Tropical infectious diseases in human immunodeficiency virus-infected patients.
Tropical infectious diseases in human immunodeficiency virus-infected patients.
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人类免疫缺陷病毒感染患者的热带传染病。
DOI：
10.1086/514745
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Franklin A. Neva
中科院分区：
文献类型：
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作者：
Christopher L. Karp;Franklin A. Neva
将“热带”疾病与其他传染病区分开来很容易。这种影响被认为主要是免疫抑制的结果。在艾滋病中，人工侧会出现异常。英美热带病专业历来集中于寄生虫和虫媒病毒。尽管细胞介导的免疫缺陷似乎具有最大的临床意义，但免疫系统的每个隔室的列表。目前在热带地区造成年死亡率最高的四种病原体只包括其中一种，即恶性疟原虫。艾滋病毒感染者的免疫系统可能会因严重的营养失调而进一步受损（例如，相当普遍的结核分枝杆菌、艾滋病毒和麻疹病毒）。然而，尽管大多数资源用于与艾滋病毒研究有关的瘦病、治疗干预措施（例如皮质类固醇治疗）或免疫异常，但已分配给阐明工业化国家中与艾滋病毒有关的疾病的表现、合并感染（例如内脏利什曼病）。在已知引起机会性感染的ú100病原体中，在世界上资源贫乏的地区，传统上存在艾滋病毒的疾病中，有几种是经典的热带病原体，被认为是“热带”病原体，继续占据主导地位。一个不幸的[2]。它们主要存在于细胞内原生动物中，因此相对忽视了共生细菌和地方性真菌的作用；艾滋病毒和传统热带病原体的感染明显缺乏。现在的后生动物。HIV合并感染相对来说比较微妙，综述的重点是HIV和病原体的交叉，从疾病过程中对其他热带病原体的影响来看。在许多热带地区的自然历史中没有发现任何变化，除了在热带感染率高的情况下（如结核分枝杆菌）。对于后一种感染，目前在热带地区以外缺乏流行，这导致了大量关于艾滋病毒合并感染对经验和研究产生重大影响的证据发表。与所有共同感染的病原体一样，疾病的表达或对治疗的反应不一定是相当复杂的生物学和临床，在相互作用的有力证据中没有这种影响。热带病病原体和艾滋病毒的共同感染。任何一种病原体与艾滋病毒和热带地方病有联系，其特点是改变自然史、免疫反应、流行程度、相互作用的微妙性、诊断困难的可能性低，或对另一种病原体的治疗反应低。研究的重点，相互作用的存在和意义很可能被忽略。总的来说，艾滋病在资源贫乏地区的临床表现艾滋病毒对热带病表达的影响热带地区似乎涉及不同的机会-感染艾滋病毒可以影响感染谱的自然史，而不是在北美和欧洲。相反，通过(1)促进感染，(2)卡氏肺囊虫肺炎（PCP）的高发病率增加疾病与感染的比率，(3)由于鸟分枝杆菌复合物的疾病表现而改变和传播疾病，或(4)加剧疾病（MAC）和巨细胞病毒（CMV）的病程，在资源丰富的北方发现。艾滋病在许多热带地区的临床表现以频繁的结核病为特征（结核病是世界上最常见、最严重的艾滋病相关机会性感染）。罗氏实验室的教育资助使这篇最先进的临床文章得以发表。大)，慢性腹泻，消瘦（消瘦病），慢性发热。无明显来源，多与肺部疾病有关[3,4]。转载或通信：克里斯托弗·l·卡普博士，热带病原体对这些后一种综合征的传染性贡献是疾病，约翰·霍普金斯大学医学系，东纪念碑街1830号，455室，马里兰州巴尔的摩市21205 （ckarp@welchlink）。不清楚。由于基础设施不足，财政资源有限（jhu.edu）。1999年《临床传染病》的来源和难以获得医疗服务；[28:947-65]在社会上处于不利地位，监测可能是零星的，1999年由美国传染病学会进行。版权所有。3.00美元，主要涉及艾滋病患者亚组的抽样
Distinguishing ‘‘tropical’’ from other infectious diseases has ease [1]. Such effects are presumed to be primarily the result of immunosuppression. In AIDS, abnormalities are found in its artificial side. The Anglo-American specialty of tropical diseases historically focused on parasites and arboviruses. A list of every compartment of the immune system, although defects in cell-mediated immunity appear to be of greatest clinical import. the current top four pathogens in terms of annual mortality in the tropics includes only one of these, Plasmodium falciparum, in The immune systems of HIV-infected individuals may be further compromised by profound nutritional derangements (e.g., the quite cosmopolitan company of Mycobacterium tuberculosis, HIV, and measles virus. Yet, although most resources devoted slim disease), therapeutic interventions (e.g., corticosteroid therapy), or the immunologic abnormalities associated with to HIV research have been allocated to the elucidation of the manifestations of HIV-related disease in industrialized countries, coinfection (e.g., visceral leishmaniasis). the ravages of the HIV epidemic have fallen most heavily on Of the ú100 agents known to cause opportunistic infection those resource-poor parts of the world where diseases traditionin the presence of HIV, several are classic tropical pathogens ally considered ‘‘tropical’’ continue to hold sway. An unfortunate [2]. These are mostly found among the intracellular protozoa, result of this has been a relative neglect of the effects of coinfecbacteria, and endemic fungi; there is a marked