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Biomedical subjects

R Cauda

Publications and source records attributed to R Cauda.

At least 55 records · Page 3Linked to original sources
PubMed1997

Central venous catheter-related sepsis in a cohort of 366 hospitalised patients.

Five hundred two central venous catheters inserted in 366 patients were evaluated prospectively over a one-year period to determine the frequency and risk factors associated with catheter-related sepsis. For study purposes, in cases in which catheter infection was suspected but the initial blood cultures were negative, the catheters were replaced by guidewire technique; otherwise, the catheters were routinely changed after 21 days by guidewire technique. A catheter-related infection was suspected in 190 cases (190/502, 38%). A diagnosis of catheter-related sepsis was established in 50 patients, which represents 10% of the total number of lines (502). Over a total of 6428 days of catheter use, the infection rate was 0.8 cases of sepsis per 100 catheter-days. Staphylococcus epidermidis, Staphylococcus aureus, and Candida spp. were the most frequently isolated aetiological agents of sepsis. On univariate analysis, six variables affecting the rate of catheter-related sepsis were identified: neutropenia for more than eight days (p < 0.001); AIDS (p < 0.001); haematological malignancy (p < 0.001); administration of total parenteral nutrition (p = 0.001); duration of site use (p = 0.04); and high APACHE II score (p = 0.04). The logistic regression analysis revealed that AIDS and haematological malignancies were independent risk factors of catheter-related sepsis. Catheter replacement over a guidewire was no more likely to be associated with sepsis than was percutaneous catheter insertion. In conclusion, although the incidence of established catheter infection is much lower than the incidence of suspected infection, in most cases of suspected infection it is wise to change the catheter with the guidewire technique and wait for culture of the tip, rather than to remove the catheter immediately. Such a policy may help reduce the number of unnecessary catheter removals.

APACHE↗
PubMed1997

Comparative analysis of prognostic indicators of aspergillosis in haematological malignancies and HIV infection.

The objective of this study was to identify the prognostic factors influencing the outcome of aspergillosis in two models of immunodeficiency, namely haematological malignancies and HIV infection. The study is based on a 5 year prospective logistic regression analysis of risk factors, clinical features, radiological findings and therapy affecting the prognosis of aspergillosis in 43 patients, i.e. 27 haematological neoplastic patients (group A) and 16 HIV infected patients (group B). Univariate analysis indicated that neutropenia (P = 0.02), haemoptysis (P = 0.03) and concomitant AIDS (P = 0.02), negatively influenced the prognosis of aspergillosis. Comparing the two groups of patients, significant differences emerged in the prognostic indicators. In particular respiratory failure (P = 0.02) and radiological bilateral involvement of the lungs were associated with a poor prognosis in group A (P = 0.04) and low (2100/mm3) T CD4+ cell count in group B (P = 0.02). At variance, a better prognosis was documented in patients treated with sequential therapy (amphotericin B and itraconazole) only within the group of haematological patients (P = 0.003). On multivariate analysis sequential therapy (P = 0.01) and AIDS (P = 0.03) were independent prognostic indicators of aspergillosis. In conclusion, our prospective study indicates that aspergillosis, although an uncommon event in patients with HIV infection, has a more severe prognosis in comparison to haematological patients. Future prospective clinical trials are necessary to confirm the real importance of the sequential therapy, with amphotericin B and itraconazole, in patients with aspergillosis.

Adult↗
PubMed1997

Gastric cryptosporidiosis complicating HIV infection: case report and review of the literature.

Gastric cryptosporidiosis is rarely reported despite the fact that Cryptosporidium has been recognized with increasing frequency as an aetiological agent of severe chronic diarrhoeal enteritis in patients with human immunodeficiency virus (HIV) infection. We report a case of gastric cryptosporidiosis that occurred in an AIDS patient. Fifteen previously reported cases of gastric cryptosporidiosis are also reviewed. The review of all cases reported in the literature, including our own, showed that 12 patients had digestive symptoms. In 14 out of 16 patients the diagnosis was achieved by biopsy of the gastric mucosa rather than by examination of the stools. Gastric localization of Cryptosporidium is a rare and severe manifestation of intestinal cryptosporidiosis in patients with AIDS, and no single drug regimen has yet been found to be effective in eradicating this organism.

AIDS-Related Opportunistic Infections↗
PubMed1997

Fluconazole resistant oral candidiasis in HIV-infected patients.

OBJECTIVE: To evaluate the risk factors associated with the emergence of fluconazole resistant Candida spp. in HIV-infected patients with oral candidiasis. METHODS: Candida spp. were isolated from oral swabs and tested in vitro for resistance to fluconazole. The factors potentially correlated with vazole-resistent Candida spp. infections were investigated. RESULTS: Fifty-one out of 118 patients (43%) with oral candidiasis had fluconazole resistant Candida spp. The following factors were significantly associated with the development of fluconazole resistance: (1) more than five episodes of oral candidiasis in the previous year (P < 0.001); (2) fluconazole therapy in the previous 6 months (P < 0.001); (3) C3 category of HIV infection (P < 0.001); and (4) low number of TCD4+ cells (< 50 mm3, P = 0.002). According to multivariate analysis, previous therapy with fluconazole was the only risk factor that independently influenced the development of Candida spp. resistance (P = 0.003). CONCLUSIONS: The prophylaxis and therapy of mild fungal infections in HIV-infected patients, which may lead to azole resistance, should be carefully considered.

AIDS-Related Opportunistic Infections↗
PubMed1997

Pneumothorax in HIV-infected patients: role of Pneumocystis carinii pneumonia and pulmonary tuberculosis.

