scholarly journals A Simple Predictive Score to Distinguish between Disseminated Histoplasmosis and Tuberculosis in Patients with HIV

2021 ◽  
Vol 8 (1) ◽  
pp. 16
Author(s):  
Mathieu Nacher ◽  
Kinan Drak Alsibai ◽  
Loïc Epelboin ◽  
Philippe Abboud ◽  
Frédégonde About ◽  
...  
Keyword(s):  
French Guiana ◽  
Area Under The Curve ◽  
Predictive Score ◽  
Hiv Disease ◽  
Performance Score ◽  
Logit Regression ◽  
Natural Logarithm ◽  
Disseminated Histoplasmosis ◽  
Advanced Hiv Disease ◽  
Logit Regression Model

Disseminated histoplasmosis is a common differential diagnosis of tuberculosis in disease-endemic areas. We aimed to find a predictive score to orient clinicians towards disseminated histoplasmosis or tuberculosis when facing a non-specific infectious syndrome in patients with advanced HIV disease. We reanalyzed data from a retrospective study in Cayenne Hospital between January 1997–December 2008 comparing disseminated histoplasmosis and tuberculosis: 100 confirmed disseminated histoplasmosis cases and 88 confirmed tuberculosis cases were included. A simple logit regression model was constructed to predict whether a case was tuberculosis or disseminated histoplasmosis. From this model, a score may be obtained, where the natural logarithm of the probability of disseminated histoplasmosis/tuberculosis = +3.917962 × WHO performance score (1 if >2, 0 if ≤2) −1.624642 × Pulmonary presentation (1 yes, 0 no) +2.245819 × Adenopathies > 2 cm (1 yes, 0 no) −0.015898 × CD4 count − 0.001851 × ASAT − 0.000871 × Neutrophil count − 0.000018 × Platelet count + 6.053793. The area under the curve was 98.55%. The sensitivity of the model to distinguish between disseminated histoplasmosis and tuberculosis was 95% (95% CI = 88.7–98.3%), and the specificity was 93% (95% CI = 85.7.3–97.4%). In conclusion, we here present a clinical-biological predictive score, using simple variables available on admission, that seemed to perform very well to discriminate disseminated histoplasmosis from tuberculosis in French Guiana in well characterized patients.

scholarly journals Disseminated Histoplasmosis in a Patient with Advanced HIV Disease - Lessons Learnt from Bangladesh

2010 ◽  
Vol 28 (3) ◽  
Author(s):  
Md Mostaq Pervez ◽  
Brian Cobb ◽  
Nashaba Matin ◽  
Lubaba Shahrin ◽  
Evelyn R Ford ◽  
...  
Keyword(s):  
Hiv Disease ◽  
Disseminated Histoplasmosis ◽  
Lessons Learnt ◽  
Advanced Hiv Disease

scholarly journals Disseminated Histoplasmosis: Fighting a neglected killer of patients with advanced HIV disease in Latin America

2020 ◽  
Vol 16 (5) ◽  
pp. e1008449
Author(s):  
Mathieu Nacher ◽  
Pierre Couppié ◽  
Loic Epelboin ◽  
Félix Djossou ◽  
Magalie Demar ◽  
...  
Keyword(s):  
Latin America ◽  
Hiv Disease ◽  
Disseminated Histoplasmosis ◽  
Advanced Hiv Disease

scholarly journals Disseminated Histoplasmosis; A Threat in Advanced HIV Disease Population in Sub-Saharan Africa?

2021 ◽  
pp. 115-144
Author(s):  
Christine E. Mandengue ◽  
Bassey Ewa Ekeng ◽  
Rita O. Oladele
Keyword(s):  
Histoplasma Capsulatum ◽  
Clinical Stage ◽  
Sub Saharan Africa ◽  
World Health ◽  
Hiv Disease ◽  
African Countries ◽  
Tb Treatment ◽  
Disseminated Histoplasmosis ◽  
Sub Saharan ◽  
Advanced Hiv Disease

