These data suggest that the CN4/CN5 primer set was highly sensitive for the identification of C. neoformans/C. gattii species complex in cerebrospinal fluid samples from patients with clinical suspicion of cryptococcal meningitis.
Background: Sexually transmitted infections (STIs), particularly genital ulcer diseases (GUD) are a neglected field in health care, partly due to the stigma associated with the diseases. Coinfection with HIV alters the clinical presentation, natural history and response to treatment. Moreover, STIs contribute significantly to increased risk of HIV transmission. Management of STIs at primary health care level is syndromic, driven by algorithms. In the absence of interest and expertise at secondary/tertiary care centres patients, who fail this management, suffer.Methods & Materials: We present a retrospective chart review of patients referred to our a specialist Infectious Diseases Unit with challenging or unusual STI/GUD, who did not respond to syndromic management.Results: We have closely documented 42 patients (23 male, 39 HIV positive) seen at King Edward VIII hospital for STI/GUD. The patients had an average of 2.6 different primary health care providers (range: 1-5) before coming to the tertiary site. Only 54.8% were formally referred.15 patients had extensive chronic HSV ulcers (8 males, all HIV + ). Of these, 7 responded to high doses of acyclovir (400 mg 8 hourly to 800 mg 5 times daily). Duration of treatment varied from 7 to 21 days. 6 chronic HSV ulcers (4 males) failed high dose acyclovir but responded to topical imiquimod treatment.Of 13 patients (9 males) with extensive condylomata acuminata (warts) 4 underwent curative circumcision and 9 required extensive ablation. 5 of the latter (3 males) had squamous cell carcinomas. All were managed syndromically as STIs for >18 months.4 patients had chronic genital ulcers with no discernible cause and very low CD4 counts. These ulcers healed completely after commencement of anti-retroviral treatment. One male with penile abscesses and multiple urinary fistulas had trichomonas vaginalis repeatedly isolated and responded to a prolonged course of metronidazole. Other diagnoses included severe tinea cruris (4), lichen planus chronicus (2), papular pruritic eruptions (PPE) (1), penile pearly papules (PPP) (1), vitiligo (1).
Conclusion:We need to develop expertise in the management of patients who do not respond to syndromic STI/GUS treatment and develop clear referral pathways to secondary and tertiary care centres with adequate facilities and investigative capacity for timeous diagnosis and intervention. This is particularly urgent in the context of HIV/AIDS.
able diagnostic tool compared to other methods such as native microscopy. flluorescin, auramin and safranin staining. In our matherial sensitivity of native microscopy vs. cultivation was 39%, and fuorescin and auramin staining vs. cultivation 42%. Emergence of T. vaginalis as a causative agent in one sixth of analysed prostate exprimates indicates the need of metronidazole treatment asid of usual quinolone medication. Unrecognized and untreated T. vaginalis infection in men appears to have a natural history of oligosymptomatic or asymptomatic urethritis in younger and adult men and evolution to chronic prostatitis in elderly.http://dx.
Background:The incidence of syphilis has increased over past decade, particularly among HIV-infected patients, with emphasis on neurosyphilis and the decision to perform lumbar puncture in asymptomatic patients. The aim of this study was to assess the prevalence of neurosyphilis in patients with concurrent HIV infection and syphilis based on lumbar puncture (LP) criteria.Methods: We conducted a cross-sectional study in the outpatient clinic of the Instituto de Infectologia Emílio Ribas (Brazil) over a period of 8 months, in which were considered eligible all subjects with HIV infection and a Venereal Diseases Research Laboratory test (VDRL) titer ≥ 1:4, irrespective of whether neurological symptoms were present or of the CD4 cell count.Results: A total of 71 cases of syphilis were identified (45 secondary, 22 tertiary and 4 late latent cases of disease). Most were male (95.8%) and 64.8% had sex with men (MSM). Mean age 39.5 years, range 22-78 years. 29 patients (40.8%) had recurrence of syphilis (sustained fourfold increase in VDRL-titers after therapy) and 19 patients (26.8%) had serum VDRL titers of 1:64 (range 1:4 to 1:2048). Of 71 subjects, 22 (31%) had neurosyphilis based on a reactive CSF VDRL test (n = 11) or increased CSF white cell counts ≥20/L (n = 12) or presence of neurologic or ophthalmic symptoms (n = 6). Most of them (81.8%) had CD4 T cell counts >350 cells/l at the time of the diagnosis of neurosyphilis. 2 patients with neurosyphilis (9%) did not meet the criteria for LP based on CDC criteria.Conclusion: We had a high prevalence of neurosyphilis in our study (31%). The decision to perform LP in patients with HIV infection and syphilis is still controversial. There are several important unanswered key questions in the management of adult syphilis, and it should be a priority for future studies.
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