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Lege Artis Medicinae

JUNE 20, 2016

[End state AIDS patient at an intensive care unit - a case report with unconventional lessons]

ORTUTAY András, MARJANEK Zsuzsa, NAGY Károly, RÁCZ József, BARCS István

[A 26 year old male patient with unknown medical background had been admitted at the Department of Anestesiology and Intensive Therapy of the Jávorszky Ödön Hospital in the city of Vác. His HIV positivity had been revealed only at the 8th day of his hospitalization. He was living in a small settlement as an i.v. drug user, unknown to the drug prevention system or the STD primary care providing network. Being an end state AIDS patient, the time of the infection, the number of his contact persons, the source of the infection and the previous epidemiological pathway were not known. With this case report we would like to call attention to the importance of the differential diagnosis of AIDS disease, the role of the proper safety regulations concerning potentially infected and infected persons, the epidemiological importance of undiagnosed infections, and the extension of drug prevention services reachable for all persons in need. ]

Clinical Neuroscience

NOVEMBER 28, 2014

[Neurocognitive impairments of HIV infected individuals - Preliminary results of a national prevalence study in Hungary]

LAKATOS Botond, SZABÓ Zsuzsa, BOZZAI Barbara, BÁNHEGYI Dénes, GAZDAG Gábor

[Background and purpose - The outcome of HIV infection has dramatically improved due to the widespread use of combined antiretroviral therapy (cART). Opportunistic infections faded and internal and hemato-oncological diseases along with neurological conditions came to the forth. Present study is to evaluate neurocognitive performance of the Hungarian HIV infected individuals, at first in this setting. Patients and methods - We performed this cross-sectional pilot study within the frames of a national, single-center; prospective study on group of HIV infected patients, analyzing medical data and neurocognitive performance. Based on international recommendations visual memory, visuomotor coordination, non-verbal learning ability, executive functions and reaction time were tested by six domains of a computerized neuropsychological test battery (Vienna Test System). Results - Data of 59 enrolled HIV individuals were analysed; nine of whom were women (15%), median age 42.6 (IQR: 32.4-48.1) years. In 32.2% (n=19) of patients neurocognitive impairment was detected. Duration of infection and cART treatment time tended to be longer in impaired group (not significant). Lower CD4 cell count at the time of examination (p=0.047), psychiatric diseases other than depression (p=0.005) were found significantly associated with impairment; tertiary education qualification were more common (p=0.033) among non-affected patients. By correlation analysis age, infected time and duration of cART were significantly associated with motor deficit. Conclusion - HAND was detected in almost one third part of examined patients, which largely corresponds that in developed countries were observed. Duration of infection and of cART therapy associated motor deficit was found to be the most common impairment. This finding might be interpreted by direct effect of HIV, neurotoxicity of antiretrovirals and also by accelerated ageing of this population.]

LAM KID

SEPTEMBER 20, 2012

[Vitamin D deficiency and infections]

LUDWIG Endre, KRIVÁN Gergely

[Studies performed in the past few years have confirmed that vitamin D is essential for maintaining the optimal immune defense, and its immunomodulatory effect has a role in the defense against infections as well. A lot of data suggest that low serum 25-(OH)-D concentration is associated with an increased frequency of certain infections and it adversely influences pathological processes. Data on this adverse effect are available mostly in case of Mycobacterium tuberculosis, respiratory viral infections in general, HIV, hepatitis C and sepsis. The outcomes of severe infections are usually influenced by a number of factors and it seems that vitamin D deficiency is one of those factors that shift the process towards an unfavourable outcome. Further studies should evaluate the significance of this role and the influence of vitamin D supplementation on pathological processes.]

LAM Extra for General Practicioners

OCTOBER 20, 2011

[Acute hepatitis caused by herpes simplex virus 1]

PATYI Márta, SEJBEN István, VÁGÓ Tibor, CSERNI Gábor, KISS Antal Zsolt, KISS József Zoltán

[INTRODUCTION - Herpes simplex virus is a rare and severe disease, which is often lethal, especially in children and those who underwent transplantation. Rapid diagnostic help determines therapy and facilitates recovery of the patient. CASE REPORT - The authors present a case of a 46-year-old patient with no underlying disease, in whom the diagnosis of hepatitis caused by herpes simplex-1 virus was suggested after histological evaluation of a blind liver biopsy specimen. The diagnosis was later confirmed by immunomorphological examination. The patient’s hepatitis resolved following acyclovir therapy, but he developed nosocomial pneumonia, sepsis caused by Candida albicans and anuria. The patient recovered due the joint efforts of an infectologist, a pathologist, an intensive care specialist and a nephrologist. CONCLUSION - During examination of the patient, immune suppression was not indicated either by HIV-serology or bone marrow biopsy. thus the findings were presumably explained by a generalised infection in an immunocompetent host. In the case described, histological examination of the liver biopsy was a life-saving procedure, because it allowed timely and efficient treatment.]

