Faculty Bibliography

The loss of body weight is a common finding in the setting of AIDS or ARC. Weight loss usually heralds the appearance of an AIDS-associated infectious disease or neoplasm. Multiple mechanisms for catabolism exist, including decreased caloric intake, excessive caloric loss, and increased metabolic caloric consumption. Among the most serious implications of weight loss is the fact that many of the immune defects observed in persons with AIDS are exacerbated by protein-calorie malnutrition. There are myriad causes of weight loss in patients with AIDS and ARC. A systematic and thorough diagnostic approach guided by the patient's presenting symptoms often yields an etiology and therapeutic direction

9-(1,3-dihydroxy-2-propoxymethyl) guanine (ganciclovir) was used to treat 41 patients (median age, 37 years) with the acquired immunodeficiency syndrome and cytomegalovirus gastrointestinal infection. Sites of infection were the colon in 31, the esophagus in 5, the rectum in 4, and the small bowel in 1. Patients received ganciclovir, 5 mg/kg body weight, intravenously every 12 hours for 14 days. Clinical improvement was seen in 30 patients and virologic response in 32. Mainly hematologic toxicity occurred: moderate leukopenia (1000 to 1900/mm3) was seen in 7 patients and severe (less than 1000/mm3) in 1, and moderate neutropenia (500 to 1000/mm3) in 5 and severe (less than 500/mm3) in 1. A cutaneous rash developed in 2 patients. Median overall survival was 16 weeks (range, 2 to 56). Cytomegalovirus recurred in 13 patients; median time to recurrence was 9 weeks from the start of treatment. Ganciclovir may be effective in treating cytomegalovirus gastrointestinal disease in patients with the acquired immunodeficiency syndrome

Eighty-six [67Ga]citrate chest scans were performed in 71 adult patients with the acquired immunodeficiency syndrome. Forty-five of these patients also had Kaposi's sarcoma. Only 29 of 57 abnormal scans were correlated with abnormal chest radiographs. Chest radiographs were negative for 27 scans and unavailable for one. Several scan patterns were seen. Diffusely increased lung uptake was seen most commonly with Pneumocystis carinii pneumonia, but also other infections and noninfectious inflammatory conditions. Focal uptake corresponding to regional lymph node groups occurred most often with Mycobacterium avium-intracellulare but aslo with lymphoma. Localized intrapulmonary uptake was seen in bacterial pneumonias. Perihilar activity occurred in two cases. When chest radiographs were abnormal and 67Ga scans negative, the most common diagnosis was pulmonary Kaposi's sarcoma

Spirochetal organisms were demonstrated histologically in skin biopsy specimens from a patient with Lyme disease and erythema chronicum migrans. The patient responded rapidly to penicillin G benzathine administration. Convalescent serum contained a high titer of antibody to an lxodes dammini spirochete antigen. The finding of spirochetes in an erythema chronicum migrans lesion in a patient with clinical Lyme disease supports further recent evidence that this illness is an infectious disease caused by a tick-borne bacterium. The skin biopsy may be a useful diagnostic tool in this disease