Die infektiöse Spondylitis

Zusammenfasung: Bei der infektiösen Spondylitis handelt es sich in der Regel um eine Osteomyelitis von 2benachbarten Wirbelkörpern unter Beteiligung der Zwischenwirbelscheibe (Spondylodiszitis). Am häufigsten ist die Lendenwirbelsäule betroffen, gefolgt von der Brustwirbelsäule. Die Symptome der infektiösen Spondylitis sind unspezifisch, was nicht selten zu einer Verzögerung von einigen Wochen bis zur Diagnosestellung führt. Die infektiöse Spondylitis kann durch eine Vielzahl von Erregern bedingt sein, die überwiegend auf hämatogenem Weg die Wirbelsäule erreichen. Der häufigste Erreger ist Staphyloccocus aureus. Die Spondylitis ist zudem die häufigste skelettale Manifestation der Tuberkulose. Wie bei anderen Formen der Osteomyelitis ist die Kenntnis des Erregers für die Wahl einer adäquaten Therapie entscheidend, weshalb eine mikrobiologische Diagnose auf jeden Fall angestrebt werden sollte. Die Mehrheit der Fälle kann konservativ mit antibiotischer Therapie geheilt werde

Nontoxigenic Corynebacterium diphtheriae Isolated from Intravenous Drug Users

During a prospective study 117 intravenous drug users were screened for infection with Corynebacterium diphtheriae. Nontoxigenic C. diphtheriae was found in 5 of 132 throat swab specimens and in 5 of 28 skin ulcer specimens taken from July 1991 to April 1992. When phenotypic and molecular typing methods were used, these 10 strains were shown to belong to a single clone. During the same period no strain was isolated from 200 controls. Clinical manifestations of infection were not clearly attributable to C. diphtheriae—no typical membranous pharyngitis was present. The presence of a single clone among homeless intravenous drug users in Zurich indicates the presence of C. diphtheriae in parts of the population with poor standards of hygiene and low socioeconomic statu

Extrapulmonary and Disseminated Infections Due to Mycobacterium malmoense: Case Report and Review

Mycobacterium malmoense is a potentially pathogenic species that was first described in 1977. During the past decade M. malmoense has been recognized with increasing frequency as a pulmonary pathogen. More than 180 cases of M. malmoense infection have been reported. Most of these infections affected a previously damaged lung. Other infection sites included the skin, lymph nodes, and bursae. Five cases of disseminated infection have been reported. The antituberculous drugs associated with the most favorable susceptibility patterns are rifampin and ethambutol. Because of the slow growth of M. malmoense on conventional, egg-based bacteriologic media, the incubation time should be >6 weeks; special solid and liquid media are recommended. We report a case of disseminated pulmonary and gastrointestinal infection due to M. malmoense in a patient with AIDS, who was treated successfully with a combination of rifabutin (ansamycin), clofazimine, and isoniazid. In addition, we review the characteristics of extrapulmonary and disseminated infections due to M. malmoens

Cell-Associated HIV-1 RNA in Blood as Indicator of Virus Load in Lymph Nodes

We have developed sensitive assays for viremia and cell-associated human immunodeficiency virus type 1 (HIV-1) RNA and DNA to assess the predictive value of virological parameters determined in blood for virus load in lymph nodes (LNs). Eighteen patients were included; 13 received stavudine/didanosine/hydroxyurea and 5 stavudine/didanosine, and all had viremia 3 months. At the time of LN biopsy (median, 10 months), the median viremia was 2.09 log copies/mL (range, <0.70-3.34). Cell-associated HIV-1 RNA and DNA were detectable in blood and LNs of all patients. The median cell-associated RNA and DNA were 2.16 log copies/106 cells and 2.60 log copies/106 cells in blood versus 4.31 log RNA copies/106 cells and 3.26 log DNA copies/106 cells in LNs. Regression analysis shows that, in treated patients with sustained low viremia, cell-associated RNA and DNA in blood are better predictors of virus load in LNs than viremi

Is depression a risk factor for heart complaints?: Longitudinal aspects in the Zurich study

