Failure to Eradicate Isospora belli Diarrhoea Despite Immune Reconstitution in Adults with HIV - A Case Series 英文参考文献.docVIP

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Failure to Eradicate Isospora belli Diarrhoea Despite Immune Reconstitution in Adults with HIV - A Case Series 英文参考文献.doc

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Failure to Eradicate Isospora belli Diarrhoea Despite Immune Reconstitution in Adults with HIV - A Case Series 英文参考文献

FailuretoEradicateIsosporabelliDiarrhoeaDespite ImmuneReconstitutioninAdultswithHIV-ACaseSeries TomH.Boyles1*.,JohnBlack1.,GraemeMeintjes1,2,3,MarcMendelson1 1Division ofInfectious Diseases andHIV Medicine, Department ofMedicine, Groote SchuurHospital,UniversityofCape Town,CapeTown,South Africa, 2GFJooste Hospital,Manenberg,CapeTown,SouthAfrica,3InstituteofInfectiousDiseasesandMolecularMedicine,CapeTown,SouthAfrica Abstract Isospora belli causes diarrhoea in patients with AIDS. Most respond to targeted therapy and recommendations are that secondary prophylaxis can be stopped following immune reconstitution with ART. We report eight cases of chronic isosporiasis that persisted despite standard antimicrobial therapy, secondary prophylaxis, and good immunological and virologicalresponsetoART.MedianCD4nadirwas175.5cells/mm3andmedianhighestCD4whilesymptomaticwas373 cells/mm3.Overall34%ofstoolsamplesand63%ofduodenalbiopsyspecimenswerepositiveforoocytes.Fourpatients died,tworemainsymptomaticandtworecovered.Possibleexplanationsforpersistenceofsymptomsincludehostfactors such as antigen specific immune deficiency or generalised reduction in gut immunity. Parasite factors may include accumulating resistance to co-trimoxazole. Research is required to determine the optimum dose and duration of co- trimoxazole therapy and whether dual therapy may be necessary. Mortality was high and pending more data we recommendextendedtreatmentwithhigh-doseco-trimoxazoleinsimilarcases. Citation:BoylesTH,BlackJ,MeintjesG,MendelsonM(2012)FailuretoEradicateIsosporabelliDiarrhoeaDespiteImmuneReconstitutioninAdultswithHIV-A CaseSeries.PLoSONE7(8):e42844.doi:10.1371/journal.pone.0042844 Editor:NicolasSluis-Cremer,UniversityofPittsburgh,UnitedStatesofAmerica ReceivedMay2,2012;AcceptedJuly11,2012;PublishedAugust6,2012 Copyright: ? 2012 Boyles et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricteduse,distribution,andr