Lege Artis Medicinae

NOVEMBER 20, 2005

[PREVENTION OF INFECTIONS IN CHRONIC HEPATITIS AND CIRRHOSIS]

PÁR Alajos, NEMESÁNSZKY Elemér

[Patients with chronic liver disease, mostly the elderly, due to their impaired immune response, frequently suffer from infections worsening the clinical course. This is sometimes overlooked in the everyday praxis. In patients with alcoholic liver disease both hepatitis A virus (HAV) and acute hepatitis B virus (HBV) infections can lead to fulminant hepatic failure, therefore their immunization with HAV and HBV vaccines is highly recommended, similarly, vaccination against flu and pneumococcus also may be indicated for alcoholics. In chronic viral hepatitis, alcohol abuse can result in rapid progression to cirrhosis and reduces the efficacy of antiviral treatment. Patients with chronic hepatitis C should also be vaccinated against superinfections by HAV and HCV. Co-infections by hepatotropic viruses and human immundeficiency virus (HIV) are frequent due to the shared routes of transmission. In HIVpositive patients the efficacy of the vaccination against HAV and HBV depends on the CD4 cell count, which also determined the timing of anti- HBV or anti-HCV treatment. Concerning the bacterial infections, spontaneous bacterial peritonitis (SBP) is the most severe complication of cirrhosis. The prevention of SBP is orally administered, moderately absorbed quinolon (norfloxacin) as long-term selective intestinal decontamination against Gram-negative pathogens. Alcoholic patients are also susceptible for tuberculosis. Bacterial infections play a role even in portal hypertension and variceal rupture, furthermore, both gastrointestinal haemorrhage and invasive endoscopic procedures increase the risk of infection, therefore in such situations a short-term (5- 8 day) antibiotic profilaxis is necessary with norfloxacin or ciprofloxacin. Taking into consideration these points of view, it may be of privotal significance for the management of patients with liver disease.]

Lege Artis Medicinae

OCTOBER 20, 2005

[THE INFLUENCE OF IMMUNOGENOMIC FACTORS ON HIV-INFECTION]

FÜST György

[Authors discuss data published in the last 2-3 years indicating that besides the characteristics of the virus itself, the natural course of HIV disease is also regulated by genetic factors from the very onset till the end. Susceptibility for HIV infection of the carriers of a non-expressing mutant allele (CCR5Δ32) of one of the main coreceptors of HIV is markedly lower than that of the non-carriers. HLA-concordancy, that is few differences in the HLA alleles between the infected and noninfected partners, increases the chance of the HIVtransmittal. On the other hand, carriage of some HLA genotype e.g. that of the HLA A2/6802 supertype may significantly decrease the risk of the sexually transmitted HIV infection or that of the HIV infection from the mother to child. The rate of progression of the HIV disease which may vary in broad range from the median value of 10 years is also dependent on genetic factors. Progression is lower than the average in the carriers of the CCR5Δ32, HLA-B*27 and HLAB* 57 alleles while it is significantly more rapid in carriers of the HLA-B*35.1 allele. Recent data on the regulation by genetic factors of some sideeffects and the efficacy of combined antiretroviral treatment indicate that in the near future individual treatment may be used on the basis of the genetic background of the patients.]

