The incidence of acquired immunodeficiency syndrome (AIDS)-related opportunistic infections has declined dramatically following the introduction of potent antiretroviral therapy (ART). However, pulmonary infections remain a significant cause of morbidity and mortality. The spectrum of pulmonary disease that can affect patients with human immunodeficiency virus (HIV) is wide and includes opportunistic infections with many bacterial, fungal, viral, and parasitic organisms. In this case, we present a 65-year-old woman with HIV, non-compliant with ART, who presented with subacute melena, fatigue, dyspnea, and hemoptysis. After extensive evaluation, she was found to have pneumonia caused by four different pathogens: Strongyloides stercoralis, Pneumocystis jirovecii, Cytomegalovirus (CMV), and Pseudomonas aeruginosa. She received trimethoprim-sulfamethoxazole, steroids, and ivermectin. However, her clinical condition did not improve and she passed away.
Between June and October 1982, an outbreak of scurvy occurred in the refugee camps of Somalia. An epidemiologic investigation eventually detected more than 2,000 cases. The outbreak came at a time when the relief programme had been well established and the general health status of the refugees had otherwise stabilized. We report on 72 of the cases. Joint pain of the lower extremities and gingivitis were prominent features in the majority. Hemorrhagic phenomena were not observed and no deaths occurred. The outbreak primarily affected the poorer refugees who were unable to purchase locally available Vitamin C‐containing foods. This outbreak demonstrates the vulnerability of a large population of displaced persons who are dependent on imported relief supplies for survival.
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