Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.16.2 (PCP)
 3,761 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Four hundred and eighty six infected adults (90.7% men) were prospectively followed from 1988 to 1993 at a multiprofessional center in Santiago, Chile. 87.8% of male patients (pts)--84% of them homo/bisexual--and 64.4% of women acquired the infection sexually. At the beginning of the follow up (F/U) 51% of men and 71% of women were asymptomatic and 30% of the total group had AIDS. (AIDS definition: CDC 1993, excluded CD4 lymphocyte count < 200 x mm3). 240/486 (49.4%) had developed AIDS at the end of the study (12/31/93). AIDS defining events (ADE) were: interstitial pneumonia (confirmed or suggestive as caused by P. carinii [PCP]), 25%; tuberculosis (all forms), 22.1%; wasting, 13.8%; Kaposi Sarcoma, 9.2%; esophageal candidiasis, 6.7%; isosporiasis, 5.4%. Of all PCP cases, 72% were ADE, the rest, post.AIDS'. As expected, AIDS pts continued having major complications (mainly bacterial pneumonias, PCPs, esophagitis, tuberculosis and diarrhea due to I. belli and Cryptosporidium. Less frequently, but also observed, were toxoplasmic encephalitis and cryptococcal meningitis). Known mortality (excluded abandonment of F/U) was 27% for the whole group and varied from 5.8%, 51.6% to 69.2% for the first, 4th and 6th year of F/U respectively. For II-III CDC pts the mortality was 5% and 57% and for IV CDC pts it was 38% and 100% during the first and 6th year of F/U respectively. 36%, 53%, 74% and 85% of the pts followed for 1, 3, 5 and 6 years respectively had developed AIDS by the end of 1993. Multifactorial causes with either diarrhea, wasting or both were responsible for the death in half the pts in whom this was known, 15% died of respiratory complications and 5.7% of cryptococcal meningitis. 80% of AIDS pts survived their ADE. This study has provided information about the clinical profile of the HIV infection and natural history of the disease in Chile.
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PMID:[Clinical characteristics and natural history of human immunodeficiency virus infection. Study in a Chilean population served at a multiprofessional pilot center]. 756 47

The authors conducted complete histories, physical examinations, blood counts, chest radiograms, sputum examinations for bacterial and fungal pathogens, and bronchoscopy with bronchoalveolar lavage and transbronchial biopsy on 35 HIV-seropositive individuals with respiratory complaints in a study to determine how often and by what means an identifiable pulmonary pathogen can be recognized in HIV-infected patients with respiratory disorders in Brazil, which are the most frequently observed microorganisms, and what impact specific therapy has on the agents. One or more microorganisms were found in 24 subjects, while another three individuals showed nonspecific interstitial pneumonitis. Tuberculosis (TB) found in 41% of cases, P. carinii in 55%, and cytomegalovirus pneumonitis in 8% were the most common respiratory opportunistic diseases among the study subjects. Histologic evaluation was essential to identify the pulmonary pathogens, with clinical, laboratory, and radiographic findings failing to distinguish the specific pathogens. 23 individuals with P. carinii pneumonitis and/or TB received specific therapy; among the patients who could be evaluated, the therapeutic response rates were 79% for PCP and 100% for TB. TB in these individuals displayed clinical and radiographic findings atypical for reactivation disease. The authors note that most of the features observed in HIV-infected patients had been previously described in infection of the normal host.
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PMID:Respiratory complications in Brazilian patients infected with human immunodeficiency virus. 828 97

