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

Tu.B.2197 - Tu.B.2202

Tuesday July 9, 1996

blood cell count of 2.5 x 109/I (53% neutrophils) and a chest radiograph revealed a moderately sized left sided pleural effusion. Decubitus films determined the effusion to be free
flowing with no evidence of parenchymal infiltrate. Diagnostic thoracentesis revealed a
mnonocytic predominant, exudative effusion. Pleural fluid cultured Aspergillus fumigotus, without evidence of bacteria, mycobacteria, other fungi, or malignant cells (cytology). A repeat
thoracentesis yielded the same result.The patient underwent pigtail catheter placement for
drainage and treatment with Amphotericin B for 2 weeks then Itraconazole (200mg bid)
after developing renal insufficiencyThe patient's fevers resolved, and he was discharged on
Itraconazole with the pigtail catheter in place (subsequently removed). Four months after
discharge, the patient died from severe HIV wasting with no evidence of respiratory disease.
Discussion: We describe an unusual cause of empyema in a patient with AIDS. Pleural
based Aspergillosis has been reported in previous studies but, to our knowledge, this is the
first report describing isolated Aspergillus empyema. Interestingly, this patient developed
Aspergillosis infection without the classic risk factors, he presented with an isolated pleural
effusion, and responded well to Itraconazole.
Monique Andersson, Charing Cross and Westminster Medical School, 369 Fulham Road,
London, UK, SW I 0 9NH telephone: [phone] fax: [phone] email: manderssondsl.cxwms.ac.uk
Tu.B.2197
FLUCONAZOLE RESISTANT OROPHARYNGEAL CANDIDIASIS IN A LARGE
URBAN HIV CLINIC
Palmieri, Philip J.***, Southern, P*; Haley, R*, Keiser, P*** *The University ofTexas
Southwestern Medical School at Dallas; **Dallas Department of Veteran's Affairs Medical
Centeor: Dallas,TX USA
Objectives: To determine the incidence, microbiology and risks for clinically resistant candida infections.
Methods: A cross sectional study of a large, metropolitan HIV clinic of over 2000 patient
was performed. Patients at the Parkland Memorial Hospital between September and
November I1995 were asked to fill out a questionnaire regarding fluconazole use and past
history of thrush.The patients' oropharynxes were then cultured for candida. Candida was
cultured on Sabouroud dextrose agar (SDA) using standard techniques. Speciation of positive cultures were performed using the bioMerieux API20C system.
Results: 137 patients were enrolled into the study Of these 49 patients (36%) had clinical
thrush on physical examination. Eighty patients (57%) had positive cultures. Candida albicans
was isolated from 90% of patients with positive cultures, C. glabrata from 22.5%, C. krusei
from 5%, C.tropicalis from 1.3% and Saccharomyces species from 2.5%. Cultures were
polymicrobic in 2 1% of patients, the most common multiple infection being C. albicans and
C. glabrata (I15%). Patients treated with fluconazole were more likely to have cultures positive for non-albicans species than those who were not treated (P=0.01I). Six patients had
thrush while being treated with high dose fluconazole and were considered clinically resistant. Of these 3 had mixed infections (C. glabrata and C. albicans), 2 had C. glabrata alone
and I had C. albicans alone.
Conclusions: Candida infections are common in HIV infected individuals. Fluconazole use is
associated with increased prevalence of candida non-albicans colonization. A high proportion of patients with clinically resistant thrush had non-albicans species isolated and these
species clearly play a role in causing thrush.
Philip J. Palmienri, 5323 Harry Hines Blvd., Dallas,TX 75235-9113
Tel: [phone] Fax: [phone]
Tu.B.2198
THE USE OF MICROSATELLITES TO DISTINGUISH STRAINS OF CANDIDA ALBICANS COLONIZING HIV-INFECTED PATIENTS ON FLUCONAZOLE
Haubrich, Richard*, Field D, Eggert L. Metzgar D, McCutchan JA, Wills C and the
California Collaborative Treatment Group, University of California, San Diego, CA, USA.
Objective: To perform genotypic analysis on strains of Candida albicans colonizing patients
on long-term fluconazole prophylaxis.
Methods: Baseline and six-month C. albicans isolates (oropharyngeal) obtained from
patients on 400 mg weekly or 200 mg daily fluconazole were genotyped using 6 different
microsatellite regions of the Candida genome. DNA was extracted from single and pooled
colonies of Candida from 31 isolates from 15 patients (14 pairs and one triple sample),
amplified using PCR with 6 sets of primers, and separated on DNA sequencing gels.
Genetic relatedness was assessed by the number of microsatellite alleles at which the
strains differ: Fluconazole susceptibility of isolates was determined using NCCLS standard
methods.
Results: The microsatellites from Candida strains had 2 to 7 alleles per microsatellite.
Clones from each isolate appear to be genetically indistinguishable from pooled DNA from
multiple colonies of that isolate. Of the 15 baseline isolates, 12 different genotypes were
identified and 14 of I 6 later isolates were different. Six of 15 patients had a detectable difference between baseline and follow-up isolates pairs.
In 4 of 6 pairs of isolates with a difference in genotype between baseline and 6-month isolate, there was at least a 4-fold reduction in fluconazole susceptibility compared with 3 of 9
pairs with no difference between genotypes (odds ratio 4, 95% Cl.4-36, P = 0.3).
Conclusion: Genetic analysis using microsatellites is able to distinguish different C. albicans
strains colonizing patients on fluconazole prophylaxis. Genotypic changes may accompany
changes in fluconazole susceptibilityThis technique may be useful for epidemiologic studies
of fluconazole resistance.
R. H. Haubrich, 2760 Fifth Ave., #300, San Diego, CA 92103-8208
Tel: 6 I 9-543-8080 Fax: [phone] email: [email protected]
Tu.B.2 199
ZYGOMYCOSIS OF THE COLON
Plt D, Gathe, Jr. J., Bonefas, E., Clemmons, J., Garland, J.
Objective: To describe to our knowledge the first case of Zygomycosis of the cecum in a
person with AIDS.
Methods: Retrospective case review of a patient followed prospectively by the authors.
Results: A 46 y/o male with a CD4 cell count of 10 was admitted because of Fever of

