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

Based on our experience, we would like to offer a few pragmatic suggestions for the practicing clinician. These recommendations are summarized in Tables 1 and 2. The first encounter with most patients gives the impression of either a dramatic acute infection, usually in the lungs, central nervous system, or gastrointestinal tract (in this order of frequency), or that of a chronic wasting disease. The former is frequently superimposed on the latter. The exploration of AIDS risk factors and a few easily detectable physical signs are the most important clues to the correct clinical diagnosis. Once AIDS is suspected, an aggressive and rapid approach for diagnosis is justified. Selected individually for each patient, the most commonly successful tests include bronchoscopy with BAL and/or transbronchial lung biopsy; bone marrow, lymph node, or liver biopsy with both microbiologic and pathologic processing of the material; blood (and often spinal fluid) cultures for fungal organisms; cranial computerized tomographic scan; and toxoplasma serology. Other tests, while potentially useful, are less important in immediate decision-making and treatment. In all cases of respiratory compromise or symptoms related to the chest, PCP has to be ruled out by invasive methods if the suspicion of AIDS is sufficiently strong. The diagnosis of one opportunistic infection should not be interpreted as a final answer. Rather, it should stimulate more vigilant efforts to uncover additional infections and other AIDS-related diseases if any abnormalities remain unexplained or persist despite treatment. Chest radiology should not be the main tool to diagnose or monitor lung infections.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pulmonary infections in AIDS. 354 59

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

We studied the characteristics and temporal trends of AIDS- associated non-Hodgkin's lymphoma (AIDS-NHL) in individuals with hemophilia. Prospective data were collected on 33 HIV-positive hemophiliacs with AIDS-NHL enrolled in the Hemophilia Malignancy Study (HMS), of whom 21 had primary and 12 had secondary or subsequent AIDS-defining illnesses, and analyzed for frequency and temporal trends. As compared with primary AIDS- NHL, secondary AIDS-NHL occurred at an older mean age, 37 versus 29 years (p = 0.12); at a lower mean CD4 count, 46 versus 154 (p = 0.07); after a longer period of immunosuppression (CD4 < 200/microl), 41 versus 16 months (p = 0.03); and with shorter median survival, 2 versus 7 months (p = 0.09). The presence of EBV in tumor tissue was associated with shorter survival, 1 versus 7 months (p = 0.17). Between 1981 and 1988 and 1989 and 1994, the proportion of primary AIDS diagnoses that were AIDS-NHL changed minimally, 4.6 versus 6.1%, whereas there were significant decreases in Pneumocystis carinii pneumonia (PCP, p = 0.02) and wasting (p = 0.07), and an increase in Candida (p = 0.004). These findings confirm that an increasing proportion of AIDS-NHL in hemophiliacs are occurring as secondary or later AIDS diagnoses, and they are associated with prolonged duration of immunosuppression.
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PMID:AIDS-associated non-Hodgkin's lymphomas as primary and secondary AIDS diagnoses in hemophiliacs. Hemophilia Malignancy Study Group. 879 89

A 27-year-old woman, who is being successfully treated for HIV, has mostly normal results from physical examinations and feels well. Yet she had a chest X-ray that showed prominent perihilar adenopathy and a miliary pattern in all lung fields. Medical records from an open lung biopsy, photographs taken during the biopsy, and the pathology reports reveal histoplasma capsulatum infection, a rare occurrence in late-stage HIV infection, especially without concurrent symptoms including fever, wasting, cytopenias, and oral and intestinal ulcerations. It is not known whether the patient's highly active antiretroviral therapy allowed her to react to this organism as immunocompetent persons do, which is with well-formed granulomas. Her travel history was evaluated and showed that she had briefly passed through histoplasma-endemic areas of the southern United States. However, tests for histoplasma antigens returned negative, as did tests for serum histoplasma antibodies. Two immunohistochemical stainings for PCP were also both negative. The patient is being treated with Itraconazole, and may also be treated with a 3-week course of atovaquone for recurrent PCP.
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PMID:An alarming x-ray in a patient who feels well. 1136 83