Background: Histoplasmosis is a neglected acquired immune deficiency syndrome (AIDS)-defining disease in sub-Saharan African countries, which is commonly misdiagnosed as tuberculosis (TB) due to similar imagery and clinical features; patients usually receive presumptive anti-TB treatment that is considered as anti-TB treatment failure. Patients with advanced human immunodeficiency virus (HIV) disease (AHD), CD4<200/mm3 or World Health Organisation clinical stage 3 or 4, develop disseminated histoplasmosis (DH) diagnosed at a late stage or at post-mortem, owing to poor clinical suspicion, lack of rapid diagnosis tools to offer rapid and accurate results, and non-availability and accessibility of appropriate antifungal medications. We report 31 cases of DH amongst patients with AHD in sub-Saharan African population from the literature, highlighting the challenging care issue in sub-Saharan Africa. Results: Out of 31 reported cases 64.51% (20/31) were caused by Histoplasma capsulatum var capsulatum, 48.38% (15/31) being immigrants in Europe, Canada and Japan, with 41.93% (13/31) mortality, and 6 cases having no reported outcome. The poor index of suspicion on the part of clinicians; the lack of skilled laboratory personnel and rapid and accurate diagnosis tools of histoplasmosis for a proper detection of either classical or African histoplasmosis coexisting in many sub-Saharan African countries; and the non-availability and accessibility of appropriate antifungal medications were the most challenges in caring DH in advanced HIV disease population in sub-Saharan Africa. Conclusion: there is a need for prompt and routine screening of advanced HIV disease patients in sub-Saharan Africa for histoplasmosis as an AIDS-defining illness.

scholarly journals Coronavirus Disease 2019 (COVID-19) in a Patient with Disseminated Histoplasmosis and HIV—A Case Report from Argentina and Literature Review

2020 ◽  
Vol 6 (4) ◽  
pp. 275
Author(s):  
Fernando A. Messina ◽  
Emmanuel Marin ◽  
Diego H. Caceres ◽  
Mercedes Romero ◽  
Roxana Depardo ◽  
...  
Keyword(s):  
Literature Review ◽  
Patient Care ◽  
Fungal Pathogens ◽  
Buenos Aires ◽  
Hiv Disease ◽  
Rapid Diagnostics ◽  
Disseminated Histoplasmosis ◽  
Appropriate Treatment ◽  
The World ◽  
Advanced Hiv Disease

The disease caused by the new SARS-CoV-2, known as Coronavirus disease 2019 (COVID-19), was first identified in China in December 2019 and rapidly spread around the world. Coinfections with fungal pathogens in patients with COVID-19 add challenges to patient care. We conducted a literature review on fungal coinfections in patients with COVID-19. We describe a report of a patient with disseminated histoplasmosis who was likely infected with SARS-CoV-2 and experienced COVID-19 during hospital care in Buenos Aires, Argentina. This patient presented with advanced HIV disease, a well-known factor for disseminated histoplasmosis; on the other hand, we suspected that COVID-19 was acquired during hospitalization but there is not enough evidence to support this hypothesis. Clinical correlation and the use of specific Histoplasma and COVID-19 rapid diagnostics assays were key to the timely diagnosis of both infections, permitting appropriate treatment and patient care.

Antiretroviral Therapy in Advanced HIV Disease: Which is the Best Regimen?

Aids Reviews ◽  
2018 ◽  
Vol 20 (1) ◽  
Author(s):  
Joaquim Burgos ◽  
Esteban Ribera ◽  
Vicenç Falcó
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Disease ◽  
Advanced Hiv Disease

scholarly journals An Early Predictive Scoring Model for In-Hospital Cardiac Arrest of Emergent Hemodialysis Patients

2021 ◽  
Vol 10 (15) ◽  
pp. 3241
Author(s):  
Shih-Hao Chen ◽  
Ya-Yun Cheng ◽  
Chih-Hao Lin
Keyword(s):  
Cardiac Arrest ◽  
Risk Group ◽  
Vital Signs ◽  
Area Under The Curve ◽  
Hemodialysis Patients ◽  
High Risk Group ◽  
Predictive Score ◽  
Primary Group ◽  
Sum Scores ◽  
Hospital Cardiac Arrest

