Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty

A simple, validated protocol consisting of a battery of tests is available to identify elderly patients with frailty syndrome. This syndrome of decreased ...

University of Arizona

Cat-scratch disease is a common infection that usually presents as tender lymphadenopathy. It should be included in the differential diagnosis of fever of unknown origin and any lymphadenopathy syndrome. Asymptomatic, bacteremic cats with Bartonella henselae in their saliva serve as vectors by biting and clawing the skin. Cat fleas are responsible for horizontal transmission of the disease from cat to cat, and on occasion, arthropod vectors (fleas or ticks) may transmit the disease to humans. Cat-scratch disease is commonly diagnosed in children, but adults can present with it as well. The causative microorganism, B. henselae, is difficult to culture. Diagnosis is most often arrived at by obtaining a history of exposure to cats and a serologic test with high titers (greater than 1:256) of immunoglobulin G antibody to B. henselae. Most cases of cat-scratch disease are self-limited and do not require antibiotic treatment. If an antibiotic is chosen, azithromycin has been shown in one small study to speed recovery. Infrequently, cat-scratch disease may present in a more disseminated form with hepatosplenomegaly or meningoencephalitis, or with bacillary angiomatosis in patients with AIDS.

Cat-scratch Disease.

Maladie des griffes du chat est une infection courante qui se pr&eacute;sente g&eacute;n&eacute;ralement comme une ad&eacute;nopathie d&#39;appel d&#39;offres. Elle devrait figurer dans le diagnostic diff&eacute;rentiel de la fi&egrave;vre d&#39;origine inconnue et tout syndrome d&#39;ad&eacute;nopathie. Chats asymptomatiques, bact&eacute;ri&eacute;mies &agrave; Bartonella henselae dans leur salive servent de vecteurs de mordant et griffant la peau. Puces de chat sont responsables de la transmission horizontale de la maladie de chat &agrave; chat, et &agrave; l&#39;occasion, des vecteurs arthropodes (puces ou tiques) peuvent transmettre la maladie &agrave; l&#39;homme. Maladie des griffes du chat est souvent diagnostiqu&eacute;e chez les enfants, mais les adultes peuvent ainsi pr&eacute;senter avec elle. Micro-organisme causal, b. henselae, est difficile &agrave; la culture. Diagnostic est le plus souvent arriv&eacute; en obtenant une histoire d&#39;exposition &agrave; des chats et un test s&eacute;rologique avec (plus de 1: 256) des titres &eacute;lev&eacute;s d&#39;anticorps de l&#39;immunoglobuline G contre b. henselae. Plupart des cas de maladie des griffes du chat sont spontan&eacute;ment et ne n&eacute;cessitent pas de traitement antibiotique. Si un antibiotique est choisi, azithromycin a &eacute;t&eacute; d&eacute;montr&eacute; dans une petite &eacute;tude &agrave; acc&eacute;l&egrave;re la r&eacute;cup&eacute;ration. Rarement, la maladie des griffes du chat peut pr&eacute;senter sous une forme plus diss&eacute;min&eacute;e avec h&eacute;patospl&eacute;nom&eacute;galie ou m&eacute;ningo-enc&eacute;phalite, ou avec une Angiomatose bacillaire chez les patients atteints de sida.

Maladie des griffes du chat.

Malattia da graffio di gatto &egrave; una comune infezione che di solito si presenta come linfoadenopatia tenera. E dovrebbe essere incluso nella diagnosi differenziale di febbre di origine sconosciuta e qualsiasi sindrome linfoadenopatia. Gatti asintomatici, batteremica con Bartonella henselae nella loro saliva servono come vettori mordendo e graffiando la pelle. Pulci del gatto sono responsabili della trasmissione orizzontale della malattia dal gatto, e in alcune occasioni, vettori artropodi (pulci o zecche) possono trasmettere la malattia agli esseri umani. Malattia da graffio di gatto &egrave; comunemente diagnosticata nei bambini, ma gli adulti possono presentare con esso pure. Il microorganismo causativo, b. henselae, &egrave; difficile per la cultura. La diagnosi &egrave; arrivata pi&ugrave; spesso ottenendo una storia di esposizione a gatti e una prova sierologica con titoli elevati (maggiori di 1:256) di anticorpo immunoglobulina G. b. henselae. La maggior parte dei casi di malattia da graffio di gatto sono autolimitati e non necessitano di trattamento antibiotico. Se viene scelto un antibiotico, azithromycin &egrave; stato dimostrato in uno studio piccolo per velocizzare il ripristino. Raramente, malattia da graffio di gatto pu&ograve; presentare in una forma pi&ugrave; diffusa con epatosplenomegalia o meningoencefalite o con Angiomatosi bacillare nei pazienti con AIDS.