Patients with acquired immune deficiency syndrome (AIDS) are at increased risk for pneumothorax, which usually occurs in the setting of Pneumocystis carinii pneumonia. The rationale of the present study was based on the hypothesis that the increased incidence of pulmonary tuberculosis in human immunodeficiency virus (HIV)-infected patients could favour the development of pneumothorax in such patients. A case-control study was performed comprising 140 HIV-infected patients grouped as follows: 35 patients with pneumothorax and 105 matched controls without pneumothorax. Univariate analysis identified four risk factors for pneumothorax: 1) previous P. carinii pneumonia (p=0.01); 2) current P. carinii pneumonia (p=0.02); 3) pulmonary tuberculosis (p=0.01); and 4) cysts, pneumatoceles or bullae on chest radiographs (p<0.001). Multivariate analysis indicated that current P. carinii pneumonia (p=0.01) and pulmonary tuberculosis (p=0.04) were both independent risk factors for pneumothorax. In conclusion, our findings demonstrate that, in addition to Pneumocystis carinii pneumonia, pulmonary tuberculosis enhances the risk of pneumothorax in patients with acquired immune deficiency syndrome.

AIDS-Related Opportunistic Infections↗
PubMed1997

Osteoarticular bacterial infections are rare in HIV-infected patients. 14 cases found among 4,023 HIV-infected patients.

Among 4,023 HIV-infected patients admitted to a large Italian university hospital in the period 1985-1996, 14 had concomitant HIV and bacterial osteoarticular infections. Staphylococcus aureus infections were commonest and were diagnosed in 8 patients. Intravenous drug addiction was the only risk factor significantly associated with the development of osteoarticular infection (p = 0.04). In contrast, no statistical correlations were found with age, sex, absolute number of circulating T-CD4+ lymphocytes, neutrophils and stage of HIV infection. In conclusion, osteoarticular infections are uncommon in HIV-infected patients and are more directly related to parenteral drug abuse than to HIV.

Adult↗
PubMed1996

Effect of Mycobacterium tuberculosis on HIV replication. Role of immune activation.

The prevalence of Mycobacterium tuberculosis (MTB) has increased worldwide, in part due to the HIV epidemic. Epidemiology data have demonstrated that HIV-infected individuals are more susceptible to MTB disease, which may lead to an acceleration in the progression of HIV disease. The purpose of this study was to determine whether MTB modulates HIV infection in vivo and to delineate the mechanisms involved by using in vitro model systems. Plasma viral load was measured in HIV-infected individuals before, during, and after the development of MTB disease; a 5- to 160-fold increase in viral replication was observed during the acute phase of MTB disease. In order to evaluate the mechanisms involved in this MTB-induced HIV replication, we used an in vitro system of primary PBMC and lymph node mononuclear cells isolated from HIV-infected individuals. The data demonstrated that MTB induced HIV replication in CD8+ T cell-depleted lymphocytes from HIV-infected individuals with a history of purified protein derivative (PPD) positivity but not in those who were PPD negative; this induction of HIV replication correlated with the level of cellular activation. In an in vitro acute HIV infection model, MTB increased HIV replication in PBMC from healthy donors with a history of PPD positivity, but not in PBMC from PPD-negative donors and this induction of viral replication also correlated with cellular activation. In conclusion, MTB increased HIV replication in vivo and in an in vitro model. This MTB-mediated viral production likely occurs through Ag-specific activation and infection of responding T cells.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Predictors of Staphylococcus aureus pneumonia associated with human immunodeficiency virus infection.

This study is based on a retrospective logistic regression analysis of all human immunodeficiency virus (HIV)-infected patients with Staphylococcus aureus pneumonia (SAP) admitted to the Department of Infectious Diseases, Catholic University, Rome, Italy between January 1986 and December 1994. Nineteen patients with 24 episodes of SAP were enrolled in the study. A control group of 38 HIV-infected patients without pneumonia was included. The attack rate of SAP was 8.31/1000 HIV-related hospital admissions and the frequency, out of the total number of bacterial pneumonia observed in the study period, was 16% (24 of 154 patients). The large majority of SAP was community acquired. On the univariate analysis, intravenous drug abuse (IVDA) (P = 0.02), history of previous Pneumocystis carinii pneumonia (PCP) (P = 0.03) and cirrhosis (P = 0.03) were significant risk factors for SAP. In addition, IVDA and previous PCP were independent risk factors on multivariate analysis. All patients presented with fever associated with cough (74%), chest pain (26%) or shortness of breath (37%). Chest X-ray documented lobar pneumonia (78%), predominantly in the lower lobes, consolidation with cavitation (11%), and interstitial-nodular infiltrates (11%). Pleural effusion was present in 31% of patients. The response to therapy was favourable in 79% of patients. Recurrence occurred in 26% and death occurred in 21% of patients. Death was significantly associated with the low level (< 50 mm-3) of circulating T CD4+ cells (P = 0.03) and the recurrence of pneumonia (P = 0.03). In conclusion, the present study indicates that S. aureus is an important aetiologic agent of bacterial pneumonia in HIV-infected patients, especially if they are drug abusers with previous PCP.

Adolescent↗
PubMed1996

Pott's disease of the cervico-occipital junction in an AIDS patient.

Pott's disease of the cervical spine is relatively rare despite the fact that tuberculous spondylitis is still the most common manifestation of bone and joint infection. We describe a case, the first to our knowledge, of sub-occipital Pott's disease associated with a retropharyngeal abscess in an acquired immune deficiency syndrome (AIDS) patient. Neurological signs were the main clinical findings. The patient was successfully treated with anti-tuberculosis drugs combined with external stabilization of the spine.

AIDS-Related Opportunistic Infections↗