Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Mo.B.121 I - Mo.B.1215

Monday, July 8, 1996

HIV-disease or AIDS
Weight loss > 10%
Diarrhoea > I mco
Recurrent fever > I mo
Chronic cough > I mo
Oro-oesophageal candida
Tuberculosis
STD

HIV I (n=80)
37
23
5
10
12
10
12
32

HIV-I & 2 (n= 18) HIV-2 (n=5)
5 I
2 I
2
3 I
3 0
3 0
4 I
9

Conclusions: Prevalence of HIV- I (77.6%). HIV- I & 2 (I 7.5%) and HIV-2 (4.8%) was established.This cross-sectional data shows decreasing frequency of disease occurrence with HIV
I, HIV- I & 2, and HIV-2. Dual HIV infections present complex diagnostic dilemma in developing countries. Also, efficiency of transmission and rate of disease progression are likely to
be different in three groups.
Dr Subhash Hira, 502 Debonair Cadell Road, Mahim, Bombay, 400 016 India.
Tel.: [phone] Fax: [phone] email:subhash [email protected]
Mo.B. 121 I1
BACTEREMIA IN A COHORT OF I 164 PATIENTS WITH AIDS: INCIDENCE, SPECIES
DISTRIBUTION AND OUTCOME.
Grossi P. Corona A., Dalla Gasperina D., Marone P., Minoli Lorenzo. Infectious Diseases
Department IRCCS San Matteo, University of Pavia, Pavia, Italy
Objective:-To deteri,nre ithe characteristics of all bacteremic episodes in a cohort of
patients with AIDS tollowed at a single Institution in northern Italy
Methods: From February I1984 through December 1995 a total of 1 164 patients with AIDS
(273 femnales, 89 I males, mean age 32.2, range 0.3-79.7 years) have been admitted at our
Institution.The risk behavior distribution was similar to all Italian patients: 70.7% i.v. drug
abusers (IVDU), I12. I% heterosexually infected, 9.7% homosexual men, 2. I% mother to
child infected, I.1% blood products infected and 4.3% undetermined. Median CD4 count at
the time of AIDS diagnosis was 60/cmm. All patients with pyrexia underwent blood cultures
for aerobes, anaerobes and mycobacteria. In the present study mycobacteremia and
fungemia episodes are excluded.
Results: During a median follow-up of 6.2 months (range 0- 11 8.2) 202 patients (38 female,
I 64 male, mean age 32.2 years, 75.2% IVDU) experienced a total of 302 episodes of bacteremia at a median of 103 days (range 0-2447) after the diagnosis of AIDS.The median
CD4 count at the diagnosis of bacterermia was 33/cmm (range 0-286). Gram+ bacteria
alone were the most frequent isolated agents (195/302, 64.6%), Gram- bacteria were
recovered from 89 (29.4%) blood cultures while I 8 (6%) blood cultures were polimicrobial.
Among Gram+, coagulase negative Staphylococcus was the most frequent isolate (I 17/342,
34.2%) followed by S.oureus (I 0.5%), Streptococcus spp. (5.5%), R.equi (4.9%), S.pneumonioe
(3.8%), group D Streptococci (3.5%), Corynebacterium spp. (3.5%). Bacillus spp. (0.8%),
L.monocytogenes (0.3%), Peptococcus spp. (0.3%). Among Gram- Salmonella spp. were the
most common (40/342, I.6%) followed by Pseudomonas spp. (6. I%), E.col (4.9%),
Enterobacter spp. (1.7%), Klebsiella spp. (I. I1%), Campylobacter spp. (I. 1%), Acinetobacter
spp. (I.1%), Bacteroides spp (I.1%), M.riorgori (0.5%). Citrobacter spp. (0.5%), Smarcescens
(0.3%). Median survival after the diagnosis of bacteremia was of 3.2 months.
Conclusions: Bacteremia is frequent in patients with AIDS and is associated with multiple
risk factors and a poor prognosis.
Prof L. Minoli Infectious Diseases Department IRCCS San Matteo-University of Pavia, Pavia,
ItalyTel. 39 382-422031 FAX [phone]
Mo.B. 1212
A COMPARATIVE STUDY OF STAPHYLOCOCCUS AUREUS ENDOCARDITIS IN HIV
POSITIVE AND NEGATIVE PATIENTS.
G6rgolas M, Blanco A, Fernaindez Guerrero ML. Infectious Diseases Divisi6n, Fundaci6n
Jimenez Diaz, Universidad Autonoma de Madrid. Spain.
Objective:To determine the clinical characteristics and mortality associated risk-factors in
patients with S. aureus endocarditis with and without HIV infection.
Methods: Seventy five cases diagnosed since 1985 were evaluated according to a established protocol. Routine laboratory test, blood cultures, chest X-ray and two-dimensional
echocardiograms were done in all cases. Fisher exact test, chi-square test and Student-t test
were used when indicated.
Results: Forty one (54.6%) and 34 (45.4 %) cases occurred in HIV positive and negative
patients respectively All HIV + patients were intravenous drug users, whereas only 29 %
were addict in the HIV negative group (p<0.00 I). 32/4 I (78 %) HIV + patients had rightsided endocarditis (31 tricuspid. I pulmonary) compared to 10/34 (29 %) (10 tricuspid) of
HIV - subjects (p<0.00 1). Left-sided endocarditis was significantly more frequent in HIV -
(7 I %) ( 15 mitral, 10 aortic) than in HIV + (22 %) subjects (7 mitral, 2 aortic) (p<0.001).
The mean age of HIV + patients was 30.9 years compared to 45.7 years of those without
HIV infection (p=0.0012). Male predominance was significantly higher within the HIV +
group (88 % versus 59 %; p=0.003). Eight left-sided infections occurred on prosthetic valves
(24 %), seven in patients without HIV infection (p=0.013). In patients with RSE no statistical
differences were detected in any clinical, analytical, echocardiographic or therapeutic results
between HIV positive and negative patients except liver and spleen enlargements which
were more common in HIV + (p<0.001I). However patients with left-sided endocarditis and
HIV infection were younger had less CNS complications (I 1% versus 54 %) and a better
outcome (cure rates 89% versus 54 %, p=0.017) than those without HIV
Conclusion:The clinical characteristics and prognosis in right-sided endocarditis is not influence by the HIV status. However HIV positive patients with left-sided infections tend to be
younger and have a better outcome than those without HIV
ML. Fernandez Guerrero. Division de E. Infecciosas. Fundaci6n Jimenez diaz. Avda. Reyes
Cat6licos, 2 28f140. Madrid. Spain.