Background: Patients undergoing hemodialysis are prone to cardiac arrests. Methods: This study aimed to develop a risk score to predict in-hospital cardiac arrest (IHCA) in emergency department (ED) patients undergoing emergency hemodialysis. Patients were included if they received urgent hemodialysis within 24 h after ED arrival. The primary outcome was IHCA within three days. Predictors included three domains: comorbidity, triage information (vital signs), and initial biochemical results. The final model was generated from data collected between 2015 and 2018 and validated using data from 2019. Results: A total of 257 patients, including 52 with IHCA, were analyzed. Statistical analysis selected significant variables with higher sensitivity cutoff, and scores were assigned based on relative beta coefficient ratio: K > 5.5 mmol/L (score 1), pH < 7.35 (score 1), oxygen saturation < 85% (score 1), and mean arterial pressure < 80 mmHg (score 2). The final scoring system had an area under the curve of 0.78 (p < 0.001) in the primary group and 0.75 (p = 0.023) in the validation group. The high-risk group (defined as sum scores ≥ 3) had an IHCA risk of 47.2% and 41.7%, while the low-risk group (sum scores < 3) had 18.3% and 7%, in the primary and validation databases, respectively. Conclusions: This predictive score model for IHCA in emergent hemodialysis patients could help healthcare providers to take necessary precautions and allocate resources.

Fiavobacteriurrt spp. organisms as opportunistic bacterial pathogens during advanced HIV disease

1999 ◽  
Vol 39 (2) ◽  
pp. 146-152 ◽  
Author(s):  
Roberto Manfredi ◽  
Anna Nanetti ◽  
Morena Ferri ◽  
Antonio Mastroianni ◽  
Olga V. Coronado ◽  
...  
Keyword(s):  
Bacterial Pathogens ◽  
Hiv Disease ◽  
Advanced Hiv Disease

The Determinants of Poverty: Case of Indonesia

2017 ◽  
Vol 5 (3) ◽  
pp. 58-68
Author(s):  
Lilik Sugiharti ◽  
Martha Ranggi Primanthi
Keyword(s):  
Rural Area ◽  
Poverty Reduction ◽  
Jel Classification ◽  
Policy Implications ◽  
Education Attainment ◽  
Education Access ◽  
Logit Regression ◽  
Rural And Urban ◽  
Poor Households ◽  
Logit Regression Model

Objective - The objectives of the study were to analyze the general picture of poverty, and determinants of poverty in Indonesia. Understanding poverty characteristic is a main point for designing an effective poverty reduction strategy. During the last five years Indonesia has experienced a slowing down growth and the poverty rates has declined slightly. Some provinces or regions have managed to reduce the poverty well, while others have been slower, and also the distribution of the poor is uneven across both rural and urban, generally the rural is more than urban area. Methodology/Technique - Factors determining poverty of households were estimated and anayzed using a logit regression model, and it is found that such demographic factors as gender and age of households head, size of households, factors of production included accessibility to the technology and credit, working status, and education attainment, and also geographic characteristics significantly explain reasons for being poor. Moreover, increasing for accessibility of households to the technology and credit, reducing the size of households, and increasing an education attainment especially in rural area are important to do as a government priority intervention. Findings - The results of the determinants of poverty in Indonesia shows that poor households are those with large number of dependents and equipped with limited education access, and the majority of these households live in rural area. Novelty - Study suggests that increasing for accessibility of households to the technology and credit, reducing the size of households, and increasing an education attainment especially in rural area are important to do as a government priority intervention or policy implications. Type of Paper: Empirical Keywords: Logit Regression; Poverty Reduction, Indonesia. JEL Classification: I21, I22, I24.

Combination Therapy With Stavudine and Didanosine in Children With Advanced Human Immunodeficiency Virus Infection: Pharmacokinetic Properties, Safety, and Immunologic and Virologic Effects

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 886-890
Author(s):  
Mark W. Kline ◽  
Courtney V. Fletcher ◽  
Marianne E. Federici ◽  
Alice T. Harris ◽  
Kim D. Evans ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Combination Therapy ◽  
Lymphocyte Count ◽  
Hiv Disease ◽  
Hiv Rna ◽  
Immunodeficiency Virus ◽  
Pharmacokinetic Properties ◽  
Cd4 Lymphocyte Count ◽  
Cd4 Lymphocyte ◽  
Advanced Hiv Disease

