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Patients with human immunodeficiency virus (HIV) infection are prone to the development of focal segmental glomerulosclerosis, a lesion in which increased mesangial cell proliferation and matrix synthesis may play a role. We undertook the present study to determine whether HIV sera may affect mesangial cell proliferation and matrix synthesis either directly or indirectly via effects on macrophage supernatants. Pooled HIV sera was found to significantly enhance (P < 0.01) mesangial cell proliferation in a concentration-related manner. Mesangial cell proliferation was significantly suppressed by two medications commonly utilized in HIV-infected patients, azidothymidine and trimethoprim/sulfamethoxazole, and was not significantly altered by lipopolysaccharide, suggesting that these medications as well as recurrent infection are unlikely to account for the proliferative effect of HIV sera. Supernatants from HIV sera-treated macrophages were found to significantly enhance (P < 0.01) mesangial cell incorporation of [3H]proline, a marker for synthesis of the matrix component collagen, compared to supernatants from control sera-treated macrophages. These results suggest that HIV sera may directly enhance mesangial cell proliferation and may indirectly increase mesangial cell matrix synthesis by altering macrophage secretory products. These effects may play a role in the development of glomerulosclerosis in patients with HIV infection.
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We report a case of melioidosis in a previously healthy Belgian man. He presented with septicemia and prostatic abscesses 1 week after a trip to Vietnam. Burkholderia pseudomallei was isolated from multiple hemocultures. He was treated successfully with intravenous ceftazidime and trimethoprim-sulfamethoxazole, followed by a per-oral maintenance therapy of amoxicillin-clavulanate with supplementary amoxicillin. There was no need for surgical drainage. This is the second reported case of melioidosis in Belgium.
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Antiphospholipid syndrome is an autoimmune disease that is characterised by tendency to thrombosis, obstetrical and hematological complications. Corticosteroids may be useful for therapy of some features of this syndrome, such as thrombocytopenia. Nocardia is an important opportunistic infectious agent in immunocompromised hosts, i.e. in patients taking corticosteroids. It is important to be aware of these rare complications, which are correlated with the prognosis. In this paper, we report a patient with primary anti-phospholipid syndrome treated by corticosteroid, who developed disseminated nocardiosis.
To evaluate the in vitro sensitivities of trimetoprim (TMP) in our area and to compare them with those to co-trimoxazole (CMX) a prospective study was carried out in females with uncomplicated lower urinary tract infection (UCLUTI), as a preliminary step for the possible use of a monodose of TMP in these patients. Fifty-five cases of UCLUTI were included. Escherichia coli was the predominating organism (70.9%). The general sensitivity to CMX was 80% and that to TMP 76.4%. The E. coli sensitivity to CMX was 79.5%, and 76.9% to TMP. The difference in the sensitivities to both antimicrobials was not statistically significant (p = 0.5). The routine introduction of TMP in the antibiogram would permit to evaluate the resistance to this antimicrobial in each area and, on the basis of the results, to assess the effectiveness of TMP in the treatment of UCLUTI.
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To make the patients more tolerable to the medication and to make clear whether or not the reaction is caused by serum sulfamethoxazole-specific IgE.
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To describe the history, clinical presentation, and successful surgical and antibiotic management of a case of posttraumatic infectious scleritis secondary to Stenotrophomonas maltophilia.
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We report the case of a 57 year old male with Whipple's disease. The patient was asymptomatic and an unexplained peripheral leucocytosis was found in a routine examination. It persisted as the only abnormality for one year and then he developed articular symptoms, diarrhoea and weight loss. The diagnosis was confirmed by duodenal biopsy five years later. The leucocyte count ranged between 14,000 and 22,000 leuc/mm3. Response to cotrimoxazole was favourable with disappearance of all signs and symptoms, including leucocytosis. In the last endoscopic control, eight years after initial manifestations, an intramucosal gastric adenocarcinoma was diagnosed.
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Legionella infections are not frequent in HIV-infected patients, although clinical manifestations and outcome are particularly severe in this subset. This manuscript analyzes the clinical features and immunological situation of HIV-infected patients with Legionnaires' disease (LD).
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Electronic databases including Pubmed, Central and EMBASE were searched without limits to language from 1980 to April 2010. Conference database searches were performed, experts were contacted and bibliographies were handsearched.
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Low-dose trimethoprim-sulfamethoxazole (four tablets per week) appears to be effective prophylaxis against toxoplasmic encephalitis in HIV-infected patients with previous P. carinii pneumonia. A prospective, randomized, controlled study is needed to further evaluate these findings.