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