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      Fatal dual infection with Salmonella and Mycobacterium avium complex infection in a patient with advanced acquired immunodeficiency syndrome: a case report

      research-article
      Author(s): 1 , , 1 , 1
      Publication date (Electronic):
      Journal: Cases Journal
      Publisher: BioMed Central

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          Abstract

          Non-typhoid Salmonella and Mycobacterium avium complex infections are part of the constellation of infections seen with increasing frequency in patients with acquired immuned deficiency syndrome. The incidence has reduced significantly since highly active antiretroviral therapy era, but their critical nature is unchanged. The co-existence of these infections and the accompanied increased mortality is presented in this case report.

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          The changing etiology of chronic diarrhea in HIV-infected patients with CD4 cell counts less than 200 cells/mm3.

          S A Call, M Saag, G Heudebert … (2000)
          The purpose of this study was to evaluate the incidence and causes of chronic diarrhea in patients with AIDS over a period of time that included the pre-HAART (highly active antiretroviral therapy) era and the introduction of HAART. The study cohort was comprised of patients receiving primary care at a university-associated outpatient HIV clinic from January 1, 1995 to December 31, 1997. Patients were identified retrospectively through a clinical database and were included in the study if their diarrhea had persisted for longer than two weeks and their CD4 cell count at time of symptoms was <200 cells/mm3. Further data were obtained by chart review. Over the 36-month period, the occurrence of chronic diarrhea did not change significantly, ranging from 8 to 10.5% per year in patients with CD4 cell counts <200 cells/mm3. The percentage of patients diagnosed with opportunistic infectious etiologies decreased over the three-year period from 53% (1995) to 13% (1997). The percentage of patients diagnosed with noninfectious causes increased from 32% to 70% over this same time period. Over the three years of the study, the incidence of chronic diarrhea in AIDS patients in our clinic did not change. The etiologies of diarrhea did change significantly, with an increased incidence of noninfectious causes and a decreased incidence of opportunistic infectious causes. This shift in etiologies coincides with the introduction and increased use of HAART in our clinic population (1996).
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            Non-typhoidal salmonella bacteraemia--an under-recognized feature of AIDS in African adults.

            Gershom A K Mwafulirwa, H. A. Gordon, Anstead Kankwatira (2004)
            Non-typhoidal salmonella (NTS) infections are severe, invasive and recurrent in the HIV-infected adult, and NTS are the commonest cause of hospital admission with bacteraemia in sub-Saharan Africa. NTS bacteraemia typically presents in patients with HIV/AIDS once the CD4 count falls below 200 cells/microL. In-patient mortality is 35%-60%, and is highest in patients with confusion or severe anaemia. Among survivors, 25%-45% may have single or multiple recurrences of NTS bacteraemia 1-6 months after the first illness, requiring retreatment. Diagnosis relies on blood culture, so in many areas this disease cannot be definitively diagnosed, and must be empirically treated. Treatment is guided by local antibiotic sensitivities; fluoroquinolones are particularly useful for initial treatment if there is multidrug reistance to other agents, and may result in lower recurrence rates than other agents. Where possible, long-term secondary chemoprophylaxis to prevent recurrence is advisable. Successful ARV treatment also prevents recurrence. There is inadequate knowledge about the epidemiology of carriage and transmission among at-risk populations.
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              Disseminated mycobacterium avium-intracellulare complex (MAC) infection in the era of effective antiretroviral therapy: is prophylaxis still indicated?

              H. R. Brodt, I Woolley, J. C. Lange (2003)
              Before highly active antiretroviral therapies (HAART) were available for the treatment of persons with HIV infection, disseminated Mycobacterium avium-intracellulare complex (MAC) infection was one of the most common opportunistic infections that affected people living with AIDS. Routine use of chemoprophylaxis with a macrolide has been advocated in guidelines for the treatment of HIV-infected individuals if they have a circulating CD4+ cell count of 100 cells/microL. These recommendations are still conservative as primary or secondary disseminated MAC infections are only rarely seen in patients who respond to HAART, despite treatment initiation at very low CD4+ cell counts. Potential adverse effects of macrolide therapy and drug interactions with antiretrovirals also metabolised via the cytochrome P450 enzyme system must be critically weighed against the marginal benefit that MAC prophylaxis may provide in addition to treatment with HAART. These authors feel that, unless patients who initiate HAART at low CD4+ cell counts do not respond to HIV-treatment, routine MAC prophylaxis should not be recommended. Nevertheless, the patient population for whom MAC prophylaxis may still be indicated in the era of HAART needs to be identified in prospectively designed clinical trials.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cases J
                Title: Cases Journal
                Publisher: BioMed Central
                ISSN (Electronic): 1757-1626
                Publication date Collection: 2009
                Publication date (Electronic): 11 September 2009
                Volume: 2
                Page: 6773
                Affiliations
                [1 ]Division of Infectious Diseases, Department of Medicine, Harlem Hospital/Columbia University, 506 Lenox Avenue, New York, NY 10037, USA
                Article
                Publisher ID: 1757-1626-0002-0000006773
                DOI: 10.4076/1757-1626-2-6773
                PMC ID: 2827132
                PubMed ID: 20181177
                SO-VID: f45ae20b-746f-46a7-a88d-b14cc84e98a2
                Copyright © Copyright ©2009 Adejumo et al.; licensee Cases Network Ltd. licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 5 August 2009
                Date accepted : 18 August 2009
                Categories
                Subject: Research article

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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