The high incidence of Tinea pedis and unguium in patients with Kaposi's sarcoma

Forty patients suffering from Kaposi's sarcoma (31 males, 9 females aged from 18 to 80 years) were examined for the presence of mycotic invasion of the toe-webs, toe-nails and soles. Fungi were found without exception in all patients. In 35 patients all three sites were invaded; the remaining 5 showed no involvement of the toe-nails. The causative agent was T. rubrum in 31 patients, T. mentagrophytes in 7, E. floccosum in 2. Four subjects with T. rubrum infection also showed a super-imposed C. albicans infection in the toe-webs. The skin tests with Trichophytin and Candidin yielded a mildly positive response to the former antigen in 4 cases and to the latter in 8 cases. The strikingly high percentage of affected cases in this group of patients with Kaposi's sarcoma is discussed.

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Résumé 40 malades (31 hommes, 9 femmes, agés de 18 à 80 ans) souffrant de la maladie de Kaposi ont été examinés pour la présence d'une invasion fongique de la région plantaire, des espaces interdigitaux et des ongles des orteils. On atrouvé une atteinte mycosique chez tous, sans exception. Chez 35 tous les trois sièges examinés étaient invadés, chez 5 les ongles étaient épargnées. On a isolé le T. rubrum chez 31 malades, le T. mentagrophytes chez 7 et E. floccosum chez 2. C. albicans a été aussi trouvé comme agent de surrinfection dans les lésions interdigitales dues à T. rubrum chez 4 malades. Les testes intradermiques ont montré une faible réaction positive à la trichophytine dans 4 cas et àla Candidine dans 8 cas. Le pourcentage tellement élevé d'atteinte mycosique dans ce groupe des malades avec maladie de Kaposi est brièvement discuté.

     

Kaposi's sarcoma in an Eskimo

An Eskimo who had been treated for a nasopharyngeal carcinoma was subsequently found to have a rapidly progressive form of Kaposi''s sarcoma confirmed at biopsy. No objective response was obtained by irradiation treatment of isolated nodules. However, vinblastine sulfate arrested the progression of the disease. Because this neoplasm is most prevalent in tropical climates its presentation in an Eskimo is believed sufficiently unusual to warrant this report.     

Drug-induced immunodeficiency associated with nodal Kaposi's sarcoma

A 40-year-old male showed a syndrome of acquired immunodeficiency after a prolonged use of antidiabetic sulfamides. The lesions were revealed by the biopsic examination of inguinal lymph nodes. Immunodeficiencies are usually associated with malignant lymphoma: our case was, however, associated with Kaposi's sarcoma.     

Analysis of DNA distribution in Kaposi's sarcoma in patients with and without the acquired immune deficiency syndrome

While Kaposi's sarcoma in patients with the acquired immune deficiency syndrome (AIDS) may present as a multicentric disease with progressive organ involvement, the classic form of Kaposi's sarcoma is an indolent tumor seldom affecting extracutaneous areas and almost never responsible for the patient's demise. An attempt was made to correlate these clinical differences with the nuclear DNA content of tumor cells in histologic sections from 15 patients (9 with AIDS and 6 without AIDS). All tumors showed a similar DNA distribution pattern, with most cells appearing diploid, indicative of a low malignant potential. These findings indicate that Kaposi's sarcoma of both AIDS and non-AIDS patients is a tumor of intrinsically low malignancy and that lack of immune surveillance is most probably responsible for its aggressive biologic behavior in many AIDS patients.     

Mechanism of paclitaxel activity in Kaposi's sarcoma

Kaposi's sarcoma (KS) is an angioproliferative disease characterized by proliferation of spindle-shaped cells predominantly of endothelial cell origin, neoangiogenesis, inflammatory cell infiltration, and edema. At least in early stage, KS behaves as a reactive lesion sustained by the action of inflammatory cytokines and growth factors, has a polyclonal nature, and can regress. However, in time it can become monoclonal, especially in the nodular stage, evolving into a true sarcoma, likely in association with the increased expression of antiapoptotic oncogenes. We have recently demonstrated by immunohistochemical analysis that Bcl-2, a proto-oncogene known to prolong cellular viability and to antagonize apoptosis, is highly expressed in spindle cells and vessels of both AIDS-KS and classical KS lesions and that its expression increases with lesion stage. Paclitaxel, a microtubule-stabilizing drug known to inhibit Bcl-2 antiapoptotic activity and to be highly effective in the treatment of certain neoplasms, has recently been found to be active also in patients with advanced HIV-associated KS. In this report we investigated the mechanism(s) of paclitaxel activity in KS. By using a model of experimental KS induced by the inoculation of KS-derived spindle cells in nude mice and primary cultures of KS spindle cells, we found that paclitaxel promotes regression of KS lesions in vivo and that it blocks the growth, migration, and invasion of KS cells in vitro. Furthermore, paclitaxel treatment promoted apoptosis and down-regulated Bcl-2 protein expression in KS cells in vitro and in KS-like lesions in mice. Our results suggest that paclitaxel interferes with KS by down-regulating Bcl-2 antiapoptotic effect.     

