and Tropical Medicine at Leicester Royal Infirmary. Adult HIV-positive patients attending a hospital clinic were included if they were CMV-seropositive with CD4 counts < or =50 cells/mm3. Subjects were seen at approximately 6-weekly intervals in the clinic and were reviewed by an experienced ophthalmologist. Serum for CMV PCR was taken and stored at regular intervals and qualitative and quantitative PCR was performed at the end of the study period. The value of PCR in predicting the development of CMV disease was then assessed. RESULTS: Twenty-six patients were followed up during the study period and 77 evaluable specimens were analysed for CMV PCR. Twenty-three (30%) samples were positive and 54 negative. Seven (27%) patients developed CMV disease (five retinitis alone, and two with retinitis and oesophagitis) during the study period. Viraemia was often intermittent and there was no significant difference in the proportions of patients with positive or negative tests who subsequently developed CMV disease. The sensitivity, specificity, positive and negative predictive values of the qualitative PCR were 71%, 47%, 33% and 82% respectively and 57%, 74%, 44% and 82% respectively for the quantitative PCR (>10(3) copies/ml). CONCLUSIONS: The results from this study, which was performed before the introduction of protease inhibitors, found that cytomegalovirus PCR was of limited clinical value in predicting the patients at greatest risk of developing CMV-disease and provided little useful prognostic information.

AIDS-Related Opportunistic Infections↗
PubMed1999

A review of ultrasound-guided percutaneous biopsy of the gastrointestinal tract in HIV-infected patients.

OBJECTIVE: To illustrate the use of percutaneous ultrasound-guided biopsy of the gastrointestinal tract in HIV-infected patients to obtain a tissue diagnosis. DESIGN: The technique was used in relation to relevant clinical situations in which a diagnosis may have only been reached by open biopsy. METHOD: Three HIV-infected patients with suspected gastrointestinal tract lesions underwent percutaneous ultrasound-guided biopsy under local anaesthetic. RESULTS: A tissue diagnosis was made in each case resulting in initiation or continuation of appropriate therapy and avoided the need for open biopsy under general anaesthetic. CONCLUSION: Although the number of patients undergoing the procedure in this series was small, the technique has so far been shown to be safe and effective with few complications.

AIDS-Related Opportunistic Infections↗
PubMed1998

Randomised placebo-controlled crossover trial on effect of inactivated influenza vaccine on pulmonary function in asthma.

BACKGROUND: Despite current recommendations, many people with asthma do not receive annual vaccination against influenza, partly because of concern that vaccine may trigger exacerbations. Colds can trigger exacerbations, which may be mistaken for vaccine-related adverse events. We undertook a double-blind placebo-controlled multicentre crossover study to assess the safety of influenza vaccine in patients with asthma, with allowance for the occurrence of colds. METHODS: We studied 262 patients, aged 18-75 years, who recorded daily peak expiratory flow (PEF), respiratory symptoms, medication, medical consultations, and hospital admissions for 2 weeks before the first injection and until 2 weeks after the second injection. Order of injection (vaccine and placebo) was assigned randomly. There was an interval of 2 weeks between injections. The main outcome measure was an exacerbation of asthma within 72 h of injection (defined as a fall in PEF of >20%). FINDINGS: Among 255 participants with paired data, 11 recorded a fall in PEF of more than 20% after vaccine compared with three after placebo (McNemar's test p=0.06); a fall of more than 30% was recorded by eight after vaccine compared with none after placebo (binomial test p=0.008). However, when participants with colds were excluded, there was no significant difference in the numbers with falls of more than 20% between vaccine and placebo (six vs three; binomial test p=0.51), although the difference for PEF decreases of more than 30% approached significance (five vs none; binomial test, p=0.06). This association was confined to first-time vaccinees. INTERPRETATION: Our findings indicate that pulmonary-function abnormalities may occur as a complication of influenza vaccination. However, the risk of pulmonary complications is very small and outweighed by the benefits of vaccination.

Adult↗
PubMed1997

Outpatient parenteral antimicrobial therapy: experience in a large teaching hospital.

OBJECTIVE: to determine the practicality of treatment of infectious conditions requiring prolonged parenteral antimicrobial therapy. METHOD: review of all patients admitted to a Regional Infectious Diseases (ID) Unit who received outpatient parenteral therapy over a 12-month period. The study identified the conditions suitable for outpatient therapy, the organization of treatment and the complications and financial implications of the service. RESULTS: fifteen patients (age range 32-81) received outpatient parenteral antimicrobial therapy during the period of the study. Five patients were HIV-positive and were treated for cytomegalovirus retinitis or severe recurrent candida infection with self-administration of drugs through a Hickman line. HIV-negative patients were treated for osteomyelitis, deep-seated abscesses and subacute bacterial endocarditis. Eight of the 10 HIV-negative patients were given ceftriaxone once daily. The organization and delivery of outpatient drug therapy depended on the nature of the underlying infection and the availability of community services. Outpatient therapy was associated with considerable financial savings, and no serious adverse events were recorded. CONCLUSION: outpatient parenteral treatment is a reasonable option for a relatively small number of patients, representing less than 2% of patients admitted to the ID Unit over the time course of the study. Patients suitable for outpatient treatment have a stable medical condition and require prolonged antimicrobial therapy.

AIDS-Related Opportunistic Infections↗
PubMed1996

Response to oral and intravenous azithromycin in a patient with toxoplasma encephalitis and AIDS.

We present a patient with AIDS and toxoplasma encephalitis who was unable to tolerate established therapy with sulphadiazine or clindamycin but responded to oral azithromycin and pyrimethamine. The patient was maintained on oral azithromycin but subsequently relapsed after 8 months. The recurrence was successfully treated with intravenous azithromycin. The case illustrates that azithromycin can be used to treat patients with toxoplasma encephalitis who are unable to tolerate or fail to respond to other therapeutic agents. Failure of oral azithromycin may be due to inadequate tissue concentrations and patients may further benefit from intravenous administration.

AIDS-Related Opportunistic Infections↗
PubMed1995

Operative procedures in patients subsequently found to be human immunodeficiency virus positive.

This study investigated the number and range of surgical procedures performed in patients subsequently found to be human immunodeficiency virus (HIV) positive. Procedures were included if they occurred during a period when the patients were likely to have been infected with HIV but unaware of their HIV status. A total of 28 operative procedures were documented in 19 (22 per cent) of 86 patients. Several operations were major and invasive. All patients had recognized risk factors for HIV infection but these had not been elicited in the surgical records. Women and patients who acquired their disease through heterosexual intercourse were more likely to have undergone surgery before a diagnosis of HIV than homosexual men. The incidence of surgical procedures in patients with HIV infection was significantly greater than in the general population of Leicestershire; however, many of these were minor and related to the management of complications associated with HIV. Surgeons are performing operations on patients who are unknowingly infected with HIV. The risk of transmission of HIV to surgeons is remote, but surgeons must be aware of risk factors for HIV infection.

Adult↗
PubMed1994

Varicella pneumonitis: a role for extra-corporeal membrane oxygenation?

Pneumonitis is the most serious complication of varicella zoster infection and may be fatal despite antiviral therapy and assisted ventilation. We report two cases of varicella pneumonitis which were complicated by severe pneumonitis. Both patients deteriorated on maximal ventilatory support and were then given extra-corporeal membrane oxygenation (ECMO) and recovered. One patient subsequently developed lymphoma and the other was found to have an immunoglobulin subclass deficiency. ECMO should be considered for patients with varicella pneumonitis who do not respond to conventional treatment. Those with severe pneumonitis should be investigated for underlying immunodeficiency.

Adult↗