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Query: UMLS:C0001175 (AIDS)
 120,706 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Observation was carried out of 44 patients affected with pulmonary pathology during the course of AIDS, each of whom presented a severe respiratory insufficiency, admitted to the Clinic of Infectious Diseases between May 1987 and March 1989. In the patients suffering from their first respiratory infection, a lower mortality rate was observed (11/28, 39.2%) compared with the patients suffering from a second or successive infection (10/16, 62.5%). In sixteen cases, the etiological agent was Pneumocystis carinii while in 14 subjects it was impossible to perform bronchoscopy due to particular conditions of the respiratory apparatus and diagnosis was made according to CDC clinical criteria. Several parameters were furthermore evaluated (age, duration of the symptoms prior to admittance, LDH, PaO2, WBC) as potential prognostic indices; at the conclusion of the study, no statistically significant differences were found, however, between the group of survivors and the deceased. For the specific anti PCP therapy, a great variety of drugs were administered; among them, first choice was given to cotrimoxazole. In particularly critical patients, methylprednisolone was added. In 21 patients, a mechanical respiratory aid (C-PAP) was applied with favourable results in 16 of them.
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PMID:[Respiratory complications in 44 patients with acquired immunodeficiency syndrome]. 167 52

We examined patterns of survival with AIDS (acquired immune deficiency syndrome) using the Centers for Disease Control (CDC) "AIDS Public Information Data Set." Analyses used a census of 23,271 cases diagnosed between January 1, 1984 and December 31, 1986. Three Cox proportional hazards models were fit to the data. The first used clinical and demographic parameters only in an effort to replicate Rothenberg's analysis of survival for patients diagnosed in New York City prior to 1986. The second model included variables that capture the effect of time of diagnosis in order to determine whether temporal trends exist. The third model included variables indicating the geographic region from which the cases were reported. The results of these models support earlier findings of demographic and clinical survival correlates. Controlling for covariates, patients diagnosed during 1986 lived significantly longer than those diagnosed earlier; the difference was most profound when Pneumocystis carinii (PCP) was present. Last, we observed large regional differences; their implications for health services planning are discussed.
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PMID:Patterns of survival with AIDS in the United States. 184 78

Recurrent Pneumocystis carinii pneumonia is common in patients with the acquired immunodeficiency syndrome who receive prophylaxis with aerosolized pentamidine. In this setting, the number of organisms is reduced and the clinical presentation may be altered. These observations have led to doubts regarding the use of induced sputum to diagnose PCP in patients receiving prophylactic AP. To determine if the examination of induced sputum is useful for patients receiving prophylactic AP, we examined our results over a 12-month period. We also examined several clinical criteria to ascertain if they could predict the likelihood of a positive induced sputum. As assessed by P(A-a)O2, need for admission and mortality, patients receiving AP presented with less severe disease than those not receiving AP. Twelve of 19 (63 percent) patients who developed PCP while receiving prophylactic AP were diagnosed by induced sputum. Induced sputum was positive for 35 of 55 (64 percent) patients who developed PCP and had not been receiving AP. However, there were no clinical characteristics which predicted a positive induced sputum. We conclude that induced sputum is an effective method for diagnosing PCP in patients receiving prophylactic AP.
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PMID:Diagnostic approach to Pneumocystis carinii pneumonia in the setting of prophylactic aerosolized pentamidine. 193 69

Pneumocystis carinii pneumonia continues to be the commonest opportunistic infection seen in AIDS patients. Early diagnosis and treatment have caused the one-year survival in AIDS-patients with PCP to increase steadily. However, PCP is still the cause of death in 25% of the AIDS-patients. Secondary prophylaxis with pentamidine-isethionate inhalations has reduced the risk of PCP relapse considerably. The risk of PCP is markedly increased at CD4-cell counts below 200 mio/l. Therefore, inhalations of pentamidine twice monthly, as a primary prophylaxis against PCP, can be recommended in HIV-positive patients with CD4-cell counts below this level.
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PMID:[Pneumocystitis carinii pneumonia in adult patients with AIDS]. 205 40

Oral candidiasis is a common complication of HIV-infected-individuals. The purpose of this study was to evaluate clinical and laboratory findings to assess the impact and efficacy of antifungal treatment. This preliminary report describes findings in 50 HIV-positive, candida culture-positive subjects (49 males, 1 female; mean age: 39 years). The group had been known HIV-positive for a mean of 28 months, and 19 met the CDC/WHO definition for AIDS (63%, KS, 21% PCP). Thirty-four of the fifty patients had oral signs of candidiasis, with almost half having both atrophic (red) and pseudomembranous (white) components. In quantitating the cultures, the higher colony forming unit counts in general were correlated with clinical signs and pain. The other most common oral manifestations were periodontal disease, hairy leukoplakia and xerostomia. The most common candida species was albicans (84%). Response to initial antifungal therapy was satisfactory clinically, but erratic regarding CFU quantitation, species changes, and bacterial emergence. In summary, oral candidiasis is a complex infection with uncertainties as to the significance of quantitation and achieving control.
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PMID:Findings in 50 AIDS virus-infected patients with positive oral Candida cultures. 207 28

