ORAL CANDIDIASIS IN HIV PATIENT SUFFERING PNEUMOCYSTIC CARINII PNEUMONIA

Background: HIV/AIDS infection provoked opportunistic infection systhemically and intraorally. Pneumocystic carinii pneumonia (PCP) and Oral candidiasis (OC) is the most prevalent opportunistic infection among HIV/AIDS patient and may serve as indicator of low CD4 count in HIV infection. Objective: This paper reports management of oral candidiasis in pneumocystic carinii pneumonia that affects a patient with HIV. Case: A 39 year-old man was hospitalized for pneumocystic carinii pneumonia with weakness of gait and emaciated posture. He was also diagnosed of HIV/AIDS infection through CD4 count and HIV rapid test. Intraoral white patches was reported occured within 2 days being hospitalized. Several tests were ordered resulting, metabolic acidosis, CD4 count were 10 cells/μL, HIV rapid test (ICT) was reactive for 3 methods, and microbiologic examination was positif to C.albicans from the smear of white plaque. The patient also diagnosed with OC pseudomembranous type. Case Management: Patient was treated using intravenous fluconazole 100 mg/day for five days and antiseptic mouthwash. Recovery was achieved within 3 weeks follow-up along with given anti retroviral (ARV) treatment by the internist. Conclusion: Management of OC in HIV/AIDS patient with PCP infection in this case were used systemic antifungal and antiseptic mouthwash. The multidiciplinary approach in managing this case obtained successful therapy.

Practical Methods for TEM, Part II.

This is an extension of our presentation from last year. We intend to continue the discussion and review several practical procedures developed in our laboratory for routine and immuno-electron microscopy.TEM Vs IM-LM In the last decade, the use of diagnostic TEM in the medical field has experienced a drastic decline. The main reason is due to the advances of immuno-labeling techniques for light microscopy and also the decreased coverage of medical insurance for EM. Currently, immuno-histochemistry or in situ hybridization staining can be performed on large paraffin or frozen sections. These procedures can be performed quickly and much less expensively than TEM. However, TEM is still needed when PAP staining is not specific or minimum numbers of cells are stained. It is also possible to process immuno-labeled paraffin slides for TEM examination to confirm a diagnosis. In addition, when only a few microorganisms such as pneumocystic carinii or protothecosis are stained by Grocott’s methenamine silver in paraffin sections, a re-examination and confirmation by TEM can be performed without the use of uranium or lead staining.

CIRCULATING ANTICOAGULANT IN AIDS

The frequency of a circulating anticoagulant has been reported to be high in AIDS, in particular in case of Pneumocystic carinii pneumonia (Pep). Twenty-five non-hemophiliac patients (23 homosexual males,1 drug addict, 1 tranfused) with AIDS were followed over a six month period. Mean age was 32 (21-42). All patients had a markedly decreased T4/T8 ratio (mean 0.12), a low absolute T4 level (mean : 155/mm3), an elevated total serum immunoglobulins level.Activated partial thromboplastin time (APTT), prothrombintime and thrombin time were measured once a week during hospitalisation. A prolonged APTT (more than 10 seconds as compared to controls) with normal prothrombin time and thrombin time was found only once in 11patients and in two or more occasions in two others.No specific factor level of intrinsic pathway wasfound low enough to explain a prolonged APTT.Evidenceofcirculating anticoagulant (failure to correct aprolonged APTT by equal mixure of normal plasma and patient plasma) was found in all these 13 patients.Nothrombotic or haemorraghic manifestations occured.AIDS manifestations were 2 Pep.1 cytomegalovirus retinitis. 2 Kaposi's sarcomas, 1 Hodgkin's disease, 2 mycobacterium avium intracellulare pulmonary infection, 4 central nervous system toxoplasmosis, 1 Cryptococcus meningitis. Amongst the 12 patients with normal APTT,3_Pcp, 2 cytomegalovirus retinitis. 2 Kaposi's sarcomas, 2 central nervous system toxoplasmosis, 1 unexplained fever, and 2 oesophagus candidiasis were diagnosed. A transiently prolonged APTT associated to a circulating inhibitor seems to be common in AIDS. Weobserved this anomaly in 52 % (13/25). In our five cases of Pcp, 3 had normal APTT. During other opportunistic infections, the circulating inhibitor was found.The similar complications seen in two groups suggest that a circulating anticoagulant is not specifically associated to any opportunistic infection and any malignancybut appearr independently from these circumstances.