Spectrum of clinical disease in a series of 135 hospitalised HIV-infected patients from north India

BACKGROUND: Literature on the spectrum of opportunistic disease in human immunodeficiency virus (HIV)-infected patients from developing countries is sparse. The objective of this study was to document the spectrum and determine the frequency of various opportunistic infections (OIs) and non-infectious opportunistic diseases, in hospitalised HIV-infected patients from north India. METHODS: One hundred and thirty five consecutive, HIV-infected patients (age 34 ± 10 years, females 17%) admitted to a tertiary care hospital in north India, for the evaluation and management of an OI or HIV-related disorder between January 2000 and July 2003, were studied. RESULTS: Fever (71%) and weight loss (65%) were the commonest presenting symptoms. Heterosexual transmission was the commonest mode of HIV-acquisition. Tuberculosis (TB) was the commonest OI (71%) followed by candidiasis (39.3%), Pneumocystis jiroveci pneumonia (PCP) (7.4%), cryptococcal meningitis and cerebral toxoplasmosis (3.7% each). Most of the cases of TB were disseminated (64%). Apart from other well-recognised OIs, two patients had visceral leishmaniasis. Two cases of HIV-associated lymphoma were encountered. CD4+ cell counts were done in 109 patients. Majority of the patients (82.6%) had CD4+ counts <200 cells/μL. Fifty patients (46%) had CD4+ counts <50 cells/μL. Only 50 patients (37%) received antiretroviral therapy. Twenty one patients (16%) died during hospital stay. All but one deaths were due to TB (16 patients; 76%) and PCP (4 patients; 19%). CONCLUSIONS: A wide spectrum of disease, including both OIs and non-infectious opportunistic diseases, is seen in hospitalised HIV-infected patients from north India. Tuberculosis remains the most common OI and is the commonest cause of death in these patients

Missed retinal breaks in rhegmatogenous retinal detachment

AIM: To evaluate the causes and associations of missed retinal breaks (MRBs) and posterior vitreous detachment (PVD) in patients with rhegmatogenous retinal detachment (RRD). METHODS: Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and 191 patients were included for analysis of PVD, depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations. RESULTS: Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs (P=0.033) with the odds of missing a retinal break being 1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy (PVR) and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae, pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD. Traumatic RRDs were rarely associated with PVD. CONCLUSION: Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD

A – Chest radiograph of a patient with pneumonia showing bilateral, diffuse interstitial infiltrates B – Contrast enhanced computed tomographic (CT) scan of chest showing mediastinal lymphadenopathy in a patient with disseminated tuberculosis

<p><b>Copyright information:</b></p><p>Taken from "Spectrum of clinical disease in a series of 135 hospitalised HIV-infected patients from north India"</p><p>BMC Infectious Diseases 2004;4():52-52.</p><p>Published online 22 Nov 2004</p><p>PMCID:PMC535567.</p><p>Copyright © 2004 Sharma et al; licensee BioMed Central Ltd.</p> Typical central necrosis evident as low attenuation areas (arrows) is seen C – Contrast enhanced CT scan of brain showing ring enhancing lesions in the basal ganglia bilaterally (arrows). Serology was positive for toxoplasma infection D – Ophthalmoscopic image of a patient with cytomegalovirus retinitis E – Non-Hodgkin's lymphoma in a HIV-infected lady presenting as unilateral maxillary swelling F – Contrast enhanced CT scan of abdomen reveals an oedematous and enlarged pancreas (asterisk) suggestive of acute pancreatitis. The patient was on didanosine and improved following withdrawal of the same and supportive treatment

Spectrum of clinical disease in a series of 135 hospitalised HIV-infected patients from north India-0

<p><b>Copyright information:</b></p><p>Taken from "Spectrum of clinical disease in a series of 135 hospitalised HIV-infected patients from north India"</p><p>BMC Infectious Diseases 2004;4():52-52.</p><p>Published online 22 Nov 2004</p><p>PMCID:PMC535567.</p><p>Copyright © 2004 Sharma et al; licensee BioMed Central Ltd.</p