AP has been shown to be a promising alternative therapy to trimethroprim-sulfamethoxazole for the treatment and prevention of PCP in AIDS patients with fewer side effects than the systemic agents. More controlled clinical trials are still needed to establish the optimal dosage regimen for treatment and prevention of PCP. Clinicians should also be aware that disseminated disease caused by pneumocystis carinii involving organs other than the lung has been reported in patients treated with AP. The selection of an effective aerosol-delivery nebulizer is also very important to achieve high lung concentrations. The Respirgard II nebulizer is the only one currently approved by the FDA for use with AP. Fisoneb, an ultrasonic nebulizer is currently under investigation for approval.
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PMID:Aerosolized pentamidine in Pneumocystis carinii pneumonia. 218 85

Oxygen consumption is pathologically dependent on oxygen delivery in ARDS and sepsis. We asked whether oxygen consumption is dependent on oxygen delivery in severe acute respiratory failure secondary to AIDS-related PCP. In five patients who had AIDS-related PCP, diffuse bilateral pulmonary infiltrates, no evidence of bacterial infection, and acute respiratory failure requiring mechanical ventilation with arterial oxygen tensions less than 75 mm Hg while breathing at least 50 percent oxygen, and PEEP greater than 10 cm H2O, we determined oxygen delivery and consumption by calculation from thermodilution cardiac output and arterial and mixed venous oxygen contents. Oxygen delivery was increased using transfusion of two units of packed red blood cells over one hour. Oxygen delivery increased 22 percent (638 +/- 204 to 778 +/- 201 ml/min.m2, p less than or equal to 0.006). Oxygen consumption increased 11 percent (134 +/- 34 to 149 +/- 29 ml/min.m2, p less than or equal to 0.02). The oxygen extraction ratio did not change. We conclude that similar to ARDS and sepsis, oxygen consumption may be pathologically dependent on oxygen delivery in patients who have severe acute respiratory failure secondary to AIDS-related PCP.
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PMID:Pathologic dependence of oxygen consumption on oxygen delivery in acute respiratory failure secondary to AIDS-related Pneumocystis carinii pneumonia. 224 89

Pneumocystis carinii (PCP) pneumonia is the most common pulmonary infection associated with the acquired immunodeficiency syndrome (AIDS). Patients at risk for PCP have defects in T lymphocyte function and include cancer and transplant patients who are on immune suppressing agents and corticosteroids. In West Virginia, PCP accounted for 53 percent of pulmonary infections in 144 cases of AIDS from 1984 to May 1990. Nationally, at least 100,000 cases of PCP are projected for the early part of this decade. Patients with PCP may present with non-specific symptoms. The chest X-ray frequently shows diffuse bilateral infiltrates but may have atypical features. Definitive diagnosis should be established using sputum staining and various bronchoscopic techniques. Trimethoprimsulfamethoxazole and IV pentamidine are the most efficacious agents for treatment, and monthly aerosolized pentamidine is recommended for prophylaxis. Further basic science and clinical research on the biology of the P. carinii and its response to treatment strategies in HIV and non-HIV related infections is urgently needed.
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PMID:Pneumocystis carinii pneumonia. 227 Jun 82

Pneumocystis carinii pneumonia (PCP is the most frequent opportunistic infection in patients with AIDS and is the most common cause of death in these patients. Conventional parenteral trimethoprim/sulfamethoxazole or parenteral pentamidine treatment is often not completed because of frequent incidence of adverse reactions. Aerosolized pentamidine appears to be better tolerated and is considered an alternative treatment for PCP in both hospital and community settings. This report describes our experience with 34 patients with AIDS who received aerosolized pentamidine at home. All patients were over 18 years old and had received either parenteral or aerosolized pentamidine within a medically supervised setting before home treatment was initiated. The Respigard II nebulizer system powered by an oxygen source was used as the delivery system. All patients took two puffs of metaproterenol sulfate 10 minutes prior to two 15-minute sessions of pentamidine inhalation. No relapse or adverse reactions were observed in patients. Large randomized clinical trials currently are underway to compare the value of aerosolized pentamidine with other forms of treatment for PCP.
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PMID:Experience with home aerosolized pentamidine treatment in patients with AIDS. 236 Mar 37

We retrospectively studied the acute toxicity of corticosteroid therapy in 23 episodes of PCP occurring in the setting of AIDS and determined the incidence of HIV-related complications following these and 16 other contemporaneous episodes of AIDS-related PCP treated with antimicrobials alone. The mean duration of corticosteroid therapy was 5.4 days and the mean total dose was 660 mg of methylprednisolone. Cryptococcus neoformans and Listeria monocytogenes infection each occurred once within one month of therapy in corticosteroid-treated patients; no other noteworthy acute corticosteroid toxicity was noted. Since all patients with imminently lethal PCP received corticosteroids, we could not assess the effect of these agents on acute mortality. After six months the rates of new AIDS-related diagnoses and of post-hospitalization mortality were equivalent in the two groups. We also have critically reviewed the available literature regarding this use of corticosteroids.
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PMID:Complications of corticosteroid therapy in patients with the acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia. 236 10


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