Background: The objective of this longitudinal study was to assess the association between major depression and heart complaints in a population of young and healthy adults. Methods: Starting at the age 20/21, participants of the Zurich Study underwent 6 structured, psychological interviews during a span of 20years. We evaluated longitudinal data from 277 persons who participated in all 6 interviews including questions about heart complaints. Results: Over 20years, heart complaints were reported by two thirds of participants, and the frequency of depression was 11.4%. At the age of 40/41, heart complaints were significantly associated with earlier heart complaints and major depression, both more often in women. Recurrent brief depression showed a tendency, but neither minor depression nor depressive symptoms were predictive for later heart complaints. Conclusions: This study suggests that major depression is a predictor for heart complaints at the age of 40 and that the severity of depressive disorder in younger age has an effect on subsequent heart complaints. Follow-up data will help to elucidate whether these subjective heart complaints show any correlation with a later coronary heart diseas

Long-term survival and interruption of HAART in HIV-related pulmonary hypertension

Reported here is a case of a patient with pulmonary arterial hypertension related to HIV (PAHRH) in which lipodystrophy necessitated interruption of highly active antiretroviral therapy (HAART) and long-term survival was the outcome. Although previous studies have suggested antiretroviral therapy may benefit patients with this rare complication of HIV infection, no worsening of PAHRH was observed when HAART was interrupted. Clinical and echocardiographic parameters remained stable during 7 months of follow up. In cases in which HAART is associated with relevant toxicity, interruption of HAART in patients with PAHRH can be considered, but should be used only if no alternatives are available. Close follow-up is warrante

Attenuated and Nonproductive Viral Transcription in the Lymphatic Tissue of HIV-1-Infected Patients Receiving Potent Antiretroviral Therapy

Human immunodeficiency virus type 1 (HIV-1) RNA that persists in the lymphoid tissue of patients despite treatment with highly active antiretroviral therapy (HAART) may represent extracellular virions or intracellular RNAs residing within HIV-infected cells. To further characterize residual viral transcription, tonsil biopsy specimens from patients receiving long-term HAART, untreated patients, and patients undergoing 2 weeks of structured treatment interruption were analyzed by polymerase chain reaction quantification of virion-encapsidated RNA, intracellular unspliced HIV RNA (HIV UsRNA), multiply spliced HIV RNA encoding tat and rev (HIV MsRNA), and HIV DNA. Tonsil biopsy specimens from viremic patients harbored high amounts of virions, which primarily stemmed from local production, as indicated by a strong correlation of extracellular tonsillar RNA with intracellular HIV-1 nucleic acid levels but not with plasma viremia, and as shown by phylogenetic analysis of clonal env sequences from lymphoid tissue and plasma. In patients receiving HAART, intracellular HIV UsRNA persisted at significantly decreased levels, whereas HIV MsRNA and lymphoid virion levels were depleted. Thus, residual lymphoid HIV-1 RNA in patients receiving HAART indicates attenuated viral transcription in HIV-1-infected cells that lack virion productio

Equal Amounts of Intracellular and Virion‐Enclosed Hepatitis C Virus RNA Are Associated with Peripheral‐Blood Mononuclear Cells In Vivo

Background. Hepatitis C virus (HCV) replicating in peripheral‐blood mononuclear cells (PBMCs) may represent an extrahepatic viral reservoir. Quantitation of HCV RNA with regard to its subcellular distribution and longitudinal course is needed for better understanding of the largely unexplored in vivo dynamics and potential pathogenetic significance of HCV in PBMCs. Methods. Plasma and PBMCs from 30 patients coinfected with HCV and human immunodeficiency virus were evaluated in cross‐sectional and longitudinal analyses, for up to 40 months. Differential extraction of virion‐enclosed HCV RNA associated with cells was performed in parallel with extraction of total cellular HCV RNA. HCV RNA of either orientation was quantified by real‐time polymerase chain reaction. Results. HCV RNA was detected only in PBMCs from patients with viremia and at relatively stable quantities over time. Intracellular HCV RNA corresponding to ∼60% of total cellular HCV RNA was strongly correlated with virion‐enclosed HCV RNA but was only weakly associated with viral loads in plasma. In contrast, the ratio of HCV RNA load in PBMCs versus that in plasma was patient specific and stable over time. Conclusions. The substantial and patient‐specific amounts of intracellular HCV RNA found by the present study support a concept of low‐level replication in PBMCs. There was no evidence for persistent HCV infection in PBMCs after clearance of viremia in plasm