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1994-08-09
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Document 0042
DOCN M9480042
TI Blastomycosis and human immunodeficiency virus: three new cases and
review.
DT 9410
AU Witzig RS; Hoadley DJ; Greer DL; Abriola KP; Hernandez RL; Department of
Medicine, Tulane University School of Medicine, New; Orleans, LA 70112.
SO South Med J. 1994 Jul;87(7):715-9. Unique Identifier : AIDSLINE
MED/94294860
AB Reports of blastomycosis in individuals infected with the human
immunodeficiency virus (HIV) are increasing. We report on 3 patients
co-infected with blastomycosis and HIV (to add to the previously
reported 21), and review important clinical aspects and outcomes in all
cases. The percentage of patients co-infected with blastomycosis and HIV
who had disseminated blastomycosis (63%) was similar to the
blastomycosis patients in the general population (67%); however, as a
group the patients with HIV were severely immunosuppressed and fared
poorly. Severe immunodeficiency was indicated by CD4 counts < 200/mm3 in
85% of co-infected patients. Central nervous system (CNS) involvement
occurred in 46% of this group, approximately 5 to 10 times more
frequently than in individuals not infected with HIV previously reported
at 5% to 10%. The mortality rate from blastomycosis for patients with
both HIV infection and blastomycosis is 54%, about 5 times the mortality
rate of blastomycosis patients in the general population, previously
reported at < 10%. Disseminated blastomycosis in individuals with HIV
may appear as deep cutaneous ulcers, as was the case in two of our
patients. Although blastomycosis is not an AIDS-defining infection, it
may be reasonable to consider HIV testing and measurement of CD4 counts
in patients with blastomycosis. Such testing could help identify
individuals who are HIV positive but asymptomatic who have
blastomycosis, as well as provide useful information regarding a
possible association between CD4 cell deficiency and various clinical
manifestations of blastomycosis. Patients with HIV and blastomycosis
should be examined carefully for any evidence of CNS involvement.
Lifetime therapy with ketoconazole or itraconazole is likely to be of
benefit to patients with HIV who have been treated successfully for
blastomycosis.
DE Adult Antigens, CD4/ANALYSIS Blastomycosis/DRUG
THERAPY/*ETIOLOGY/MORTALITY Case Report CD4-CD8 Ratio Human HIV
Infections/*COMPLICATIONS/IMMUNOLOGY HIV Seropositivity/COMPLICATIONS
Itraconazole/THERAPEUTIC USE Ketoconazole/THERAPEUTIC USE Male Middle
Age Survival Rate JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).