Opportunistic lung infections and malignancies are life-threatening complications in HIV-positive patients. In 72 HIV-positive patients the role of different non-invasive tests such as lung function tests, blood gas analysis, 67 gallium scanning and epithelial lung clearance with 99m Tc-DTPA for the management of these patients was prospectively studied. For all non-invasive tests the mean values of patients with pulmonary complications (n = 25) differed significantly from those of asymptomatic HIV-positive patients (n = 47) (p < 0.001). In 10 patients presenting with acute Pneumocystis carinii pneumonia, 99m Tc-DTPA clearance rates and 67 gallium uptake differed significantly before and after therapy (4.80 +/- 1.23%/min vs 2.47 +/- 0.72%/min and 2.15 +/- 0.42 vs 1.39 +/- 0.18, respectively). Follow-up after therapy revealed different time courses of these tests for normalization. A significant inverse correlation was found between DLCO and 99m Tc-DTPA lung clearance (r = -0.90, p < 0.001, n = 35). A diffuse homogeneous 67 gallium uptake is not diagnostic for PCP, the same pattern was found in a patient with lymphoid interstitial pneumonitis and in patients with CMV pneumonitis; these patients also had accelerated epithelial lung clearance rates. 67 gallium (6/6) was superior to 99m Tc-labelled immunoglobulin G (3/6) for detection of PCP. The 3 patients with Kaposi sarcoma of the lung had negative 67 gallium scans, but positive 201 thallium scans and increased 99m Tc-DTPA clearance rates.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Contribution of nuclear medicine to management of pulmonary complications in patients with acquired immune deficiency]. 838 18

The aim of this retrospective study is to evaluate the correlation between T-cell immunity and pulmonary disorders in a group of Italian subjects with HIV infection. HIV-infected patients seen at the Institute of Infectious Diseases, University of Verona, were included in this study if they had a specific acute pneumonia, a CD4+ cell count and a CD4+/CD8+ ratio during the 60 days immediately before the onset of pulmonary disease. Cases receiving any antimicrobial prophylaxis were excluded. Pneumonia was recognized by usual clinical and radiologic abnormalities. The diagnostic procedure included sputum examination, bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. The specimens were processed for bacterial, mycobacterial and fungal stains and cultures. Ziehl-Neelsen, periodic acid-Schiff and silver methenamine stains were performed on the transbronchial biopsy specimens in addition to usual pathologic examinations mononuclear. Determination of percentage of peripheral blood mononuclear cells bearing CD4+ and CD8+ markers was done by conventional fluorescent antibody cell-sorter analysis of the mononuclear cell population. Absolute number of CD4+ lymphocytes was determined by multiplying the total lymphocyte count by the percent of mononuclear cells bearing CD4+ marker. From October 1987 to August 1991, 61 patients, 50 males and 11 females, had 65 episodes of specific pneumonia. The average age of patients was 31.4 years (range 29-59 years). The risk factors for HIV infection included intravenous drug abuse (47 patients), homosexuality (6 patients), bisexuality (3 patients) and heterosexual contact (5 patients). Before the onset of pulmonary disorders, patients were classified in the following clinical HIV-related stages: asymptomatic state (22 episodes), ARC (22 episodes) and AIDS (21 episodes). In decreasing order of frequency diagnosis of pneumonias were PCP (29 episodes), community-acquired bacterial pneumonia (16 episodes), pulmonary tuberculosis (8 episodes), nonspecific interstitial pneumonia (4 episodes), PCP and pulmonary tuberculosis (3 episodes), cytomegalovirus pneumonia (2 episodes), and one of each episode of PCP and pulmonary cryptococcosis, pulmonary candidiasis, pulmonary Kaposi's sarcoma. The mean and the standard deviation of immunologic values regarding the four primary diagnostic groups were: PCP CD4+/CD8+ 0.50 +/- 0.42, CD4+/mm3 196 +/- 190; bacterial pneumonia CD4+/CD8+ 0.53 +/- 0.44, CD4+/mm3 247 +/- 139; pulmonary tuberculosis CD4+/CD8+ 0.62 +/- 0.38, CD4+/mm3 260 +/- 170; nonspecific interstitial pneumonia CD4+/CD8 + 0.57 +/- 0.48, CD4+/mm3 240 +/- 189. No significant statistical differences with respect to CD4+/CD8 ratios and CD4+ cell counts among these diagnostic groups were found by standard analysis of variance.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Acute pneumonia and cell-mediated immunity in patients with HIV infection]. 849 71