Unknown Origin (temp 100 -101 degrees F) and abdominal pain for > 6 months. Right
lower quadrant tenderness with mild rebound was noted on exam. An abdominal ultrasound revealed fluid collection around the cecum suspicious for an appendiceal abscess. CT
scan confirmed an inflammatory process in the cecum suspicious of but not diagnostic of
appendicitis. A colonoscopy revealed a friable cecal mass that was felt to be a tumor. A right
hemicolectomy with iectransverse anastomosis was performed, with findings of a large
7.6cm mass involving the entire cecum with evidence of perforation. Histopathology
revealed multiple aseptate hyphae in a background of necrosis, with cultures positive for
Rhizopus sp.The patient was treated successfully by surgical resection and 19 days of
Amphotericin B. He died I 8 months later of other AIDS related complications with no evidence of Rhizopus infection seen at autopsy
Conclusions:
I.While Zygomycetes infection of other systems have been reported in AIDS patients, we
present the first involving the colon.
2. Histopathology would suggest this disease was blood borne, though we cannot rule out
direct ingestion of the organism.
3. Local resection and Amphotericin B was curative
4. Zygomycosis should be considered in the differential diagnosis of GI mass lesions in
patients with AIDS.
Dr D. Plot I I I I Hermann Drive Ste 10-C, Houston,Texas 77004 Telephone: [phone] I Fax: [phone]
Tu.B.2200
OROPHARINGEAL CANDIDIASIS IN HIV-INFECTED CHILDREN: EVALUATION OF
CANDIDA SPP. MULTIRESISTENT STRAINS PRESENCE
Caselli D, Gulminetti R**, Maccabruni A*, Michelone G*, DeiCas A*, Arlandi L*.
Department of Pediatrics, Department of Infectious Diseases*, Research Laboratory
Infectious Diseases**. IRCCS Policlinico San Matteo, University of Pavia, Italy
Introduction: High incidence of oral candidiasis is reported in HIV infected children;
although this is not a life-threatening condition, since it may impair nutrition and progress to
esophagitis, specific treatment is often requested. Moreover antimicotic resistent strains have
been frequently reported in adult patients.To evaluate the incidence of oral thrush and of
resistent strains of candida we studied a group of HIV infected children.
Patients: We evaluated 22 HIV infected children (age range 2- I12 years), II with mild disease (I N or B I-2-or C I according to "CDC 95" classification), and I I with severe disease
(IB3- C2or3). Surveillance oral swabs from twenty-two exposed children aged less than one
year, who seroreverted in the follow-up, were studied as controls. Oral swabs from children
with clinically suspected oral candidiasis, observed over one year, were cultured. Sensitivity
of isolated strains was tested by Kirby-Bauer test. Children with confirmed infection were
treated with oral fluconazole and then retested on day 21. Multiresistent strains were those
who lacked sensitivity to >2 of the eight tested antimicotic drugs.
Results: All cultures obtained from children of the control group were negative. Of the 133
cultures from infected children 70 were positive. Candida albicans is the only isolated
species. In the group with mild disease 36/57 cultures were positive (63%). and 19 of these