Clinical Neuroscience

DECEMBER 20, 2003

[HIV infection and neurology - long term follow-up of HIV infected children]

KOLLÁR Katalin, JELENIK Zsuzsanna, HEGELSBERGER Edit

[Objectives - Before the widespread introduction of combined antiretroviral therapy (1995) complications from HIV and AIDS in the central nervous system had been reported in larger proportion in infants and children than in adults: 80-90% versus 60-70%. Particular clinical manifestations tend to occur at different stages during the evolution of HIV infection. The authors review the neurological aspects of HIV infection. Method - First, a summary of the protocol of the neurological examinations and related experience is given. Then authors present the evaluation of neuro-psychological development, prevalence of neurological impairment and neuro-imaging of nine HIV infected children (seven boys, two girls) for the period of ten years (1991-2001). Three/ten children had vertically transmitted HIV, six/nine were infected by a nosocomial route in their early childhood. Children were regularly followed up from the diagnosis of HIV. The median follow up time has been 79 month (range: 18-144 month). Four patients died during the study period. The neurological status, the motor and mental development were examined at three month intervals or monthly under one year of age. EEG was performed every six month and CT/MRI once a year. All patients received combined antiretroviral treatment and immunglobulin therapy continuously. Results - Three/nine children have normal development, one/nine has hyperactive and attention deficit disorder with normal IQ range, two/nine have slight, one/nine moderate and two/nine serious mental retardation. Mild neurological signs were found in two children, various moderate and serious neuro/psychological symptoms were found in four patients, one of them was treated with benign epilepsy too. There was also close correlation between the clinical symptoms and the results of EEG examination (diffuse background slowing) and results of neuroimaging studies (cortical atrophy, calcification of the basal ganglia, toxoplasma abscesses). According to the results of different examinations three/nine children were found to be symptom-free, one/nine case showed the static form, two/nine patients showed the plateau form, two/nine the rapid progressive form and one/nine the progressive infantile form of AIDS encephalopathy. The majority of the patients suffered from adapting problems and difficulties of socialisation since their families lives were damaged by isolation and rejection from the community. Conclusion - The regular neurological and psychological examinations completed with EEG, CT/MRI were very informative to follow the course of neuro-psychological problems of HIV infected children. Symptom-free patients have to face psychosocial problems too, which cause much more damage in their mental progress than HIV itself.]

Lege Artis Medicinae

MAY 20, 2011

[Acute hepatitis caused by herpes simplex virus 1]

PATYI Márta, SEJBEN István, VÁGÓ Tibor, CSERNI Gábor, KISS Antal Zsolt, KISS József Zoltán

[INTRODUCTION - Herpes simplex virus is a rare and severe disease, which is often lethal, especially in children and those who underwent transplantation. Rapid diagnostic help determines therapy and facilitates recovery of the patient. CASE REPORT - The authors present a case of a 46-year-old patient with no underlying disease, in whom the diagnosis of hepatitis caused by herpes simplex-1 virus was suggested after histological evaluation of a blind liver biopsy specimen. The diagnosis was later confirmed by immunomorphological examination. The patient’s hepatitis resolved following acyclovir therapy, but he developed nosocomial pneumonia, sepsis caused by Candida albicans and anuria. The patient recovered due the joint efforts of an infectologist, a pathologist, an intensive care specialist and a nephrologist. CONCLUSION - During examination of the patient, immune suppression was not indicated either by HIV-serology or bone marrow biopsy. thus the findings were presumably explained by a generalised infection in an immunocompetent host. In the case described, histological examination of the liver biopsy was a life-saving procedure, because it allowed timely and efficient treatment.]

Lege Artis Medicinae

FEBRUARY 21, 2006

[PRINCIPLES AND NATIONAL REGULATIONS OF BLOOD DONOR QUALIFICATION]

TOMONKÓ Magdolna

[During the assessment of blood donor candidates the physician considers two factors; first, whether the loss of 450 ml blood would be of any risk for them (e.g., because of hypotension) and second, whether they have any illness, current (seasonal allergy, antibiotic use, etc.) or chronic conditions (oncological or autoimmune disease, drug use, etc.) that may confer risk to the recipient. For the safety of blood preparations it is essential that the donors are dependable individuals who lead a lifestyle of low risk of getting infected (by HIV, hepatitis, etc.). Hungarian practice concerning donor qualification are generally stricter (e.g., because of the differences in the health care system, in the health culture) than the directive of the European Union. This implies that a number of donor candidates are temporarily or permanently disqualified. Following medical interventions (e.g., surgery, transfusion), environmental effects (e.g., radiation exposure) and recovery from diseases, however, the donor may again give blood after a certain period of time. Certain chronic diseases, if properly managed and if the patient is in perfect general condition, do not constitute a cause for exclusion either. General practicioners can greatly contribute to safe national blood supply by identifying and advising potential blood donors.]