dmcanzi@watserv1.waterloo.edu (David Canzi) (11/24/89)
Volume 2, Number 43 November 20, 1989
Editor: David Dodell, D.M.D.
St. Joseph's Hospital and Medical Center
10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA
Copyright 1989 - Distribution on Commercial/Pay Systems Prohibited without
Prior Authorization
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Medical News
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Medical News for Week ending November 19, 1989
Copyright 1989: USA TODAY/Gannett National Information Network
Reproduced with Permission
---
Nov. 15, 1989
---
RESEARCHERS CHOOSE PENTAMIDINE:
The drug Pentamidine is gaining acceptance as the treatment of choice for
fighting pneumonia in AIDS patients. Why: It has proven to reduce the
fatalities from pneumonia and produces fewer side effects than the drug
combination Septra - the drug now commonly used. Future: Research still needs
to find other drugs to combine with Pentamidine for treatment.
DRUG IS MARGINALLY EFFECTIVE:
The drug combination Septra - composed of Trimethoprim and Sulfamethoxazole
- used as a standard treatment for Pneumocystis carinii pneumonia in AIDS
patients is marginally effective, said researchers at UC San Francisco.
Findings: Trimethoprim is the weaker of the two drugs in Septra and lessens
the effectiveness of the drug combination.
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Dental News
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
ORAL SECONDARY SYPHILIS IN AIDS PATIENT. A CASE REPORT.
By B. Martinez and A. Silva. School of Dentistry, U. of Chile.
School of Dentistry
Universidad de Chile
Santiago - Chile
Casilla 1414 - Correo Central.
Electronic Mail: DENTAL01@UCHDCI01.BITNET
Syphilis has been described as a common previous infection in Aids patients
with and without oral manifestations (1,2) but it has not been described oral
syphilitic lesions in theses patients (3). We have seen recently a Chilean
with Aids and oral syphilitic lesions that is the syubject of this report.
CASE REPORT.
A 29-yr-old male was referred because caries in some teeth. During the
clinical examination he reported that had Aids, and presented Kaposi's Sarcoma
in the skin of the arms, legs and trunk. At the oral examination were noted
two lesions on the left margin of the tongue, slightly raise, with irregular
border, fissures and grayish-white surface, and another smallest behind, both
were painless and also presented erosion on the mucosa of upper lip. These
lesions appeared one week before the examination and the patient gave not
importance because they did not cause discomfort, and he refused a biopsy of
theses lesions. He had bilateral submandibular lymph nodes. Due to economical
problems the patient delayed 2 months the serologic tests, but during this
time he was controlled and we noted that the anterior ulcer of the tongue
decreased in size, but appeared another in the left buccal mucosa.
Previously the patient had presented fever, diarrhea, and in Spain where
probably he contracted Aids, was treated before the first symptoms of Aids, of
genital syphilis, four or five years previously. At the time of the initial
examination a smear for candida of the tongue's ulcers was negative and also
the darkfield examination for treponema. But the VDRL (1:2) and FTA-abs were
reactive and one week later the patient was started on benzatine penicillin G
(2.4 million units), one injection per week for four weeks. All the oral
lesions disappeared three days after the first injection, but simultaeously
the patient presented Kaposi's Sarcoma of hard palate.
DISCUSION
We think that this patient presented some special aspects. First, the
secondary syphilitic lesions in the oral mucosa appeared 4-5 years after the
primary genital lesions. According to the literature (4), most syphilitic
patients have the secondary lesions 9 to 90 days, average of three weeks after
the onset of the chancre. Probably in this immunedeficiency the time is longer
or the clinical manifestations of syphilitic lesions are different. Second,
this is the first case of oral syphilitc secondary lesions in an Aids patient.
Oral ulcers are not uncommon in Aids, and Schulten et al. (5), in 75 Aids
Dutch patients reported 4% with ulcers of unknown etiology; also, Phelan et al
(6), similarly found 3% of ulcers with uncertain cause that were negative in
virus cultures. We suggest that all patients with this type of ulcers, that do
not cause discomfort, and there are not aphtous stomatitis, must be ruled out
syphilis, trough serologic tests, specially in Aids patients. Third, the oral
syphilitic lesions were alone. Commonly the mucous membrane lesions appear
coincidentall with cutaneous manifesttions (macular rash on the palms and
soles, systemic symptoms, condylomata lata, ulcerating skin lesion), but may
also appear alone (4) as in this case.
