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

Tu.B.2175 - Tu.B.2180

Tuesday July 9, 1996

Results: In all patient samples tested the serum, plasma and whole blood test results
agreed. In 97/98 HIV+ patients, all 3 samples tested positive using the rapid Immunoassay
One patient had a negative test result for all 3 samples. Upon further investigation, this
donor disclosed that he was previously diagnosed in 1989 as HIV positive by a re active
ELISA test but had no confirmatory studies. Polymerase chain reaction (PCR) testingr was
negatve. The patient's Western blot showed negative p24, g41 p55. gp 120 and gp 160 bands
and a weakly positive pl18 band, qualifying as a negative result by Public Health criteria.The
patient was not considered in the statistical analysis. 96/100 HIV negative plasma donors
were identified as non-reactive and 4/100 as reactive. Using data from the 97 evaluable HIV
positive patients and the 100 HIV negative plasma donors, the sensitivity and specificity
were 100% and 96%, respectivel. All 7 HIV-2 samples were correctly identified.
Conclusions: The First CheckTM HIV I 2 test is a simple, reliable, hand-held test which can
be performed on plasma, serum or whole blood specimens.Thus, the test is suited to
screening blood products in developing nations, emergency rooms and other settings where
rapid, low cost results are desirable. If accompanied by proper counseling and educational
materials, this simple, low cost, 5 minute test may also be useful as a home HIV test using
whole blood fr om a fingerstick.
Darryl M. See, University of California, Irvine Medical Center, Dept. of Medicine, Bldg. 53,
Rte. 8i, 101 City Drive So., Orange, CA 92668,TEL: [phone]; FAX: [phone];
EMAIL: DMSEEc@UC. EDU
Tu.B.2175
SIMULTANEOUS INFECTION WITH RHODOCOCCUS EQUI,ASPERGILLUS
FUMIGATUS AND SERRATIA MARCESCENS IN AN AIDS PATIENT
Maltez F, Serrano A, Proenca R. Hospital de Curry Cabral - Servico I (D Infecciosas)
Lisboa - Portugal
The authors present a case report of a male patient 34 years old, intravenous drug user
HIV infected since two years before, always asymptomatic, with a marked irmmunodeficiency (4 CD4 lymphocytes/mm3) who developed a bilateral interstitial pneumonia caused
by Aspergillus fumrigatus and Serratia marcescens and a mitral endocarditis due to
Rhocococcus equi.
We emphasize the difficulty of therapeutic approach and the complicated clinical evolution
with sepsis and multiorgan failure.
Some comments are made about the agents envolved and its role in AIDS.
Maltez F,. Hospital de Curry Cabral, Servico I -Pay. F Rua da Beneficencia, 1000 Lisboa
Portugal.Tel/Fax: [phone]
Tu.B.2176
RHODOCOCCUS EQUI INFECTION COMPLICATING AIDS.
Valenrcia ME,Toro C', MorenoV, Laguna F, Enriquez A*, SorianoV, Gonzalez Lahoz J.
Infectious Diseases and Microbiology*. Clinical Investigation Center (CIC). Madrid. Spain.
Introduction: RPodococcus equi is a primary pathogen in animals and it has only rarely been
seen in immunocompromised humans. Over the last 5 years, the acquired immunodeficiency syndrome (AIDS) epidemic and a better interpretation of the clinical profile of R. equi
infection have resulted in an increase in the number of reported cases.