36 (53%) strains multiresistent. In the group with severe disease 34/76 cultures were positive (45%) and only 5 (I 5%) were multiresistent.
Conclusions: High incidence of oral trush is confirmed in our children, with a median of 5
infections/child/year. No species other than Candida albicans were found. Multtresistent candida strains accounted for 34% (24/70) of all isolates. Surprisinlgy, both occurrence of infection and of multiresistence are more frequent in children without severe immunodeficiency
Desiree Caselli, Clinica Pediatrica, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Fax: [phone]
Tu.B.220 I
LIVER DISEASE IN PATIENTS WITH AIDS
Silva.M,,Tannuri,A.A.S., Lobo,A.N., Lima,M.B.C., Basilio,C.A., Mello,C.E.B. Universidade Do
Rio De Janeiro (Uni - Rio) Rio De Janeiro - Brasil
Objective: The evaluation of clinical, biochemical, serological and morphological data of liver
involvement in high risk groups with AIDS was the aim of this work. Our purpose was to
determine the spectrum of liver disease in AIDS and the clinic morphological correlation in
order to ascertain if any clinical or pathological feature was characteristic of AIDS.
Methodology: We have evaluated 217 patients with AIDS, being 21 hemophiliacs (1I9 A and
2 B) severely affected and 196 homosexual men.We studied hepatitis B virus (HBV) serum
markers by commercial RIA kits for the detection of HBsAg, Anti-HBe, HBeAg and AntiHBe. Liver function tests including aminotransferases, total bilirubin, alkaline phosphatase
were performed. Mostly of the liver biopsies were obtained percutaneously but some samples were obtained from autopsy material.
Results: The great majority of the patients were anicteric. More than 80% of them were
Anti-HBs and Anti-HBc (+). Serum aminotransferases levels were mildly elevated (less than
twice the upper limit of the normal range) in the majority of the patients. Liver tuberculosis,
chronic active hepatitis, sinusoidal dilatation, hiparplasy of Kupffer cells, cirrhosis were the
most frequent findings in the study We also found the presence of hepatocellular carcinoma, cryptoccccosis, histoplasmosis, amebiasis and schistosomiasis.
Conclusions: a) The clinical and biochemical alterations of the liver in AIDS patients were
subclinical and not very characteristic; b) Morphologicaly there was conspicuous predominance of chronic liver disease, opportunistic liver infectious in special due to
Mycobacterium.
Rua-Miguel De Frias,201/1801 Icarai Niteroi Rio De Janeiro Brasil Cep 24220-001
Tu.B.2202
HEPATITIS MARKERS IN PAEDIATRIC HIV INFECTION
Costa R, Serban M, Cucuruz M, Rosiu N, Jinariu S. IlIrd Paodiatric ClinicTimisoara, Romania
Hepatitis viruses are a highly infectious pathogen that spread along percutaneous and parenteral routes.Taking into account that horizontal transmission is the main course of the
paediatric HIV infection in Romania, in about 60% of cases the way of contamination being
unknown, we studied the prevalence of hepatitis markers in HIV/AIDS children.The prevalence of hepatitis markers among blood donors is about 7% for HBV and 16% for HCV.
Method: Sera were collected in 1990-1995 from 108 children aged between I mo- 16yrs,

0~
-
299