Mo.B.1213
UNCOMMON CAMPYLOBACTERS ARE NOT SO UNCOMMON IN STOOL OF
HIV-INFECTED PATIENTS.
Fransje Snijders EJ Ku jpcr"",SA Danner*, J Dankert**. Division of Infectious Diseases,
Tropical MedicOine and AID)S.*"Department of Medical Microbiology, Academic Medical
Center, Amsterdam, he Netherlands.
Objectives: Uncommon Campylobacters (other than C. jejuni, C. coli, and C. lari) have sporadically been isolated from humans with diarrhoea. Little is known about the incidence of
uncommon C.'s in stool of HIV-infected patients. Our objectives were to evaluate: the
occurrence of uncommon C.'s in HIV-infected patients, the association of diarrhoea with
uncommon C.'s, the phenotypical characteristics of the uncommon C.
Methods: Stool samples and questionnaires were obtained from HIV-infected patients with
and without diarrhoea. Besides parasitological stool examination and selective culture methods, the membrane filter technique on nonselective blood agar plates was applied for isolation of C.s. All C. isolates were identified according to Vandamme and Ursing.The KruskalWallis test (x2) and Fischer's exact test were applied.
Results: Stool samples were examined from 20 I patients, of whom 43 had diarrhoea.
Parasites (4 Cryptosporidia, 9 Microsporidia, I Giardia) were found I 5 patients, of whom 7
had diarrhea. Salmonella was found in 2 and Clostridium difficile in one patient with diar
rhoea. One C. jejuni, one C. coli and 1I0 uncommon Campylobacters were isolated.The
presence of uncommon C.s was associated with diarrhoea (P=0.007). Of the 6 patients
with diarrhoea, one harboured C. lejuni subspecies doylei (resistant to erythromycin!), two
C. concisus, one C. mucosalis and one C. sputorum. One strain could not be identified. Of
the 4 patients without diarrhoea, two patients harboured C. upsaliensis (both patients kept
dogs at home!), one C. sputorum.The fourth isolate did not show a specific biochemical
pattern. CD4 cell count, CDC stage and cotrimoxazol use were similar between the 12
patients with C. spp. and the I 89 C. negative patients.
Conclusions: The frequency of uncommon C.'s is significantly higher than of common C.'s
among HIV-infected patients, if special culture techniques are applied.The presence of
uncommon C.'s in stool is associated with diarrhoea.Whether uncommon C.'s are the
cause of the diarrhoea among such patients, remains to be elucidated.
Fransje Snijders, F4-222, AMC, PO Box 22700, 1100 DE Amsterdam,The Netherlands. Fax: -
31-20-6972286, tel:-3 I -20-566-5963/-4380
Mo.B. 1214
FREQUENCY AND MICROBIAL ETIOLOGY OF SINUSITIS IN CHILEAN HIV
POSITIVE PATIENTS.
Noriega LM,Vial PA, Rosenblut A, Gonzalez P Perez J, Henriquez A, Michaud P Hospital
S6tero del Rio and Universidad Cat6lica, Santiago.
In a previous cohort study of Chilean patients with CD4 counts over 400 cells/mm3 sinusitis was detected with a frequency of I10% patient/year of follow up.
Objective.To characterize clinical, radiologic and microbiological aspects of sinusitis in
Chilean HIV+ patients.
Methods. Among a cohort of 100 HIV+ patients, 12 presented symptoms consistent with
sinusitis (nasal discharge and congestion, headache, fever cough) during the study period
(from January to July 1995). All were studied with standard sinus radiographic projections
and CT scan of the sinuses. Sinus puncture was performed in patients with CT scan positive
