Mycobacterium avium

CNS disease from M. avium is a result of the hematogenous dissemination of this organism from a respiratory or gastrointestinal source of infection. M. avium and M. intracellulare are separate species, but their separation has no clinical value, and therefore, they are considered together in this section. Infection with these species of mycobacteria occurs primarily in patients with advanced HIV disease, generally in patients with fewer than 50 CD4 + cells/pl. Infection of the CNS can present as meningitis, meningoencephalitis, rhombencephalitis, brain abscess, or cranial neuropathies. Neuroimaging may demonstrate meningeal enhancement, hydrocephalus, or single or multiple enhancing lesions. Diagnosis is made by acid-fast smear and culture of the CSF or brain abscess aspirate. There have been few randomized, comparative controlled treatment trials for M. avium and M. intracellulare CNS infections. Clarithromycin and azithromycin have excellent activity in the therapy of disseminated M. avium disease in HIV-infected individuals, but their therapy in M. avium CNS infections has not been studied. Rifabutin is efficacious for the prophylaxis of disseminated M. avium infection in HIV patients and has been shown to increase survival in HIV-infected individuals with disseminated disease when used at higher doses (450 to 600 mg). The treatment of a CNS complication of disseminated disease should include at least a four-drug regimen, which at present is clarithromycin (500 mg twice daily), rifampin (600 mg daily), ethambutol (25 mg/kg/d for 2 months then 15 mg/kg/d), and streptomycin (0.75 to 1.0 g at least three times per week). A combination of azithromycin (250 mg/ d), rifabutin (300 mg daily), and ethambutol and streptomycin has been recommended as an alternative treatment regimen. Treatment is continued until cultures are negative for at least 12 months and will likely need to be continued for the life of the patient. y

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Alcohol No More

Alcohol No More

Do you love a drink from time to time? A lot of us do, often when socializing with acquaintances and loved ones. Drinking may be beneficial or harmful, depending upon your age and health status, and, naturally, how much you drink.

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