OBJECTIVES:In a cross-sectional study of human immunodeficiency virus (HIV)-infected adults, the authors showed lower distortion product otoacoustic emissions (DPOAEs) in HIV+ individuals compared ...with controls as well as findings consistent with a central auditory processing deficit in HIV+ adults on antiretroviral therapy. The authors hypothesized that HIV+ children would also have a higher prevalence of abnormal central and peripheral hearing test results compared with HIV− controls.
DESIGN:Pure-tone thresholds, DPOAEs, and tympanometry were performed on 244 subjects (131 HIV+ and 113 HIV− subjects). Thirty-five of the HIV+, and 3 of the HIV− subjects had a history of tuberculosis treatment. Gap detection results were available for 18 HIV− and 44 HIV+ children. Auditory brainstem response results were available for 72 HIV− and 72 HIV+ children. Data from ears with abnormal tympanograms were excluded.
RESULTS:HIV+ subjects were significantly more likely to have abnormal tympanograms, histories of ear drainage, tuberculosis, or dizziness. All audiometric results were compared between groups using a two-way ANOVA with HIV status and ear drainage history as grouping variables. Mean audiometric thresholds, gap detection thresholds, and auditory brainstem response latencies did not differ between groups, although the HIV+ group had a higher proportion of individuals with a hearing loss >25 dB HL in the better ear. The HIV+ group had reduced DPOAE levels (p < 0.05) at multiple frequencies compared with HIV− subjects. No relationships were found between treatment regimens or delay in starting treatment and audiological parameters.
CONCLUSIONS:As expected, children with HIV+ were more likely to have a history of ear drainage, and to have abnormal tympanograms. Similar to the adult findings, the HIV+ group did not show significantly reduced audiometric thresholds, but did have significantly lower DPOAE magnitudes. These data suggest that (1) HIV+ children often have middle ear damage which complicates understanding the direct effects of HIV on the hearing system, and (2) even when corrected for confounders DPOAEs were lower in the HIV+ group. Previous studies suggest ototoxicity from antiretroviral drugs is an unlikely cause of the reduced DPOAE magnitudes. Other possibilities include effects on efferent pathways connecting to outer hair cells or a direct effect of HIV on the cochlea.
Outpatient parenteral antibiotic therapy (OPAT) for infective endocarditis (IE) is being applied widely, despite the absence of controlled data that demonstrates that outcomes are equivalent to those ...with standard inpatient antibiotic therapy. We review existing OPAT guidelines, published data on the timing of complications from IE, and data on risk factors that can be used to predict complications. These data are used to propose more stringent criteria for patient selection and clinical management of OPAT for native valve IE. We recommend a conservative approach (inpatient or daily outpatient follow-up) during the critical phase (weeks 0–2 of treatment), when complications are most likely, and we recommend consideration of OPAT for the continuation phase (weeks 2–4 or 2–6 of treatment) when life-threatening complications are less likely.
During the past decade, malassezia species have emerged as increasingly important pathogens in neonates in intensive care nurseries. These organisms are lipophilic and have been associated with ...bloodstream infections in low-birth-weight neonates receiving lipid emulsions. There have been numerous outbreaks caused by
Malassezia furfur
(which is obligately lipophilic), and one outbreak involving
M. pachydermatis
(which is not obligately lipophilic) has been reported.
1
In that outbreak, patient-to-patient transmission of
M. pachydermatis
was documented in an intensive care nursery, but the source of the outbreak was not identified.
M. pachydermatis
has been associated with otitis externa in dogs.
In November 1993,
M.
. . .
BACKGROUND:A positive tuberculin skin test (TST) may indicate cross-reacting immunity to non-tuberculous mycobacteria (NTM) and not latent tuberculosis infec- tion (LTBI). OBJECTIVES: To assess ...misclassification of LTBI, as assessed by skin testing with Mycobacterium avium
sensitin (MaS), and to determine how this misclassifica- tion affects the analysis of risk factors for LTBI. METHODS: In a population-based survey, participants underwent skin testing with M. tuberculosis purified pro- tein derivative (PPD) and MaS. A PPD-dominant skin test was a reaction
that was ≥ 3 mm larger than the MaS reaction; a MaS-dominant skin test was a reaction that was ≥ 3 mm larger than the PPD reaction. RESULTS: Of 447 randomly selected persons, 135 (30%) had a positive PPD test. Of these, 21 (16%) were MaS- dominant, and were therefore attributable to
NTM and misclassified as LTBI. PPD reactions of 5-14 mm were more likely to be misclassified than those ≥ 15 mm (OR = 5.0, 95%CI 1.9-13.2). Adjusting for misclassification had only a small impact on the analysis of risk factors for LTBI. CONCLUSIONS: A substantial number of
individuals who are diagnosed with LTBI are actually sensitized to NTM. Using dual skin testing would reduce misdiagnosis and prevent unnecessary treatment.
The advisory group concluded that the benefits of BCG immunization for all children outweighed the risks among those with HIV infection, and the group recommended that routine childhood immunization ...be continued and that BCG vaccine only be withheld from infants with symptomatic HIV infection I. Contemporary in vitro techniques for detecting prior mycobacterial immunity have now shown that many adults have detectable in vitro responses to mycobacterial antigens, despite having negative results of skin tests for antigens derived from Mycobacterium tuberculosis and/or nontuberculous mycobacteria 8, 9. Adolescents and adults with later acquisition of HIV may have persistence of some protection from childhood BCG immunization, but this would certainly be less than the minimal level of protection against adult pulmonary tuberculosis typically detectable among HIV-uninfected adults who received BCG vaccine at birth. Unfortunately, however, existing US guidelines are still sufficiently restrictive, that BCG vaccine is not distributed in the United States and is not available for select high-risk groups of subjects who might benefit (i.e., health care workers who are traveling to areas where tuberculosis is highly endemic, children exposed to multidrug-resistant tuberculosis, and homeless persons and those in congregate settings at high risk of tuberculosis) 15, 16.