findings. Sinus aspirated samples were studied for Gram, Zhlel Neelsen and silver stains,
anaerobic and aerobic bacterial cultures, fungal and mycobacterial cultures.
Results. 10 of the 12 patients evaluated had sinusitis confirmed by CT scan: 9 of these had
stage C3 disease (CDC93), 8 with CD4 counts of less than 50 cells/mm3. CT scan findings
were pansinusitis (9) and unilateral maxilar sinusitis (I). Sinus puncture was well tolerated in
all patients and no related complications were observed. Sinus aspirated pus aerobic cultures were positive in 9 patients, 3 of them with more than I bacterial isolate (5. pneumon.
oe 4, Hinfluenza 3, 5. oureus 2, B. cathorralis 2, P aeruginos 1, S. epidermidis 1. C. albicans I).
Zhiel Neelsen and silver stains, mycobacterial, fungal and anaerobic cultures were negative
in all patients. Clinical response to specific antimicrobial therapy was defined as cure (5
cases), improved (3) and failure (2). Among the 8 with favorable clinical response, 5 had
recurrences within I month. Antibiotic susceptibility studies showed that 3 of the 4 S. pneurnonioe isolates had intermediate resistance to penicillin (MIC>0. I<2.0).
Conclusions. We confirmed a high incidence rate of sinusitis in HIV+ patients. Incidence of
sinusitis (patient/year of follow up) seems to be higher among patients with more advance
disease, however microbial etiology does not differ significantly to that reported in HIV(-)
adults. S. pneurnonioe resistance to penicillin is an emergent problem among Chilean HIV+
patients.
Mo.B.1215
BACTEREMIA AND SEPSIS IN HIV-SEROPOSITIVE PATIENTS
Gritti Francesco M., Guerra L., Fasulo G., Mazzetti M., Raise E. *Di Pede B. Div. of Infectious
Diseases, *Dep.of Clincal Pathology Ospedale Maggiore. Bologna, Italy
Objectives.To evaluate: prevalence/incidence of bacteremia (B) and sepsis (5) in HIV+ patients
(Pts) in retrospective (RsP) and prospective (PsP) periods; clinical features of S by SAPS and
APACHE II; citokines, IL- I0, IL-2, IL-6, IL-8,TNF-c, and INF-y in prospective cases of S.
Methods: Incidence of B was evaluated on 54 I HIV+Pts/ I 3 13 admission in the PsP
I I. 1.94-5.31.95, while prevalence and incidence of S (according to Bone R.C. et al., Chest
1992;10:1644-.54) were evaluated on I.165 Pts/3.457 admissions in previous PsP and RsP
I. 1.87-10.31.94. Cytokines were determined on ELISA on serum of the first 24 h from the
beginning of 5, comparatively in 5 AIDS/S and 6 HIV-Pts with S.
Results: During the PsP the incidence of B was I23%o/year (y) with a S incidence of
40%o/y and a 5.7%o/y mortality During the RsR 34 S/30 Pts were reported: prevalence
I O%o/y mortality 2 %o/y Sixtythree % of S were due to gram+ bacteria and 35% to gram-:
56% were community acquired (e.v.drug abuse, 29%) and 44% hospital acquired (due to
CVC, 47%).The reported incidence%o/y of principal agents of B, in AIDS and ARC Pts, was
respectively: S.epidermidis 39 - 5; other coagulase- Staphylococ 4.5 - I.5; Saureus I 4 - 1.5:
S.pnemoniae 3.8 - 0: Enterococcus spp 0.76 - 3; non-hemolytic Streptococ 0.6 - 0: Poerugr
nosa 9 - 0; Salmonello spp other than S.typhi 8.4 - 0; E.coli 2.3 - 3: X.maltophilht 2.3 - 0.The
acute pysiology scores for sepsis, SAPS and APACHE II, and cytokines values were found to
be in the medium-low range of the common S findings and did not differ significantly in
AIDS versus HIV-Pts.

10
CA
IL
C
0

91