The haemolytic uraemic syndrome in patients with AIDS.

Kelleher, Peter; Severn, Alison; Tomson, Charles; Lucas, SB; Parkin, Jacqueline; Pinching, A J; Miller, R F

doi:10.1136/sti.72.3.172

Cited by 6 publications

(3 citation statements)

References 25 publications

(3 reference statements)

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“…Patients with no previous HIV-related symptoms have been reported to respond equally well to adequate therapy [37][38][39][40][41]44]. On the contrary, the outcome in patients with AIDS is often poor, despite administration of treatment, and is related to the severity of the underlying disease [4,5,45,46]. Our study confirms the high mortality rate (100% for TMA and 71% for HUS) in patients with advanced HIV infection.…”

Section: Discussionsupporting

confidence: 73%

Thrombotic Microangiopathy in Patients With Acquired Immunodeficiency Syndrome Before and During the Era of Introduction of Highly Active Antiretroviral Therapy

&NA;

2002

Infectious Diseases in Clinical Practice

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The incidence of thrombotic microangiopathy (TMA) was retrospectively evaluated in a cohort of 1223 patients with acquired immunodeficiency syndrome (AIDS) who were observed from January 1985 through December 1996 (before the era of highly active antiretroviral therapy [HAART]), and the incidence was prospectively assessed for 347 patients with AIDS during the period of January 1997 through December 2000 (during the HAART era). Seventeen cases were reported in the former cohort (1.4%). The increased risk of developing TMA was statistically significant in patients with cryptosporidiosis or AIDS-related cancer but not in those with other diseases. In the 1997-2000 cohort, no cases were observed during follow-up. TMA is associated with conditions observed in the advanced phases of human immunodeficiency virus infection. The disappearance of TMA during the HAART era may be explained by the lower percentage of patients with long-lasting CD4 + T cell depletion, advanced AIDS, or cryptosporidiosis or who have undergone multiple courses of chemotherapy for treatment of cancer. Thrombotic microangiopathy (TMA) is a clinical syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, microvascular thrombosis, and multiple organ dysfunction. In the clinical spectrum of TMA, thrombotic thrombocytopenic purpura (TTP) is associated with up to 5 symptoms, including fever, neurological abnormalities, anemia, thrombocytopenia, and renal failure, all of which (except cerebral involvement) also occur in patients with hemolytic uremic syndrome (HUS) [1, 2].

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Section: Discussionsupporting

confidence: 73%

Thrombotic Microangiopathy in Patients With Acquired Immunodeficiency Syndrome Before and During the Era of Introduction of Highly Active Antiretroviral Therapy

&NA;

2002

Infectious Diseases in Clinical Practice

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“…Drug-induced nephrotoxicity and renal ischemia are common precipitating events. The hemolytic uremic syndrome with severe hypertension as an early prominent sign has also been reported [10,11]. The most common cause of chronic renal insufficiency in HIV-1 positive patients is HIV-associated nephropathy [12].…”

Section: Hiv Renal Failurementioning

confidence: 99%

Hypertension in the HIV-infected patient

Aoun

Ramos

2000

Current Science Inc

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HIV infection has reached endemic proportions in many African countries. In addition, HIV infection is a significant cause of renal dysfunction in the United States. HIV patients are at higher risk of developing hypertension at a younger age than the general population. Predisposing factors for developing hypertension include vasculitis in small, medium, and large vessels in the form of leukocytoclastic vasculitis, and aneurysms of the large vessels such as the carotid, femoral, and abdominal aorta with impairment of flow to the renal arteries. A syndrome of acquired glucocorticoid resistance has been described in patients with HIV with hypercortisolism and a lower affinity of the glucocorticoid receptors. The syndrome is characterized clinically by weakness, hypertension or hypotension, and skin pigmentation changes. Acute and chronic renal failure is often associated with HIV infection. The associated dysfunction in water and salt handling often induces hypertension. Finally, atherosclerosis has been described in young adults with HIV infection secondary to receiving highly active antiretroviral therapy.

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“…Although this was not the case, HIV-seropositive patients may present dysenteric diarrhea with intestinal multiparasitism, including E. histolytica and enterotoxigenic E. coli concomitantly [19], but those cases are usually in the context of AIDS, where the relationship between HIV and HUS is well described [20].…”

Section: Discussionmentioning

confidence: 96%

Hemolytic uremic syndrome associated withEntamoeba histolytica intestinal infection

2005

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Amebiasis secondary to Entamoeba histolytica (E. histolytica) continues to be a major source of morbidity and mortality worldwide, mainly in developing countries. An association between amebic dysentery and hemolytic uremic syndrome (HUS) has been mentioned, but a cause-and-effect relationship has never been confirmed. We report the case of an 11-year-old healthy white female who developed severe bloody diarrhea after drinking contaminated unboiled water, developing classic HUS and requiring acute intermittent hemodialysis. The etiological study confirmed numerous cysts and hematophagous trophozoites of E. histolytica on stool smear, but without evidence of other pathogens. This report contributes to the concept that classic post-diarrheal HUS, usually related to colitis secondary to enterohemorragic Shiga-toxin producing Escherichia coli (E.coli) strains, may be associated with other pathogens, including E. histolytica. Additional information regarding mechanisms of virulence of E. histolytica and host immunological reaction is needed to clarify the temporal association of these two disorders (HUS and amebiasis).

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The haemolytic uraemic syndrome in patients with AIDS.

Cited by 6 publications

References 25 publications

Thrombotic Microangiopathy in Patients With Acquired Immunodeficiency Syndrome Before and During the Era of Introduction of Highly Active Antiretroviral Therapy

Thrombotic Microangiopathy in Patients With Acquired Immunodeficiency Syndrome Before and During the Era of Introduction of Highly Active Antiretroviral Therapy

Hypertension in the HIV-infected patient

Hemolytic uremic syndrome associated withEntamoeba histolytica intestinal infection

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