Animal models of Pneumocystis carinii (Pc) pneumonia (PCP) play a central role in research on the Pc microorganism itself and the disease, especially the pathogenesis and the host defence. The classic rat model with corticosteroid-induced reactivation of a latent infection has been most widely used. In our search for alternative non-rodent models, six 31/2-week-old piglets were injected intramuscularly with methylprednisolone acetate, at 18 mg/kg body weight, once a week for 6 weeks. Six littermate piglets constituted the control group. The principals showed a markedly lower growth rate than the controls. Furthermore, they developed "moon face" and "pot belly", snoring sounds while eating, and pronounced respiratory distress during handling. Significant changes in haematological parameters, including lymphopenia, were observed in the principal group. The Pc antibody titres of the controls increased to high levels, whereas the principals were all low-titred or seronegative for Pc at the last blood sampling. At necropsy, the mean body weight of the principals was about half that of the controls. In addition, they had an extreme reduction of the thymus together with dark red consolidations of the frontal lung lobes and/or atelectatic looking diaphragmatic lobes. Histopathologically, there was a focal interstitial pneumonia. Alveolar walls and interstitia had mononuclear cell infiltrations and the alveolar lumina were occluded by foamy acidophilic honeycomb material with a varying number of Pc cysts. The reduced body weight, the thymus involution, and the lymphopenia, together with the reduced levels of specific Pc antibodies and the histomorphology of the PCP, were consistent parameters of the principal group and comparable to the findings of the classic rat model. Thus, the present study is the first to describe that prolonged administration of high doses of methylprednisolone acetate can induce PCP in piglets.
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PMID:Experimental corticosteroid induction of Pneumocystis carinii pneumonia in piglets. 1054 89

Interstitial pneumonitis is a rare disease that is seen in the context of some infections (e.g. PCP and CMV pneumonia), as side-effects of drugs (e.g. beta-blockers, amiodarone) and rarely in the context of renal transplantation. It manifests itself usually as a pneumonic illness; with symptoms of dyspnea, cough, fatigue and sometimes fever. Characteristic radiological changes are bilateral lower zone haziness. Interstitial pneumonitis is now emerging in solid organ transplant patients secondary to sirolimus). We describe three cases of sirolimus-induced pneumonitis in two patients who started sirolimus to permit cyclosporin withdrawal and in one patient initially started on sirolimus. The presentations in these cases ranged from insidious to fulminant; there was a rapid response to sirolimus withdrawal. This is an important syndrome, with an unknown frequency.
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PMID:Sirolimus-induced pneumonitis: three cases and a review of the literature. 1467 46

A prospective study was conducted at Bamrasnaradura Hospital, Nonthaburi Province, Thailand from November 11, 2002 to January 5, 2003. A total of 59 HIV/AIDS patients with interstitial infiltrates on chest radiographs were included in the study. The objectives of this study were to describe the clinical manifestations and determine the etiologies of interstitial pneumonitis, assess the short-term outcomes and determine the accuracy of the clinical diagnosis of the etiologies of interstitial pneumonitis in HIV/AIDS patients at Bamrasnaradura Hospital, Nonthaburi, Thailand. Tuberculosis was the most common diagnosis (44%), followed by Pneumocystis carinii pneumonia (25.4%), bacterial pneumonia (20.3%) and fungal pneumonia (10.2%). In tuberculosis, compared to other diagnoses, a mild cough (p = 0.031), pallor (p = 0.021), lymphadenopathy (p < 0.001), absence of skin lesions (p = 0.003), higher mean body temperature (p = 0.004) and an absence of dyspnoea on exertion (p = 0.042) were significant findings. On multivariate analysis, however, only an absence of skin lesions (p = 0.023) remained a statistically significant predictor of TB. In Pneumocystis carinii pneumonia compared to other diagnoses, dyspnea on exertion (p = 0.014), non-purulent sputum production (p = 0.047), a higher mean respiratory rate (p < 0.001), absence of lymphadenopathy (p < 0.001) and lack of purulent sputum (p = 0.030) were significant factors. By multivariate analysis, only an absence of lymphadenopathy were shown to be independently and statistically significantly associated (p = 0.040). In bacterial pneumonia, compared to other diagnoses, production of purulent sputum (p = 0.014), hemoptysis (p = 0.006), pallor (p = 0), skin lesions (p = 0.002) and a severe cough (p = 0.020) were significantly associated factors. On multivariate analysis, none of these factors were statistically significant. In fungal pneumonia, compared to other diagnoses, headache and papulonecrotic skin lesions were common findings, but no factor had a significant association. After four weeks, 59.3% of the patients were alive, 13.6% died and 27.1% were lost to follow-up. Among the alive patients 88.6% had clinically improved. On multivariate analysis, no factor was shown to be a statistically significant predictor of death. The cumulative survival after 28 days was highest among PCP patients, followed by bacterial pneumonia, tuberculosis and fungal pneumonia, but this difference was not statistically significant (p = 0.0453).
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PMID:Clinical features, etiology and short term outcomes of interstitial pneumonitis in HIV/AIDS patients. 1661 Jun 49