Prevalence of human herpesvirus-8 infection in HIV-positive patients with and without Kaposi's sarcoma in Hungary

Human herpesvirus-8 (HHV-8) infection of 130 Hungarian HIV-positive individuals with or without Kaposi's sarcoma was investigated from 158 serum and 122 peripheral blood samples using anti-latency-associated nuclear antigen (LANA) indirect immunofluorescence assay (IFA), recombinant orf65 and orfK8.1 antigen enzyme-linked immunosorbent assays (ELISAs), Western blot assays and orf26 specific nested polymerase chain reaction (PCR). The overall prevalence of HHV-8 infection was found to be 31.5% (41/130) among the Hungarian HIV-positive patients. This seroprevalence rate is 7-11-fold higher than that of healthy HIV-negative blood donors in Hungary. The highest prevalence of HHV-8 infection (36.1%, 35/97) was observed in homo- or bisexual patients. Similar to the serologic results, HHV-8 DNA was not always detectable in all serial samples previously shown to be positive for HHV-8 DNA.     

NKG2C+ NK cells are enriched in AIDS patients with advanced-stage Kaposi's sarcoma

Kaposi's sarcoma (KS) is an AIDS-defining condition in individuals with human immunodeficiency virus type 1 infection. We investigated the phenotype and function of the NKG2C+ NK cell population in individuals with AIDS and Kaposi's sarcoma. The staging of AIDS KS patients according to the AIDS Clinical Trial Group criteria revealed that patients with the S1 disease stage have a significantly higher proportion of NKG2C+ cells than those with the S0 disease stage. NKG2C+ cells from S1-stage patients are highly enriched for the expression of KIR3DL1, are depleted of NKp46, and respond poorly to major histocompatibility complex class I-positive target cells. These data demonstrate a link between NK cell phenotype and function and disease prognosis in AIDS.     

Primary Kaposi's sarcoma of an intraparotid lymph node with AIDS

A case of Kaposi's sarcoma of an intraparotid lymph node in a patient with previously undiagnosed AIDS is presented. In patients at risk for AIDS who present with undiagnosed head and neck tumors, the diagnosis of epidemic Kaposi's sarcoma should be considered. Although transmission of AIDS to health care workers is exceedingly rare, proper precautions should be exercised when working with these patients.     

Pegylated liposomal doxorubicin in the treatment of AIDS-related Kaposi's sarcoma

Kaposi's sarcoma is a vascular tumor of skin and viscera first described in 1872. Prior to the 1980s, this disease was rarely seen in the Western world, but was quite prevalent in Sub-Saharan African countries. Since the onset of the HIV pandemic in the 1980s, the incidence of Kaposi's sarcoma has increased markedly in Africa and continues to be a significant problem in association with AIDS in Western countries. Many therapies have been demonstrated to be effective in the treatment of HIV-related Kaposi's sarcoma, including alitretinoin gel, interferon alpha, and various forms of cytotoxic chemotherapy. Antiretroviral therapy combined with cytotoxic agents has yielded significantly greater efficacy than chemotherapy alone. However, as reviewed in this report, pegylated liposomal doxorubicin has been established as the treatment of choice for patients with AIDS-associated Kaposi's sarcoma in Western countries. Compelling preclinical and clinical evidence, reviewed herein, has demonstrated that the nanoparticle (pegylated liposome) delivery system of this formulation leads to greater tumor localization of doxorubicin and consequent improved efficacy, as well as reduced toxicity.     

Effects of interferon-alpha in patients with AIDS-associated Kaposi's sarcoma are related to blood interferon levels and dose

Definition of improved therapeutic regimens of interferon-alpha (IFN-alpha) for the treatment of Kaposi's sarcoma (KS) would be useful since currently recommended doses are sometimes associated with unacceptable toxicity. IFN concentrations were measured in serum samples from men with AIDS-associated KS who were enrolled in a trial of IFN-alpha alone (16 patients) or a trial of IFN-alpha combined with zidovudine (25 patients). Analyses were done to examine the relationship between the dose of IFN-alpha, blood level of IFN, and the patient's clinical response to treatment. There was no correlation between dose of zidovudine given and response. As expected, there was a high correlation between dose of IFN-alpha and blood level in both studies (p less than 0.001). Furthermore, we found relationships between clinical response and both dose of IFN-alpha and blood level achieved. In the two studies combined, among men with greater than 200 CD4+ cells/mm3 of blood at baseline on average daily doses of greater than or equal to 10 million international units (MIU) of IFN-alpha, 13/19 (68%) responded compared to 6/17 (35%) on less than MIU (p = 0.05). Similarly, of men with IFN blood levels greater than or equal to 100 IU/mL 12/16 (75%) responded compared to 7/20 (35%) of those with blood levels less than 100 IU/mL (p = 0.02). The dose and blood levels of IFN achieved and maintained may be important factors in determining responses of KS. Additional clinical trials of IFN-alpha treatment of KS at doses about 10 MIU/day appear warranted.     

Upper gastrointestinal Kaposi's sarcoma in patients positive for HIV antibody without cutaneous disease

Six patients with antibodies to the human immunodeficiency virus (HIV) and with persistent gastrointestinal symptoms of HIV infection but without cutaneous lesions of Kaposi''s sarcoma underwent endoscopy. Four also underwent barium meal examination. In all six cases small lesions were seen in the stomach at endoscopy, and histological examination of biopsy specimens taken from the lesions confirmed the diagnosis of Kaposi''s sarcoma. The barium meal examinations were reported as normal in three patients and showed oesophageal candidiasis in the fourth.These findings suggest that Kaposi''s sarcoma of the upper gastrointestinal tract is common in patients positive for HIV antibody, even those without cutaneous lesions. Endoscopy, with biopsy of suspicious lesions, is necessary to make the diagnosis and is recommended in all HIV antibody positive patients with persistent upper gastrointestinal symptoms.