HIV/AIDS News & Information

Microbiology of Anthrax

B. anthracis is a large aerobic, gram-positive, spore-forming, nonmotile Bacillus species (1-1.5 |xm x 3-10 |im). Spores grow on ordinary lab media at 37°C and resemble a “jointed bamboo- rod” appearance and a “curled-hair” colonial appearance. B. anthracis forms a prominent capsule in tissue in vivo and in vitro in the presence of bicarbonate and carbon dioxide. Germination occurs when the bacillus is exposed to an environment rich in amino acids, nucleosides, and glucose. Spore formation (sporulation) will occur when the infected body is opened and exposed to air. These spores can survive for decades in ambient conditions.

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The present findings suggest a substantial minority of older HIV-infected white and African-American men may continue to engage in risk behaviors following diagnosis. Indeed, a disturbingly high proportion of men in each of the three groups reported some kind of unprotected sex since their diagnosis that could potentially transmit HIV infection to others, result coinfection with another sexually transmissible disease, or reinfection with another strain of HIV Although the percentages of men still reporting unsafe sex in the past six months were lower, a third or more in each group still acknowledged at least one unsafe contact. Although their current partner status may not be the same as at the time of their unsafe behavior, the large majority of African-American gay/bisexual men and white gay/bisexual men (83% and 78% respectively) had no steady partner, suggesting that their unsafe sex may be taking place outside the context of a monogamous relationship.

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INTRODUCTION

Anthrax in North America is astonishingly rare. Before 2001, the most recent fatal case of inhalation anthrax in America was in 1976, when a craftsman acquired the disease from imported yarn. Prior to that, a minor mill outbreak in the 1960s occurred. Few physicians had, or have, any experience in detecting or caring for this condition. Even veterinarians rarely encounter this problem, despite the natural occurrence of anthrax in the soil in many areas of North America.

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Sample Characteristics

The subsample for the analyses reported here (N=59) consisted of 15 African-American heterosexual men (25%), 12 African-American gay/bisexual men (20%), and 32 white gay/bisexual men (54%). The men ranged in age from 50 to 68 years (M=56.42 years, SD=5.27 years). Sixty-two percent has less than a college education, and 37% a college degree or more. Most (81%) were no longer working. The median yearly household income was between $5,000 and $9,999. Thirty-two percent were married or had a steady partner. Seventy-five percent reported living alone. Using CDC criteria, 68% had ever met the criteria for an AIDS diagnosis. Participants reported an average of 7.8 HIV-related symptoms (SD=6.4), and 24% had a current CD4 cell count of 200 or less (M=360, SD=208, median=300). The length of time since first testing HIV-positive ranged from less than a year to over 15 years (M=6.91 years, SD=3.46 years). MyCanadian Order net Continue Reading »

Based on our patient’s laboratory findings and culture reports, aseptic meningitis was diagnosed. However, his development of meningeal irritation during hospitalization, after his recovery and following a rechallenge of TMP/SMX, established that there might be a high probability that his disease process was due to TMP/SMX. When the protecting barriers of the brain, including the skull, meninges and blood-brain barrier, are broached by a pathogen, meningitis can result. Predisposing factors include preexisting diabetes mellitus, immunosuppression, otitis media, pneumonia, sinusitis and alcohol abuse. One study revealed that when sulfonamides were used in dogs, they exhibited signs of suspected meningitis making them hypersensitive. Therefore, this could have led to a slightly higher percentage crossing the blood-brain barrier, causing aseptic meningitis. Forty percent of TMP/SMX crosses the inflamed and noninflamed meninges. Trimethoprim has also been associated with causing aseptic meningitis, especially in patients with autoimmune disease. Meningitis due to cryptococcosis, coc-cidiomycosis, histoplasmosis or other fungal infection represents an AIDS-defining event and occurs typically with very low CD4+ lymphocyte counts The patient had a low CD4 count of 95/mm³, which made him more susceptible to meningitis.

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Measures

Demographic variables. Using standard demographic items, interviewers gathered data on participants’ gender, race/ethnicity, age, marital/partner status, living arrangements, educational attainment, and household income. Sexual orientation was assessed using a five-point Likert-type scale ranging from “completely heterosexual” (1) to “completely homosexual” (5). Only those identifying as completely heterosexual were categorized as heterosexual, with all others categorized as gay or bisexual. Although five African-American men and eight white men did not complete this item because they were interviewed prior to the inclusion of this item, it was possible to determine their sexual orientation from information provided during the semistruc-tured interview. For the current analyses, race/ethnicity and sexual orientation were combined into a single race-by-sexual-orientation variable noting whether the participant was an African-American gay/bisexual man, a white gay/bisexual man, or a completely heterosexual African-American man. Educational attainment was collapsed into a dummy variable indicating whether the individual had graduated from college. Household income was categorized into a dummy variable indicating whether the participant received $20,000 or more per year.

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Subjective Information

A 46-year-old African-American man with AIDS presented to the hospital with confusion, lethargy, headache and fever. The patient was doing fine until late that morning, when he took his medications consisting of tablet zidovudine + drug lamivudine + medication abacavir (Trizivir®), atazanavir (Reyataz®) and the newly prescribed thrice-weekly TMP/SMX (800/160 mg) for Pneumocystis carinii pneumonia prophylaxis. Symptoms began about an hour after he took one dose of his medications, and he took acetaminophen before presenting to the hospital. Two weeks earlier, he had a similar episode after taking his medications, which included a dose of TMP/SMX (400/80 mg). He was admitted for meningitis, and a computed tomography of the head was negative for any pathology; cerebrospinal fluid analysis was negative for any bacteria and opportunistic organisms. He was treated for aseptic meningitis and recovered fully within three days but signed out against medical advice. The etiology of the aseptic meningitis was not ascertained. On his second visit, his primary care physician increased his TMP/SMX (400/80 mg) to 800/160 mg, which was to be taken three times per week. He had just taken the first dose when symptoms reappeared. Patient had quit tobacco, alcohol and drug use two years previously, and he was currently unemployed.

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