There are some factors that contribute tho the clinical development of Aids.
These factors include genetic predisposition, environmental responses, drug
use or abuse, infections with cytomegalovirus, Epstein-Bar, Hepatitis B,
Treponema pallidum or intestinal parasites, and malnutrition (7). Since our
patient presented secondary syphilis, and the past medical history was
negative for another previous infections, the treponema could be important
factor in the evolution of the disease. In early epidemiologic studies
conducted by the Centers for Disease Control (CDC), homosexual patients with
Aids more commonly (68%) reported a history of syphilis, as compared with
homosexual controls (36%) (8). This, initially suggested a possible role for
syphilis in the development of Aids, but also is consistent with the
hypothesis that Adis patients are more sexually active. The latter is
supported by the fact that among less sexually actrive heterosexual patients
with Aids, only 6% of 31 patients studied by CDC reported a history of
Syphilis (8).
Some investigators have suggested that early (primary or secondary) syphilis
infection suppresses the immune response, particularly cellular immunity. This
is based on antigen- and mitogen-induced lymphocyte-transformation responses
an on macrophage migration-inhibition studies using peripheral blood
lymphocytes from syphilitic humans or rabbits, but that results are quite
contradictory, and one investigator may demostrate reduced lymphocyte
function, another shows increased responsiveness, and a third may demostrate
no change in lymphocyte function during syphilis (9).
References.
1. Silverman S., et al. Oral findings in people with or at high risk from
AIDS. A study of 375 homosexual males. J Am Dent Assoc 1986:112: 187-192.
2. Jaffe HW., et al. National case-control study of Kaposi's Sarcoma and
pneumocystis carinii pneumonia in homosexual men: Part 1. Epidemiologic
Results. Ann Intern Med 1983:99:145-151.
3. Pindborg JJ. Classifation of oral lesions associated with HIV infection.
Oral Surg Oral Med Oral Path 1989:67:292-295.
4. Fiumura NJ. Venereal Diseases of the oral cavity. J Oral Med. 1976:31: 51-
55.
5. Schulten EAJM., et al. Oral manifestations of HIV infection in 75 Dutch
Patients. J Oral Pathol Med 1989:18:42-46.
6. Phelan JA., et al Oral findings in patients with acquired immnode-ficiency
syndrome. Oral Surg Oral Med Oral Path 1987:64:50-56.
7. Haverkos HW. Factors associated with the pathogenensis of AIDS. J Infect
Dis 1987:156:251-257.
8. Guinan ME. et al. Heterosexual and homosexual patients with acquired
immunedeficiency syndrome. A comparision of surveillance, interview and
laboratory data. Ann Intern Med 1984:100:213-218.
9. Schell RF. Musher DM. Eds. Pathogenesis and immunology of treponemal
infection. New York: Marcel Dekker 1983:271-364.
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Food & Drug Administration News
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
AZT for Kids
P89-44 Brad Stone/FDA
FOR IMMEDIATE RELEASE (301) 443-4177
Oct. 26, 1989 Elaine Baldwin/NIAID
(301) 496-5717
HHS Secretary Louis W. Sullivan, M.D., today announced that the Food
and Drug Administration has granted permission for distribution of zidovudine,
commonly called AZT, for use in treating children under the age of 13 who have
AIDS or who are suffering from symptoms of advanced infection with the AIDS
virus.
"Today's action is a significant advance in extending AIDS therapy to
children. It will give many sick children access to a drug that offers
promise for improving or even extending their lives," Dr. Sullivan said.
Zidovudine will be distributed free of charge to children with AIDS
or at advanced stages of AIDS virus infection under a Treatment IND
(investigational new drug) program sponsored by the Burroughs Wellcome Company
of Research Triangle Park, N.C., with medical and technical assistance by the
National Institute of Allergy and Infectious Diseases (NIAID), a component of
the National Institutes of Health (NIH).