Our objective was to describe the risk factors for the development of bronchiectasis in HIV-1 infected children. This study was a retrospective, case controlled study based upon medical record review of HIV-1 infected children receiving primary care at a single large, urban medical center in Miami, Florida. Cases (HIV-1 infected children who developed bronchiectasis while being cared for between January 1982 and September 2000) were matched 1:3 (birth +/- 24 months) with controls (HIV-1 infected children without bronchiectasis). Variables analyzed including number of episodes of pneumonia (including Pneumocystis jiroveci pneumonitis [PCP], lymphoid interstitial pneumonitis (LIP), and CDC category of immunosuppression) were noted in both cases and controls until the age at which the cases developed bronchiectasis. Of the 749 patients whose charts were reviewed, 43 met the case definition for bronchiectasis and 19 met the eligibility criteria for this study. Fifty-seven controls were randomly selected from the patients without bronchiectasis. Cases were more likely to have experienced recurrent pneumonia than the controls; 17 (89.5%) versus 5 children (8.8%) respectively (P-value <or=0.001) as well as a greater mean number of episodes of pneumonia 8.2 (range, 4-13) versus 1.45 (range, 0-9) respectively (CI = (5.58,7.82); P-value <or=0.001). Cases were more likely to have progressed to CDC immunological category 3 than the controls; 19 (100%) versus 32 (56%) children respectively (P-value <0.001). LIP occurred more frequently in the cases than in the controls; 14/19 (73.6%) versus 19/57 (33.3%), respectively (P-value = 0.005). HIV-1 infected children with a history of recurrent pneumonia, profound immuno-suppression (CDC immunologic category 3), and LIP appear to have a higher risk of developing bronchiectasis.
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PMID:Risk factors for the development of bronchiectasis in HIV-infected children. 1772 16

Pneumocystis jirovecii infection causes fulminant interstitial pneumonia (Pneumocystis pneumonia, PCP) in patients with rheumatoid arthritis (RA) who are receiving biological and/or nonbiological antirheumatic drugs. Recently, we encountered a PCP outbreak among RA outpatients at our institution. Hospital-acquired, person-to-person transmission appears to be the most likely mode of this cluster of P. jirovecii infection. Carriage of P. jirovecii seems a time-limited phenomenon in immunocompetent hosts, but in RA patients receiving antirheumatic therapy, clearance of this organism from the lungs is delayed. Carriers among RA patients can serve as sources and reservoirs of P. jirovecii infection for other susceptible patients in outpatient facilities. Development of PCP is a matter of time in such carriers. Considering the poor survival rates of PCP cases, prophylactic antibiotics should be considered for RA patients who are scheduled to receive antirheumatic therapy. Once a new case of PCP occurs, we should take prompt action not only to treat the PCP patient but also to prevent other patients from becoming new carriers of P. jirovecii. Short-term prophylaxis with trimethoprim-sulfamethoxazole is effective in controlling P. jirovecii infection and preventing future outbreaks of PCP among RA patients.
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PMID:Pneumocystis jirovecii Pneumonia in Rheumatoid Arthritis Patients: Risks and Prophylaxis Recommendations. 2639 51