Malattia da graffio di gatto.

Posaconazolo &egrave; il pi&ugrave; recente azoli antifungini approvato dalla US Food and Drug Administration e possiede un ampio spettro di attivit&agrave; contro numerosi lieviti e funghi filamentosi. &Egrave; disponibile come una sospensione orale ed &egrave; generalmente ben tollerato dai pazienti, ma assorbimento gastrointestinale &egrave; a volte inadeguata e rimane una preoccupazione clinica nel trattamento delle infezioni profonde. Esso &egrave; utilizzato regolarmente e in modo efficace per la profilassi delle infezioni fungine invasive negli immunodepressi host ed &egrave; un efficace trattamento della candidosi orofaringea, compresa malattia resistente agli azoli.

Ruolo di posaconazolo nel trattamento della candidosi orofaringea.

Posaconazole is the newest azole antifungal approved by the US Food and Drug Administration, and possesses a broad spectrum of activity against numerous yeasts and filamentous fungi. It is available as an oral suspension and is generally well tolerated by patients, but gastrointestinal absorption is sometimes inadequate and remains a clinical concern in treating deep-seated infections. It is used routinely and effectively for the prophylaxis of invasive fungal infections in immunosuppressed hosts and is an effective treatment of oropharyngeal candidiasis, including azole-resistant disease.

Role of posaconazole in the treatment of oropharyngeal candidiasis.

Le posaconazole est l&#39;antifongique azol&eacute; plus r&eacute;cent approuv&eacute; par la US Food and Drug Administration et poss&egrave;de un large spectre d&#39;activit&eacute; contre les nombreuses levures et champignons filamenteux. Il est disponible comme une suspension buvable et est g&eacute;n&eacute;ralement bien tol&eacute;r&eacute; par les patients, mais l&#39;absorption gastro-intestinale est parfois insuffisante et demeure une pr&eacute;occupation clinique dans le traitement des infections profondes. Il est utilis&eacute; syst&eacute;matiquement et efficacement pour la prophylaxie des infections fongiques invasives chez les immunod&eacute;prim&eacute;s h&ocirc;tes et est un traitement efficace de la candidose oropharyng&eacute;e, y compris la maladie r&eacute;sistante aux azol&eacute;s.

R&ocirc;le du posaconazole dans le traitement de la candidose oropharyng&eacute;e.

HIV-1-infected patients are surviving longer and by 2015 half will be older than 50 years of age. Frailty is a syndrome associated with advanced age but occurs in HIV-1-infected patients at younger ages. One hundred outpatient HIV-1-infected persons were prospectively tested for clinical markers of frailty: shrinking weight, slowness in walking, decrease in grip strength, low activity, and exhaustion. Age, length of infection with HIV, CD4 count, HIV-1 RNA, and comorbidities were compared. CD4 counts <200 cells/mm(3) were associated with 9-fold increased odds of frailty relative to patients with a CD4 count >350 cells/mm(3) (odds ratio [OR] 9.0, 95% confidence interval [CI] 2.1-44). Seven frail patients were measured 6 months later: 2 died refusing therapy, 4 were no longer frail, and 1 patient remained frail. We conclude that frailty is common in HIV outpatients and is associated with low CD4 counts. However, our data suggest that frailty is transient, especially in younger patients who may revert to their prefrail state unlike uninfected elderly individuals in whom a stepwise decline in function occurs.

Antiretroviral Therapy Protects against Frailty in HIV-1 Infection.

