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Alveolar and cystic echinococcoses (AE and CE) are parasitic zoonoses, mainly affecting the liver. Primary extrahepatic localizations remain rare and are difficult to diagnose. We report two cases of primary subcutaneous echinococcosis and the largest literature review on the subject. The first case is an alveolar echinococcosis located in the forehead region and the second a cystic echinococcosis in the abdominal wall. To our knowledge, a primary AE location in the face has never been described before. Pre-surgical diagnosis was not made in these two cases. However, it is essential to apply specific measures, depending on the type of echinococcosis (AE or CE), to prevent parasitic dissemination and recurrence. In view of the cases presented here, prolonged albendazole can be a second-line alternative to a surgical strategy. Echinococcosis should be kept in mind for differential diagnosis of soft tissue lesions in any part of the body.

Background. Yellow fever vaccine (17DV) has been investigated incompletely in human immunodeficiency virus (HIV)-infected patients, and adequate immunogenicity and safety are of concern in this population. Methods. In the Swiss HIV Cohort Study, we identified 102 patients who received 17DV while they were HIV infected. We analyzed neutralization titers (NTs) after 17DV administration using the plaque reduction neutralization test. NTs of 1:⩾10 were defined as reactive, and those of 1:<10 were defined as nonreactive, which was considered to be nonprotective. The results were compared with data for HIV-uninfected individuals. Serious adverse events were defined as hospitalization or death within 6 weeks after receipt of 17DV. Results. At the time of 17DV administration, the median CD4 cell count was 537 cells/mm3 (range, 11-1730 cells/mm3), and the HIV RNA level was undetectable in 41 of 102 HIV-infected patients. During the first year after vaccination, fewer HIV-infected patients (65 [83%] of 78; P=.01) than HIV-uninfected patients revealed reactive NTs, and their NTs were significantly lower (P<.001) than in HIV-uninfected individuals. Eleven patients with initially reactive NTs lost these reactive NTs ⩽5 years after vaccination. Higher NTs during the first year after vaccination were associated with undetectable HIV RNA levels, increasing CD4 cell count, and female sex. We found no serious adverse events after 17DV administration among HIV-infected patients. Conclusion. Compared with HIV-uninfected individuals, HIV-infected patients respond to 17DV with lower reactive NTs, more often demonstrate nonprotective NTs, and may experience a more rapid decline in NTs during follow-up. Vaccination with 17DV appears to be safe in HIV-infected individuals who have high CD4 cell counts, although rate of serious adverse events of up to 3% cannot be excluded.

Background. Atherosclerosis has been assessed in human immunodeficiency virus (HIV)-infected persons by using various methods. Peripheral arterial disease (PAD) has not been evaluated, however. We studied the cross-sectional prevalence of lower limb PAD in an HIV-infected population. Methods. PAD was assessed using the Edinburgh Claudication Questionnaire and by measuring the systolic ankle-brachial blood pressure index (ABI) at rest and after exercise. Patients with PAD were further evaluated by duplex scan of lower limb arteries. Results. Ninety-two consecutive HIV-infected patients were evaluated (23.9% women; mean age, 49.5 years; 61.9% current smokers). Claudication was reported by 15.2% of the patients. PAD was found in 20.7% of the patients: 9.8% had an abnormal ABI (<0.90) at rest, and 10.9% had normal ABI at rest but a >25% decrease after exercise. Of the patients with PAD, 84.2% were investigated with duplex scan, all of whom had atherosclerotic occlusions or stenoses of the iliac or femoral arteries. Age, diabetes, smoking, and low CD4+ T lymphocyte counts were identified as independent predictors of PAD. Conclusions. The prevalence of symptomatic and asymptomatic PAD is high in the HIV-infected population and is much higher than expected (prevalence in the general population, ∼3% at 60 years). This study suggests the presence of an epidemic of PAD ∼20 years earlier in the HIV-infected than in the general population. Larger epidemiological studies are needed to better define risk factors and to evaluate whether PAD is associated with increased mortality, as it is in the general population.

Background. Yellow fever vaccine (17DV) has been investigated incompletely in human immunodeficiency virus (HlV)-infected patients, and adequate immunogenicity and safety are of concern in this population. Methods. In the Swiss HIV Cohort Study, we identified 102 patients who received 17DV while they were HIV infected. We analyzed neutralization titers (NTs) after 17DV administration using the plaque reduction neutralization test. NTs of 1:^ 10 were defined as reactive, and those of l:< 10 were defined as nonreactive, which was considered to be nonprotective. The results were compared with data for HIV-uninfected individuals. Serious adverse events were defined as hospitalization or death within 6 weeks after receipt of 17DV. Results. At the time of 17DV administration, the median CD4 cell count was 537 cells/mm 3 (range, 11-1730 cells/mm 3 ), and the HIV RNA level was undetectable in 41 of 102 HIV-infected patients. During the first year after vaccination, fewer HIV-infected patients (65 [83%] of 78; P = .01) than HIV-uninfected patients revealed reactive NTs, and their NTs were significantly lower (P< .001) than in HIV-uninfected individuals. Eleven patients with initially reactive NTs lost these reactive NTs ^ 5 years after vaccination. Higher NTs during the first year after vaccination were associated with undetectable HIV RNA levels, increasing CD4 cell count, and female sex. We found no serious adverse events after 17DV administration among HIV-infected patients. Conclusion. Compared with HIV-uninfected individuals, HIV-infected patients respond to 17DV with lower reactive NTs, more often demonstrate nonprotective NTs, and may experience a more rapid decline in NTs during follow-up. Vaccination with 17DV appears to be safe in HIV-infected individuals who have high CD4 cell counts, although rate of serious adverse events of up to 3% cannot be excluded.