A rare convergence: adult-onset Langerhans cell histiocytosis and HIV infection

While primarily described in children, adult-onset Langerhans cell histiocytosis (LCH) has been reported, albeit infrequently. In the present scenario, we unveil a unique case of adult-onset LCH in an HIV-infected individual. After the diagnosis was made, the patient was successfully treated and demonstrated total disease remission. This case illustrates the diagnostic challenge that rare clinical entities such as LCH pose, especially in the context of an untreated HIV infection. Furthermore, the complexity of treating adult-onset Langerhans cell histiocytosis in an HIV-positive patient is highlighted, with emphasis given on a multidisciplinary approach

Μελέτη b-D glucan σε HIV(+) ασθενείς

Το σύνδρομο HIV/ AIDS που προκαλείται από τον ιό της ανοσοανεπάρκειας (HIV) χαρακτηρίζεται από λοίμωξη των ατόμων με τον ιό και μια επακόλουθη μείωση των Τ- κυττάρων του ανοσοποιητικού που εξελίσσεται σε μια περίοδο ετών. Η β-(1→3)-D-γλυκάνη (BDG) είναι ένας πολυσακχαρίτης που βρίσκεται στο κυτταρικό τοίχωμα μυκήτων όπως Aspergillus, Candida και Pneumocystis. Καθώς αυτοί οι πολυσακχαρίτες του κυτταρικού τοιχώματος ανιχνεύονται στην κυκλοφορία κατά τη διάρκεια της μόλυνσης, τα αυξημένα επίπεδα BDG ορού μπορούν να χρησιμοποιηθούν για τη διάγνωση μυκητικής πνευμονίας σε ανοσοκατασταλμένους πληθυσμούς ασθενών με HIV λοίμωξη. Επιπλέον, σε άτομα αυτά, η μικροβιακή αλλόθεση από το έντερο στην αιματική κυκλοφορία σχετίζεται με συστηματική φλεγμονή, εξέλιξη του HIV, θνησιμότητα και εξέλιξη συνοδών νοσημάτων. Η μετατόπιση των γαστρεντερικών βακτηρίων στα άτομα με HIV λοίμωξη, αλλά και η αυξημένη ευαισθησία τους σε μυκητικές λοιμώξεις και χρόνιο αποικισμό από μύκητες, έδωσε τη δυνατότητα ώστε η BDG να χρησιμοποιηθεί ως βιοδείκτης. Με αυτόν τον τρόπο, τα προϊόντα μυκήτων, μέσω της BDG, είναι ανιχνεύσιμα στο αίμα και σχετίζονται με την έκβαση της HIV λοίμωξης και την επιτυχία της θεραπείας. Στην παρούσα ανασκόπηση, αναλύθηκε η χρήση της BDG ως διαγνωστικό εργαλείο για μυκητικές λοιμώξεις σε HIV-θετικούς ασθενείς.The HIV/AIDS syndrome caused by the Human Immunodeficiency Virus (HIV) is characterized by infection of individuals with the virus and a subsequent decline in immune T-cells that progress over a period of years. Β-(1→3)-D-glucan (BDG) is a polysaccharide found in the cell wall of fungi, such as Aspergillus, Candida and Pneumocystis. Because these cell wall polysaccharides are shed into the circulation during infection, elevated serum BDG levels can be used to diagnose fungal pneumonia in immunocompromised HIV patient populations. Furthermore, in HIV-infected individuals, microbial translocation from the gut to the blood circulation is associated with systemic inflammation, HIV progression, mortality, and the development of comorbidities. The displacement of gastrointestinal bacteria in HIV-infected individuals, but also their increased susceptibility to fungal infections and chronic fungal colonization, enabled BDG to be used as a biomarker. Thus, fungal products via BDG are detectable in the blood and are related to HIV outcome and treatment success. In the present review, the use of BDG as a diagnostic tool for fungal infections in HIV-positive patients was analyzed

The Veracity of Traumatic Spinal Cord and Related Nerve Injuries in a Developing Country: The Cyprus Case Study

Background and Aim: This is a retrospective epidemiological study, based on ICD-10 system, using statistical data from the Cyprus Statistical Service official archives. To estimate the spinal cord injury incidence and its characteristics like gender preference and hospitalization, in Cyprus people, over a 10-year period of time. The study investigated cases that have occurred within the territory of the Republic of Cyprus. Methods and Materials/Patients: The data from the Cyprus Statistical Service official archives were reviewed based upon the ICD-10 searching, using annual reports, from 2005 to 2014. The extracted information included the number of hospitalized patients, using ICD-10 codes S14, S24 and S34, sex and days of hospitalization. In order to report the incidence rates, we used the Cyprus Statistical Service official demographic data. Results: The Mean Spinal Cord and the related Nerves Injury (SCI and NI) incidence was calculated to be 0.24%. The Mean SCI & NI male incidence was 0.158 %. The Mean SCI and NI female incidence was 0.076 %. There were 2.8 days of hospitalization per every SCI and NI patient per year. Conclusion: Based on the study results, it seems advisable to have a National Spine and Spinal Cord Injury registry, in order that different parameters be correlated in a more effective way. The study highlights the need for a well-organized trauma and rehabilitation center which would be of great benefit for the health system of the country. Furthermore, this information can be useful in future health economic studies related to the SCI and NI