HIV-1-infected patients survivent plus longtemps et d&#39;ici &agrave; 2015, la moiti&eacute; seront &acirc;g&eacute;s de plus de 50 ans. Fragilit&eacute; est un syndrome associ&eacute; &agrave; un &acirc;ge avanc&eacute;, mais survient chez les patients infect&eacute;s par le VIH-1 chez les jeunes. Cent personnes de HIV-1-infected ambulatoire ont &eacute;t&eacute; test&eacute;s prospectivement les marqueurs cliniques de fragilit&eacute; : diminution de poids, lenteur dans la marche, diminution de la force de pr&eacute;hension, de faible activit&eacute; et d&#39;&eacute;puisement. &Acirc;ge, la dur&eacute;e de l&#39;infection par le VIH, CD4 count, ARN du VIH-1 et comorbidit&eacute;s ont &eacute;t&eacute; compar&eacute;s. De CD4 &lt; cells/mm(3) 200 &eacute;taient associ&eacute;s &agrave; permis cotes une augmentation de la fragilit&eacute; par rapport &agrave; des patients pr&eacute;sentant une num&eacute;ration des CD4 &gt; cells/mm(3) 350 (odds ratio [OR] 9.0, 95 % intervalle de confiance [IC] 2.1-44). Sept patients fragiles ont &eacute;t&eacute; mesur&eacute;es &agrave; 6 mois plus tard: 2 mort refus un traitement, 4 n&#39;&eacute;taient plus fragiles et 1 patient restait fragile. Nous concluons que la fragilit&eacute; est fr&eacute;quente chez les patients VIH et est associ&eacute;e &agrave; faible num&eacute;ration de CD4. Cependant, nos r&eacute;sultats sugg&egrave;rent que la fragilit&eacute; est transitoire, surtout chez les jeunes patients qui peuvent revenir &agrave; leur &eacute;tat prefrail &agrave; la diff&eacute;rence des personnes &acirc;g&eacute;es non infect&eacute;s chez lesquels se produit une diminution progressive en fonction.

Traitement antir&eacute;troviral prot&egrave;ge de la fragilit&eacute; de l&#39;Infection &agrave; VIH-1.

Pazienti affetti da HIV-1 sono sopravvissuti pi&ugrave; a lungo ed entro il 2015 la met&agrave; saranno pi&ugrave; di 50 anni di et&agrave;. Fragilit&agrave; &egrave; una sindrome associata all&#39;et&agrave; avanzata, ma si verifica in pazienti affetti da HIV-1 in et&agrave; pi&ugrave; giovane. Persone HIV-1-infected ambulatoriale di un centinaio sono stati testati prospetticamente per marcatori clinici di fragilit&agrave;: calo peso, lentezza nel camminare, diminuzione della forza prensile, bassa attivit&agrave; ed esaurimento. Et&agrave;, la durata dell&#39;infezione da HIV, il conteggio CD4, HIV-1 RNA e comorbidit&agrave; sono stati confrontati. Conta di CD4 &lt; cells/mm(3) 200 sono stati associati con il terzo maggiore probabilit&agrave; di fragilit&agrave; rispetto a pazienti con una conta di CD4 &amp;gt; 350 cells/mm(3) (odds ratio [OR] 9.0, 95% intervallo di confidenza [CI] 2.1-44). Sette pazienti fragili sono stati misurati dopo 6 mesi: 2 mor&igrave; terapia rifiuta, 4 non erano pi&ugrave; fragile e 1 paziente rimase fragile. Possiamo concludere che la fragilit&agrave; &egrave; comune nei pazienti HIV ed &egrave; associato con bassa conta di CD4. Tuttavia, i nostri dati suggeriscono che la fragilit&agrave; &egrave; transitoria, soprattutto nei pazienti pi&ugrave; giovani che possono tornare al loro stato prefrail a differenza delle persone anziane non infetti in cui si verifica un graduale declino nella funzione.

Voichita Ianas

Division of Infectious Diseases

University of Arizona

Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty

Voichita Ianas

.css-o250i3{font-size:18px;font-family:Open Sans,sans-serif;line-height:21.6px;}Division of Infectious Diseases

University of Arizona

Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty

Division of Infectious Diseases