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Assessing the role of intestinal absorption, permeability, and nutrition in AIDS patients
Published in Ronald R. Watson, NUTRIENTS and FOODS in AIDS, 2017
Infection with Isospora belli may also cause severe and protracted diarrhea in patients with AIDS. The parasite is the cause of gastrointestinal infection in approximately 1 to 3% of patients with AIDS and diarrhea in the U.S. but in 15 to 19% of patients in developing countries. Clinically, isosporiasis resembles cryptosporidiosis. Watery diarrhea without blood or inflammatory cells, cramping, abdominal pain, weight loss, anorexia, malaise, and fever are usually present. Laboratory findings in isosporiasis may include steatorrhea and, in contrast to cryptosporidiosis, eosinophilia. Although heavily concentrated in the small intestine, Isospora belli can be identified throughout the entire gastrointestinal tract and in other organs.
Trimethoprim and Trimethoprim–Sulfamethoxazole (Cotrimoxazole)
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Jason A. Trubiano, M. Lindsay Grayson
Cyclospora cayetanensis is a coccidian parasite, previously referred to as cyanobacteria or coccidian-like body, that causes watery diarrhea in both developed and developing countries but has become particularly notable as a cause of diarrhea in HIV-infected patients. It is presumed to be waterborne and tends to cause diarrhea that is generally self-limiting in immunocompetent hosts predominantly in the summer months (Wurtz, 1994; Soave and Johnson, 1995). Wurtz et al. (1993) and Madico et al. (1993) first reported anecdotal success with CoT therapy. Subsequently, Hoge et al. (1995) have demonstrated the efficacy of CoT in a placebo-controlled double-blind trial in travelers and foreign residents with Cyclospora infections in Nepal. A regimen of 160/800 mg CoT twice daily for 7 days resulted in fecal clearance of Cyclospora in 29% (CoT) versus 0% (placebo) after 3 days (p = 0.016), whereas after 7 days of therapy, 94% of CoT-treated patients had cleared stools versus 12% of placebo recipients (p < 0.0001). Eradication of the pathogen correlated with clinical efficacy, and no relapse among CoT-treated patients was noted in those followed for an additional 7 days. Among HIV-infected patients, however, the rate of relapse appears to be relatively high. Pape et al. (1994) noted a high incidence of Cyclospora infection among HIV-infected Haitians with diarrhea. Clinically their symptoms were indistinguishable from those seen in patients with isosporiasis or cryptosporidiosis. Because both Cyclospora and Cryptosporidium are acid-fast staining and Cryptosporidium do not respond to CoT (unlike Isospora), care must be taken to differentiate these two pathogens (Madico et al., 1993; Soave and Johnson, 1995). Among the 43 patients treated with CoT, 160/800 mg four times daily for 10 days, diarrhea ceased and stool examination was negative within 2.5 days after starting therapy. Recurrent symptomatic cyclosporiasis developed in 12 of 28 patients (43%) followed for more than 1 month, but all responded to a further course of CoT. Subsequent secondary prophylaxis with CoT, 160/800 mg three times per week, was associated with only one recurrence after 7 months. Sifuentes-Osornio et al. (1995) have also described the clinical efficacy of CoT therapy for cyclosporiasis in HIV- and non–HIV-infected patients in Mexico City. They noted two HIV-infected patients with acalculous cholecystitis, probably due to Cyclospora, which responded to CoT.
Strategies for the diagnosis and management of meningitis in HIV-infected adults in resource limited settings
Published in Expert Opinion on Pharmacotherapy, 2021
Marise Bremer, Yakub E Kadernani, Sean Wasserman, Robert J Wilkinson, Angharad G Davis
Treatment options for cerebral toxoplasmosis include cotrimoxazole, pyrimethamine plus sulfadiazine, pyrimethamine plus clindamycin or atovaquone. Folinic acid is given as an adjunct to pyrimethadine. In sub-Saharan Africa cotrimoxazole is recommended as first line treatment due to its wide availability and if pyrimethamine is the agent of choice it’s paired with clindamycin for the same reason. Secondary prophylaxis should be given if CD4 count <200 cells/mm3 [124] and again cotrimoxazole is preferred due to protection against pneumocystis pneumonia and isosporiasis. Therapy is discontinued when CD4 count >200 cells/mm3, for more than 6 months, in response to ART. There is limited data regarding the use of corticosteroids (such as dexamethasone) for the treatment of HIV-associated cerebral toxoplasmosis. These agents, which may predispose infected patients to other infections due to their immunosuppressive potential, are only clinically indicated to treat life-threatening mass effect associated with focal lesions or associated edema, and should be discontinued as soon as it is clinically feasible [125].
Prevalence of kidney injury in patients taking tenofovir based antiretroviral therapy at a primary health care clinic, in East Rand,Gauteng Province
Published in Hospital Practice, 2021
P Makamu, S Bezuidenhout, M Matlala
The most common medications co-administered to patients were the angiotensin-converting enzyme inhibitor, mainly enalapril. Cotrimoxazole antibiotic was used as a preventative therapy for Pneumocystis pneumonia, bacteremia, isosporiasis, toxoplasmosis, and bacterial pneumonia in patients in WHO stages II, III and IV or patients with CD4-T cells count below 200cells/mm3 [8]. Angiotensin-converting enzyme inhibitors are known to cause hemodynamically mediated kidney injury, whilst cotrimoxazole is associated with intratubular obstruction and nephrolithiasis [38]. Nevertheless, all six affected patients were not taking any antihypertensive medication. Furthermore, these patients were taking a prophylactic therapy of cotrimoxazole 960 mg daily. It is therefore possible that cotrimoxazole could have contributed to the progression into renal injury.