Document 0375
 DOCN  M9590375
 TI    The diagnosis of appendicitis in patients with AIDS/HIV infection--four
       case reports.
 DT    9509
 AU    Hammett RJ; Edwards R; Kotsiou G; Pigott P; HIV Medicine Unit, Royal
       North Shore Hospital, St. Leonards,; N.S.W.
 SO    Annu Conf Australas Soc HIV Med. 1994 Nov 3-6;6:115 (unnumbered
       abstract). Unique Identifier : AIDSLINE ASHM6/95291724
 AB    We present four case reports of HIV positive patients, presenting with
       acute appendicitis in whom there was a significant delay in the
       diagnosis of their presenting symptoms and signs. This, in turn,
       resulted in delays to the time of appendicectomy and led to prolonged
       hospitalisation and increased morbidity. All patients had CD4 counts
       less than 50 x 1000/ul. All patients presented to hospital with some or
       all of the symptoms and signs commonly found in non-immunosuppressed
       patients with appendicitis i.e. fever, nausea, abdominal pain which
       localised to the right iliac fossa, guarding and rigidity. All patients
       had a provisional diagnosis of appendicitis made at the time of
       presentation, usually by the medical officer in the Emergency
       department; however, this diagnosis was reviewed by the surgical teams
       and thought to be incorrect. The time delay between presentation and
       operation was 24 hours, 48 hours, 9 days and 6 months for the four
       cases. Three patients had evidence of appendiceal perforation and
       peritonitis at operation. All patients developed wound infections. All
       patients had persistent fevers in the post-operative period and required
       greater than one week of intravenous antibiotics. All patients underwent
       a number of imaging procedures aimed at determining the diagnosis. None
       of the patients had elevation of their white cell count above the normal
       range at the time of presentation. None of the patients had evidence of
       malignancy in the operative specimen. One patient had Cytomegalovirus
       (CMV) present in the wall of the appendix. The mean duration of hospital
       admission was 25 days. All four patients in this series had prolonged
       hospitalisation and increased morbidity associated with the delay in
       diagnosis of their appendicitis. These cases confirm a previous report
       of the difficulty of diagnosing appendicitis in patients with AIDS, and
       show the consequences of delayed diagnosis.
 DE    Acquired Immunodeficiency Syndrome/*DIAGNOSIS/SURGERY  Acute Disease
       Appendectomy  Appendicitis/*DIAGNOSIS/SURGERY  AIDS-Related
       Opportunistic Infections/*DIAGNOSIS/SURGERY  CD4 Lymphocyte Count
       Diagnosis, Differential  Human  HIV Infections/*DIAGNOSIS/SURGERY
       Length of Stay  Patient Care Team  Postoperative Complications/DIAGNOSIS
       MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).