Patients and methods: Four cases of infection due to R. equi in 4 patients with HIV infectioen are reported. Diagnosis was made following the isolation of this pathogen in clinical
specimens.
Results: Mean age was 27 years (range: 20-30) and 3 patients were women.Two were drug
abusers and the two others heterosexuals. All were severely immunodepressed with CD4+
lymphocyte count below 25 mnm3. Clinical manifestations were fever and respiratory symptoms with cough and hemoptoic sputum. Radiograph of the chest was abnormal in all
patients and showed a cavitated infiltrate in upper lobes in 3 (two in the right lobes and
one in the left) and the other had bilateral pleural effusion. R. eqgui was isolated in pleural
effusion (I). blood (2) and sputum (2).The patients were treated with vancomycin and
another antibiotic: rifampicin (2), ceftriaxone (I) and imipenem (I).All improved, but one
had 3 relfpses with recurrent pulmonary disease. One patient died with progresive pulmonary disease because he stopped the treatment.
Conclusions: Infectiorn due to R. equl usually appears in the form of chronic cavitated pneumonia, similar to that observed in mycobacterial infecions. It must be suspected in severely
im nocompromised patients with AIDS, respiratory symptoms with negative studies for
raycobacternas and infiltrate in the upper lobes. It is necessary the administration of a combination of antibiotics with good intracelular penetration for avoiding relapses, which are
frequent in HIV infected patients.
Juan Gonzalez Lahoz. Service of Infectious Diseases CIC. Sinesio Delgado 10. 28029 Madrid.
Spain.
Tu.B.2177
BACTEREMIA IN HIV-INFECTED PATIENTS
Mireia Pui, Pere Dornino, Roser Pericas, Montserrat Fuster, Beatriz Mirells, Josep Ris, Josep
LI. Barrio, Joan Nolla and Guillem Prats
Aim of the study: To assess the clinical and bacteriological spectrum of bacter ermia, and its
significance in HIV-infected patient.
Patients and methods: A prospective study of all the episodes of bacteremia that occurred
in our hospital and the risk factors associated with it was performed. An episode of bacteremia was defined by the isolation and identification of a pathogenic bacterium f6rom
blood culture, excluding mycobacteria. For the purposes of the present study a case was
con.idered when bacteremia was detected in a patient infected with the human immunodeficiency virus (HIV). Contamination was defined by a cnosensus between clinicians at
charge of the patient and microbiologists. Statistical analyses were performed by means of
the Stat View I1TM statistical package (Abacus Concepts Inc., Berkeley CA 94704).
Results: From June, I, 1993 to June 1, 1994, 624 episodes of bacteremia were detected at
our hospital. 35 of them (5.6%) occurred in patients with HIV infection. Bacteremia was
clinically significant in 26 patients (74.3%), whereas 9 positive blood cultures were considered contamination.There were 5 women (19.2%) and 2 I men (80.8%) a mean age of 32
~ 6. I years (range: 2452 years). Aside from HIV infection 17 patients had other comorbid
conditions which were: chronic hepatitis (12), hematologic malignancy (3), and solid malignany (2). Predisposing factors for bacteremia were: intravascular catheters (5), granulopenia