absence of tion with HIV and traditional tropical pathogens. The current metazoans. Coinfection with HIV has comparatively subtle efoverview focuses on the intersection of HIV and pathogens from fects on the course of disease with other tropical pathogens. all phyla that cause disease of markedly greater incidence in No alterations have been found in the natural history of many the tropics, except in cases (e.g., M. tuberculosis) where high tropical infections. With the latter infections, the current lack prevalence outside of the tropics has led to considerable published of evidence for significant effects of HIV coinfection on the experience and research. As with all coinfecting pathogens, there expression of disease or response to treatment is not necessarily is considerable biological and clinical complexity in the interacstrong evidence for the absence of such effects. Where coinfection of agents of tropical disease and HIV. Either pathogen has tion with HIV and endemic tropical diseases is marked by low the potential for altering the natural history, immune response, prevalence, subtlety of interaction, diagnostic difficulty, or low or response to therapy of the other [1]. research priority, the presence and significance of interactions are likely to be missed. Overall, the clinical expression of AIDS in resource-poor areas Effects of HIV on the Expression of Tropical Diseases of the tropics appears to involve a different opportunistic-infecInfection with HIV can influence the natural history of infection spectrum than that in North America and Europe. Instead tion with other pathogens through (1) facilitating infection, (2) of the high incidence of Pneumocystis carinii pneumonia (PCP) increasing the ratio of disease to infection, (3) changing the and disseminated disease due to Mycobacterium avium complex presentation of disease, or (4) exacerbating the course of dis(MAC) and cytomegalovirus (CMV) found in the resource-rich North, the clinical expression of AIDS in much of the tropics has been marked by frequent tuberculosis (the most common, serious AIDS-related opportunistic infection in the world at Publication of this State-of-the-Art Clinical Article has been made possible by an educational grant from Roche Laboratories. large), chronic diarrhea, wasting (slim disease), chronic fever Received 2 December 1998. without an obvious source, and pulmonary disease [3, 4]. The Reprints or correspondence: Dr. Christopher L. Karp, Division of Infectious contribution of tropical pathogens to these latter syndromes is Diseases, Department of Medicine, Johns Hopkins University, 1830 East Monument Street, Room 455, Baltimore, Maryland 21205 (ckarp@welchlink. unclear. With inadequate infrastructures, limited financial rewelch.jhu.edu). sources, and difficult access to medical care on the part of the Clinical Infectious Diseases 1999;28:947–65 socially disadvantaged, surveillance is likely to be sporadic and q 1999 by the Infectious Diseases Society of America. All rights reserved. 1058–4838/99/2805–0001$03.00 to involve mainly the sampling of subgroups of AIDS patients
内脏利什曼病的免疫化疗：锑与锑加干扰素γ的对照试验。
DOI：
10.4269/ajtmh.1993.48.666
发表时间：
1993
期刊：
The American journal of tropical medicine and hygiene
影响因子：
--
作者：
Squires,KE;Rosenkaimer,F;Sherwood,JA;Forni,AL;Were,JB;Murray,HW
通讯作者：
Murray,HW