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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eleven children were identified as being seropositive for HIV-1 at the Ethio-Swedish Children's Hospital, Addis Abeba, Ethiopia between January 1988 and September 1989. The diagnosis was confirmed by both ELISA and Western blot methods performed at the National Research Institute of Health, Special Laboratory for AIDS. The mean age was 2 years and 5 months, with a range of 1 week to 10 years. There were 7 boys and 4 girls. The most common admitting diagnoses were pneumonia (5), gastroenteritis (5), marasmus (5), disseminated tuberculosis (4), and abandonment (3). One patient had extensive facial molluscum contagiosum. Symptoms at admission or during hospitalization included diarrhoea (9), failure to thrive (8), fever (7), and cough (7). Physical findings included hepatosplenomegaly (5), lymphadenopathy (3), and oral candidiasis (2). No patient with an opportunistic infection or radiographic evidence of lymphocytic interstitial pneumonitis (LIP) was identified. Five patients were classified as marasmic and 4 as underweight. Evidence suggestive of encephalopathy (developmental delay and/or microcephaly) was present in 5 patients. The VDRL was non-reactive in the 5 patients in whom it was tested. Nine children were presumed to have acquired the infection by perinatal transmission, though the passive transfer of maternal antibodies or postnatally acquired infection could not be excluded. One child was thought to have acquired the infection by blood transfusion. Three children died during their hospital stay. Paediatric HIV infection exists in Ethiopia; however, these children do not present with characteristic opportunistic infections but with signs and symptoms reflecting the most common paediatric problems seen in the country. Prevention of HIV infection in children entails the prevention of infection in women of childbearing age, counselling of infected women, and effective screening of blood products.
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PMID:Clinical and epidemiological features of HIV-1 seropositive hospitalized Ethiopian children. 206 May 7

Over a 2 years' period, 49 AIDS patients and 3 non AIDS patients were treated for pneumocystosis in our chest department. Forty-six were male and 6 were female. Pneumocystosis was the first opportunistic infection in 77 p 100 of patients. Fever above 38.5 degrees C was the major symptom in 92 p 100. Cough was present in 90 p 100 and dyspnoea in 94 p 100. Clinical symptoms had begun 21.7 +/- 15.7 days before diagnosis. Mean PaO2 value was 50.9 +/- 15.7 mmHg. Forty-eight patients were initially treated by daily intravenous administration of trimethoprim 960 mg and sulfamethoxazole 4,800 mg. Three patients received a pentamidine aerosol and one received DFMO. Treatment was effective in 39 patients; 11 patients died between the 5th and the 29th days of treatment; 2 had an early relapse. Fever disappeared after 9.8 +/- 6.6 days, and blood gases returned to normal within 10.8 +/- 7.7 days. All patients whose PaO2 was above 56 mmHg were cured. Thus, the trimethoprim-sulfamethoxazole combination proved active in the treatment of pneumocystosis. Other treatments are useful in case of side-effects or failure of the initial therapy. Failures can be suspected on the fourth day of treatment and in such cases CMV co-infection must be looked for and treated.
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PMID:[Aspects of pneumocystosis seen in a French pneumonology department in 1987-1988]. 209 16

Intrathoracic Kaposi's sarcoma (KS) in AIDS is remarkable for its frequency and severity. It is responsible for 10% of "pneumonias" and almost 50% of pleurisies observed in these patients. The time elapsed between the discovery of the lesion and the patient's death does not exceed a few months on average. The initial manifestations of pulmonary KS are usually discreet and consist of cough and/or dyspnoea in patients with KS of the skin and mucosae. Fever is lacking or moderate. The most suggestive radiological findings are dense, nodular, tumour-like opacities and bilateral linear and/or micronodular opacities around the bronchi and vessels. The diagnosis rests on bronchial fibroscopy which shows red, non friable lesions which, to a trained endoscopist, are very characteristic. When these lesions are absent, thoracotomy may be necessary for diagnostic purposes. Treatment essentially consists of chemotherapy; zidovudine therapy and prophylaxis of pneumocystosis are indicated if the circulating CD 4 cell count falls below 200/mm3. When its symptoms are predominant, pleural KS is typically progressive, with normal or slightly elevated temperature, associated parenchymal lesions that are clearly visible on CT scans and copious, bilateral, blood-stained serous or chylous pleural fluid. When these signs are absent throacoscopy or thoracotomy may be necessary. Future advances in this field will be due not only to improvements in chemotherapy but also to a better understanding of the physiopathology of intrathoracic Kaposi's sarcoma.
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PMID:[Pulmonary and pleural localizations of Kaposi's sarcoma in AIDS]. 209 51