(4), immunosuppressor rr py (3), steroid therapy (2), indwelling urinary catheter (I), previous surgery I ),,plenctomy (I), and cutaneous ulcer (I). 23 episodes (88.5%) were
community acquired, and 3 (.5%) were hospital acquired. All the episodes were monomicrobial bacterermias','.'m the pathogens implicated grampositive cocci predominated (19,
79.2%) whereas?r,r.rne,,tive bacilli represented only 20.8% (5 episodes). Most common
causative pathogens wser e: Streptococcus pneumonie (7), Salrmonella enteritids (5).
Stophylococcus epiderricis s (2), Staphylococcus oureus (2), coagulase negative staphylocococci
(2), Enterococcus viridir (2), Haemophilus influenzoe (I). Enterococcus sp. (I), Aonetobrcter
woff i (I), Bacteroides ovatus (I), Corampylobacter jejuni (1), and Eschericha coli (I). Primary
focus of infection could be detected in 19 patients (73.1%) and the most common were:
pneumonia (8), gastrointestinal infection (3), urinary (2), ENT infection (2). osteomyelitis (2),
colecystitis (I), and subcutaneous venous reservoir (I). Empiric antibiotic therapy was adequate in 23 patients (92%).There were no deaths attributable to bacterial septicemia
among our patients.
Conclusions: HIV infection was the main underlying disease in 5.6% of patients with bacterial septicemia diagnosed during one year but other comorbid conditions were found in
most of the patients. Most of the episodes were community acquired and almost 80% were
due to grampositve cocci.The single most frequent pathogen was Streptococcus pneurronioe
and the most frequent primary focus of infection was pneumonia. Empiric antibiotic therapy
was adequate in most of the episodes.There were no deaths attributable to septicemia.
Pere Domingo, MD. Department of Internal Medicine. Hospital de la Santa Creu I Sant Pau.
Av. Sant Antoni Ma Claret, I 67. 08025 Barcelona.Telephone: [phone], Fax: 34-3
2919269
Tu.B.2178
THE INTENSIVE CARE UNIT SUPPORT OF HIV-INFECTED PATIENTS WITH
PNEUMOCOCCAL BACTEREMIA
Davis, Wayne P *, Afessa, B.**, Frederick, W.*. *Howard University Hospital, Washington
DC, USA **University of Florida, USA
Objective: To assess the predictive value of the APACHE II prognostic scoring system in
HIV infected patients with pneumococcal bacteremia and compare their clinical outcome
with age-matched controls.
Design: The study was a retrospective chart review of HIV infected patients with pneumococcal bacteremia in the Medical Intensive Care Unit of Howard University Hospital, an
inner city university hospital, in the 10 year period between January 1985-December 1995.
Age-matched controls of non HIV infected patients with pneumococcal bacteremia were
identified by computer Data collected consisted of demographics, source of bacteremita,
need for mechanical ventilation, APACHE II score, and in hospital mortality APACHE II predicted mortality was calculated. Stat View 4.5 with Chi-square. Fisher's exact. Student's t and
Mann-Whitney U tests were used. P<.05 was considered significant.
Results: Each group consisted of 25 patients-18 male and 7 female.Twenty-four patients in
the HIV group and 23 patients in the control group were black.The mean age was
40.5~7.8 vs 38.4+~ 10 years, (p=0.4232).The source of the infection was the lung in 25 of
the HIV group and 23 of the control group. Mechanical ventilation was needed in 2 I (84%)
of the HIV group vs 19(76%) of the control group (p=0.7252). Median APACHE II score
for the HIV group was 33.5 vs 23 for the control group (p=0.0186).APACHE II predicted
mortality was 68% for the HIV group vs 50% for the control group (p=0.029 I). Observed
mortality was 56%(14/25) vs 48%(I 2/25)(p=0.5713).
Conclusion: The APACHE II prognostication system showed that HIV infected patients with
pneumococcal bacteremia were more severely ill and had a higher predicted mortality than
the non-HIV infected patients. However, the observed mortality was similar for both
groups
Wayne P Davis Howard University Hospital 204 I Georgia Ave NW Washington DC 20060
USA Telephone [phone] Fax [phone]
Tu.B.2179
A STUDY OF COMMUNITY-ACQUIRED SINUSITIS IN AIDS
Lorenz Karl. Boone J,. Koeller K, Grille M, Olson P Nowacki M,Wallace M. Naval Medical
Center; San Diego, California
Objective: To evaluate diagnostic methods in community-acquired sinusitis in subjects with
AIDS (by CDC criteria).
Methods: We prospectively followed subjects with AIDS for symptoms of sinusitis from
January 1995 to January 1996. 110 subjects with AIDS were surveyed for symptoms of
sinusitis including persistent nasal discharge, facial/sinus pain, and persistent nasal congestion
unresponsive to decongestants. Subjects were evaluated with nasal smears, nasal endoscopy,
plain radiography and computerized tomography (CT) of the paranasal sinuses.
Results: 57 subjects (52%) reported symptoms compatible with sinusitis, of whom 19
(33%) consented to the protocol. Computerized tomography demonstrated evidence of
sinusitis in I 6 of I 8 subjects (89%) and was helpful in demonstrating septal deviation in a
subject with nornmal sinuses. Plain radiography failed to demonstrate sinus disease in 10
cases that were abnormal by coronal CT and failed to add additional diagnostic information
in the remaining cases. Nasal endoscopy demonstrated sinus osteal purulence in two cases
with radiographic sinusitis and was helpful in identifying findings consistent with allergic rhinitis in one additional case. Nasal smears revealed significant neutrophilia in 4 of I 6 (25%) of
cases with radiographic sinusitis.
Conclusion: Coronal CT and nasal endoscopy were complementary in studying subjects
with clinical sinusitis. Plain radiographs and nasal smears did not meaningfully contribute to
diagnosis in this small case series.
Dr Karl Lorenz, Naval Medical Center: San Diego, CA 92134 Telephone [phone] Fax
619-532-7478
Tu.B.2180
DOES CD4 COUNT INFLUENCE CLINICAL FINDINGS AND RISK FACTORS FOR
INFECTIVE ENDOCARDITIS AMONG HIV-INFECTED INJECTION DRUG USERS
(IDUS)?
Manoff, Susan B. Flynn CR Hoover DR, Druskin LL. Nelson KE,Viahov D. Department of
Epidemiology Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland,
USA.

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