This Treatment IND program is based on clinical data that indicate
that the drug may prolong survival and relieve severe AIDS symptoms in
children, as it does in adults. These data were obtained through clinical
trials sponsored by Burroughs Wellcome and conducted by researchers at the
National Cancer Institute and through NIAID's AIDS Clinical Trials Group
network. The pediatric trials began in 1986 and have involved more than 200
children.
"The need for providing effective AIDS therapy for children has been a major
concern for some time, and I commend FDA, NIAID, NCI and Burroughs Wellcome
for their work in helping to fill this need," said Dr. James O. Mason,
Assistant Secretary for Health.
The Treatment IND mechanism was established by FDA to allow patients
suffering from serious or life-threatening conditions for which there are no
satisfactory treatments to obtain promising experimental drugs that have
undergone sufficient clinical testing to show they may be safe and effective.
Under this Treatment IND protocol, physicians caring for children 3
months to 12 years of age who have symptoms of advanced infection with the
AIDS virus will be eligible to receive the drug at no cost in this program
sponsored by Burroughs Wellcome. A recently approved strawberry-flavored
syrup form of zidovudine will be used, since it is more easily swallowed by
children and the doses can be more easily adjusted to their body size than the
capsule form of the drug.
Zidovudine has been approved since March 1987. It is indicated and
labeled for the treatment of patients, age 13 or older, who have severe
symptoms of AIDS virus infection. Label indications do not restrict
physicians from prescribing zidovudine for other patient populations,
including children under 13 years of age. However, many physicians and
hospitals have been reluctant to use zidovudine for children because it is not
labeled for this use, and because of concerns that the drug's known side-
effects in adults might be even more severe in children. Clinical data now
indicate that children receiving zidovudine experience side-effects similar to
those occurring in adults.
Although zidovudine is the only drug that has been shown to be
effective in prolonging the lives of people with AIDS, it is also known to
have significant side-effects. The drug can inhibit the production of red
blood cells, which may result in severe anemia requiring blood transfusions.
Zidovudine can also reduce white blood cell counts to the point where the
drug's use has to be discontinued, to avoid infections.
Using data accrued from the pediatric clinical trials of zidovudine,
the Treatment IND has been designed to minimize the risks of these side-
effects. Patients enrolled in this Treatment IND program will be carefully
monitored for any adverse reactions.
Physicians interested in enrolling patients in the Treatment IND
protocol can call the Burroughs Wellcome toll-free number at 1-800 829 PEDS
from 8 a.m. to 7 p.m., Eastern Time. The company will immediately begin
processing applications from physicians for their pediatric patients.
Those interested in this Treatment IND or in other AIDS studies can
call 1-800 TRIALS-A, a toll-free service offering information about AIDS
clinical trials from 9 a.m. to 7 p.m., Eastern Time, Monday through Friday.
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Volume 2, Number 43 November 20, 1989
+------------------------------------------------+
! !
! Health Info-Com Network !
! Newsletter !
+------------------------------------------------+
Editor: David Dodell, D.M.D.
St. Joseph's Hospital and Medical Center
10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA
Telephone (602) 860-1121
FAX Available - Call/Write/Email for Additional Information
Copyright 1989 - Distribution on Commercial/Pay Systems Prohibited without
Prior Authorization
International Distribution Coordinator: Robert Klotz
Nova Research Institute
217 South Flood Street, Norman, Oklahoma 73069-5462 USA
Telephone (405) 366-3898
The Health Info-Com Network Newsletter is distributed weekly. Articles on a
medical nature are welcomed. If you have an article, please contact the
editor for information on how to submit it. If you are intrested in joining
the distribution system please contact the distribution coordinator.
E-Mail Address:
Editor:
FidoNet = 1:114/15
Bitnet = ATW1H @ ASUACAD
Internet = ddodell@stjhmc.fidonet.org
LISTSERV = MEDNEWS @ ASUACAD
anonymous ftp = vm1.nodak.edu
(Notification List/ftp = hicn-notify-request@stjhmc.fidonet.org)
Distribution:
North America Australia/Far East Europe
FidoNet = 1:19/9 David More George Cordner
Usenet = krobt@mom.uucp FidoNet = 3:711/413 Fidonet
Internet = krobt%mom@uokmax.ecn.uoknor.edu 2:23/105
--
David Canzi