We compared macronutrient intake, food insecurity, and anthropometrics in breastfeeding women40 HIV-positive women not yet on antiretroviral therapy and 40 HIV-negative women. Calculated deficits at ...2 weeks were 517 kcal per day for HIV-positive women vs 87 kcal per day surplus for HIV-negative women (P = 0.01) and 29 g protein per day for HIV-positive women vs 16 g protein per day for HIV-negative women (P = 0.04). Food insecurity scores were 11.3 for HIV-positive women vs 7.8 for HIV-negative women (P < 0.01). Enhanced dietary education together with macronutrient supplementation may be required to improve health outcomes in HIV-positive women and their infants.
The role of preexisting interferon (IFN) γ responses in controlling bacillary burden in human immunodeficiency virus (HlV)-associated tuberculosis is not known. Among BCG-immunized HIV-infected ...adults who developed tuberculosis in a phase III trial of an investigational tuberculosis vaccine, greater baseline IFN-γ responses to early secretory antigenic target 6 and Mycobacterium tuberculosis whole-cell lysate were associated with reduced bacillary burden on sputum smear grade, days to culture positivity on agar, and sputum culture grade during subsequent tuberculosis. This association was most consistent among recipients of the investigational vaccine. When HIV-associated tuberculosis develops, greater preexisting IFN-γ responses to mycobacterial antigens are associated with reduced tuberculosis bacillary burden. ClinicalTrials.gov Identifier. NCT0052195
OBJECTIVES:Abnormal hearing tests have been noted in human immunodeficiency virus (HIV)–infected patients in several studies, but the nature of the hearing deficit has not been clearly defined. The ...authors performed a cross-sectional study of both HIV+ and HIV− individuals in Tanzania by using an audiological test battery. The authors hypothesized that HIV+ adults would have a higher prevalence of abnormal central and peripheral hearing test results compared with HIV− controls. In addition, they anticipated that the prevalence of abnormal hearing assessments would increase with antiretroviral therapy (ART) use and treatment for tuberculosis (TB).
DESIGN:Pure-tone thresholds, distortion product otoacoustic emissions (DPOAEs), tympanometry, and a gap-detection test were performed using a laptop-based hearing testing system on 751 subjects (100 HIV− in the United States, plus 651 in Dar es Salaam, Tanzania, including 449 HIV+ 130 ART− and 319 ART+, and 202 HIV−, subjects. No U.S. subjects had a history of TB treatment. In Tanzania, 204 of the HIV+ and 23 of the HIV− subjects had a history of TB treatment. Subjects completed a video and audio questionnaire about their hearing, as well as a health history questionnaire.
RESULTS:HIV+ subjects had reduced DPOAE levels compared with HIV− subjects, but their hearing thresholds, tympanometry results, and gap-detection thresholds were similar. Within the HIV+ group, those on ART reported significantly greater difficulties understanding speech in noise, and were significantly more likely to report that they had difficulty understanding speech than the ART− group. The ART+ group had a significantly higher mean gap-detection threshold compared with the ART− group. No effects of TB treatment were seen.
CONCLUSIONS:The fact that the ART+/ART− groups did not differ in measures of peripheral hearing ability (DPOAEs, thresholds), or middle ear measures (tympanometry), but that the ART+ group had significantly more trouble understanding speech and had higher gap-detection thresholds indicates a central processing deficit. These data suggest that(1) hearing deficits in HIV+ individuals could be a CNS side effect of HIV infection, (2) certain ART regimens might produce CNS side effects that manifest themselves as hearing difficulties, and/or (3) some ART regimens may treat CNS HIV inadequately, perhaps due to insufficient CNS drug levels, which is reflected as a central hearing deficit. Monitoring of central hearing parameters could be used to track central effects of either HIV or ART.
We compared macronutrient intake, food insecurity, and anthropometrics in breastfeeding women: 40 HIV-positive women not yet on antiretroviral therapy and 40 HIV-negative women. Calculated deficits ...at 2 weeks were 517 kcal per day for HIV-positive women vs 87 kcal per day surplus for HIV-negative women (P = 0.01) and 29 g protein per day for HIV-positive women vs 16 g protein per day for HIV-negative women (P = 0.04). Food insecurity scores were 11.3 for HIV-positive women vs 7.8 for HIV-negative women (P < 0.01). Enhanced dietary education together with macronutrient supplementation may be required to improve health outcomes in HIV-positive women and their infants.
Herpes simplex virus (HSV) oral shedding has not been studied among HIV-positive children in Africa. We sought to evaluate longitudinal oral HSV reactivation in HIV-positive and -negative children. ...Twenty HIV-positive antiretroviral-naive and 10 HIV-negative children aged 3-12 years in Tanzania were followed prospectively for 14 days. Oral swabs were collected daily and submitted for HSV DNA PCR analysis. Clinical data were collected via chart review and daily diaries. HSV DNA was detected in 10 (50%) of HIV-positive and 4 (40%) of HIV-negative children. Children who shed HSV had virus detected in a median of 21.4% of samples; shedding was intermittent. Median CD4 count among HIV-infected children was 667 cells/µL in those with positive HSV DNA and 886 cells/µL in those who were negative (p = 0.6). Of the HIV-positive children reporting prior sores, five (83%) had positive HSV swabs, whereas the one HIV-negative child with prior sores did not have a PCR-positive swab. HSV is detected frequently in children with and without HIV. HIV-infected children reporting oral sores have a high rate of HSV detection. Given the proven strong interactions between HIV and HSV, further study of co-infection with these viruses is warranted in children.
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