Objectives. To obtain preliminary information on the pharmacokinetic properties, tolerance, safety, and antiviral activity of combination therapy with stavudine and didanosine in children with advanced human immunodeficiency virus (HIV) infection. Methods. Eight children (median age, 6.6 years; range, 2.8 to 12 years) with advanced HIV disease (median CD4+ lymphocyte count at baseline, 42 cells/µL; range, 8 to 553 cells/µL) were treated with stavudine (2 mg/kg per day in two divided doses) and didanosine (180 mg/m2 per day in two divided doses) for 24 weeks. Seven children had histories of prior zidovudine therapy. All children had received stavudine alone for 19 to 33 months before the addition of didanosine to the treatment regimen. Children were assessed clinically and with laboratory studies at baseline, weekly through week 4 of combination therapy, and every 4 weeks thereafter. Results. Analysis of stavudine and didanosine plasma half-life values, clearances, and area under the plasma concentration-versus-time curves revealed no obvious clinical pharmacokinetic interaction between the drugs through study week 12. Combination therapy was well tolerated, and there were no drug-associated clinical or laboratory adverse events. Signs and symptoms of peripheral neuropathy were not observed. All three children with baseline CD4+ lymphocyte counts greater than 50 cells/µL had greater than 20% increases in their counts within the first 12 weeks of therapy; CD4+ lymphocyte count increases were not observed in the other children. Plasma HIV RNA concentrations showed median declines of 0.88 log10 (range, -3.41 log10 to 0.31 log10) and 0.30 log10 (range, -0.63 log10 to 0.89 log10) at study weeks 12 and 24, respectively. Conclusions. Combination therapy with stavudine and didanosine was well tolerated and safe in this small group of children with advanced HIV disease. Plasma HIV RNA concentration declines suggest a favorable effect of therapy on virus load. These findings should be confirmed, and the regimen's clinical efficacy should be examined, in controlled studies of HIV-infected children with less-advanced disease.

Socio-demographic Determinants of Undernutrition In HIV- Infected Under- Five Children

2021 ◽  
Vol 2 (3) ◽  
pp. 22-29
Author(s):  
Sylvia T. Echendu ◽  
Ebelechuku F. Ugochukwu ◽  
Kenneth N. Okeke ◽  
Chinyere U. Onubogu ◽  
Joy C. Ebenebe ◽  
...  
Keyword(s):  
Low Socioeconomic Status ◽  
Disease Process ◽  
Single Parents ◽  
Hiv Positive ◽  
Growth Monitoring ◽  
Hiv Disease ◽  
Low Socioeconomic ◽  
Under Five ◽  
Under Five Children ◽  
Advanced Hiv Disease

Background: The disease burden associated with HIV/AIDS is a key factor in the etiopathogenesis of undernutrition in growing children. This is aggravated by resultant social factors in HIV such as orphaning, low socioeconomic status, food insecurity, and marital status of caregivers. Objectives: The relationship between sociodemographic factors and malnutrition in the background of HIV was evaluated. Methods: A cross-sectional descriptive survey was conducted among under-five HIV positive children in Anambra State, Nigeria. Results: A total of 370 HIV positive under-five children comprising 208(56.2%) males and 162(43.8%) females were recruited. The mean age of the children was 44.5±12.9 months. One hundred and forty-seven (39.7%) were globally undernourished: 15.7.0% (58) underweight (WFA <-2SD), 13.3% (49) wasted (WFH < -2SD), and 27.9% (103) stunted (HFA <-2SD). Males were significantly more stunted than females (p<0.001). 77% (285) were of low socioeconomic class (SEC), 47.3% (175) had advanced HIV disease, and 68.1% (252) had been on HAART for >12 months. 26% (96) were orphans, while 28.6% (106) were cared for by single parents. Being on HAART for >12 months was associated with less undernutrition, while advanced HIV disease seemed to enhance it. Children of low SEC were more likely to be undernourished. Not having been breastfed, introduction of complementary feeds at age 3mo or less, poor food variety and suboptimal feeding frequency increased susceptibility to undernutrition. Orphans were more wasted and stunted than underweight. Single parenthood predisposed to undernutrition. Conclusions: HIV-infected children are vulnerable to malnutrition by virtue of the disease process, further compounded by interwoven social dilemma associated with HIV. It, therefore, behooves the health care provider to ensure a proactive growth monitoring and nutritional support, with prompt treatment of co-morbid debilitating infections. There is also a dire need for public health interventions targeted at single parents of low socioeconomic means.

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