Pneumocystis carinii pneumonia (PCP) is the most common presenting symptom in patients with the acquired immunodeficiency syndrome (AIDS). Clinical trials have shown that inhaled pentamidine, delivered by nebulizer, is an effective prophylaxis for PCP in high-risk patients, and can be used to treat mild to moderate episodes. Side effects are minor, in marked contrast to the parenteral route of administration. The choice of nebulizer system will determine both alveolar delivery of pentamidine and the incidence of cough related to deposition of droplets on large conducting airways. Radioaerosol studies have suggested that optimum nebulizer systems for inhaled pentamidine deliver the majority of the aerosol mass in droplets smaller than 2 microns diameter, ideal for alveolar penetration.
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PMID:Aerosol therapy in AIDS. 211 80

Cytomegalovirus (CMV) infection in patients with the acquired immunodeficiency syndrome (AIDS) can present as either disseminated disease, pneumonitis, retinitis, gastroenteritis, neuropathy, or a subclinical infection. We report a patient whose initial manifestation of CMV infection was severe central airways obstruction due to necrotizing tracheitis. At bronchoscopy, the lesion appeared deeply ulcerated, distinctly different from previously described airway lesions in patients with AIDS. Mucosal biopsies showed characteristic intranuclear and intracytoplasmic inclusions and cultures yielded only CMV. The patient responded partially to ganciclovir, steroids, and antibiotics against suspected anaerobic superinfection but died as a result of central nervous system disease believed due to toxoplasmosis or lymphoma. CMV infection of the upper airway should be considered in the patient with AIDS presenting with atypical cough or stridor and ulcerated endobronchial lesions.
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PMID:Central airway obstruction due to cytomegalovirus-induced necrotizing tracheitis in a patient with AIDS. 217 87

The seroprevalence, clinical epidemiology, modes of transmission, clinical presentation in adults, pregnancy women and children, diagnosis, impact and control strategies of AIDS in Africa are covered in this review. HIV-1, the causative virus in AIDS, is epidemic in a central Africa belt from Gabon to the east coast, and from Uganda to Zimbabwe, with the highest prevalence in the lakes and highlands of Central Africa. HIV-2 causes a milder disease in Western Africa centered in Senegal. HIV infections occur primarily in young adult men aged 30-34, women aged 20-24, infants and children under 4, and a few girls. Transmission patterns vary widely depending on sexual customs in the ethnically diverse continent. Prevalence tends to be high in cities and among subgroups such as prostitutes, where promiscuity is restricted. Where female sexual permissiveness exists, seropositivity is high in women generally. Besides sexual behavior, risk factors for HIV in Africa also include uncircumcised man, oral contraception, STDs causing genital ulceration and Chlamydia infection. Transmission to neonates occurs, especially if the mother has advanced AIDS, but transmission by breast milk is uncertain. Transmission by blood transfusion is common because transfusion are up to 10 times as common in Africa as in the West, especially in obstetrics and pediatrics. Clinically, HIV infections present as herpes zoster in 95% of Africans, and commonly as slim disease: weakness, fever, chronic watery diarrhea and weight loss of unknown cause. Associated infection are candidiasis, cryptosporidiosis, isosporiasis, tuberculosis and salmonellosis. Other presenting symptoms are unusual sites of lymphadenopathy, cough and sepsis. Diagnosis can be made by the WHO clinical case definition, or be screening tests, which are now more reliable for African patients than formerly. In Africa, AIDS can cause destitution and disgrace for families, and will probable severely affect progress made national economies because of deaths of young productive adults. Strategies for control of HIV in Africa are outlined.
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PMID:AIDS in Africa. 218 39

Children with human immunodeficiency virus (HIV) frequently have recurrent otitis media, chronic rhinorrhea, parotitis, cough and other common pediatric otolaryngologic problems. As these complaints often occur before more unusual opportunistic infections or pulmonary conditions prompt a diagnosis of acquired immunodeficiency syndrome (AIDS), members of our specialty are liable to see HIV-positive children before infection with the virus has been recognized. Children with HIV infection are also likely to be referred to us after diagnosis, as is any immunosuppressed child with otolaryngologic infections. These children may require procedures such as bronchoscopy, sinus irrigations or tympanocentesis. The subject of this review is the natural history of pediatric HIV infection with special emphasis on otolaryngologic manifestations and recommendations for safe techniques of examination and treatment.
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PMID:Pediatric human immunodeficiency virus infection: an otolaryngologist's perspective. 219 74

Patients with AIDS but without pneumocystis carinii pneumonia, patients with advanced AIDS-related complex (ARC), and asymptomatic patients with less than 200 CD4-positive lymphocytes/mm3 were randomized to one of two groups: group I: Inhalation of 300 mg of pentamidine every 28 days; group II: Inhalation of placebo (300 mg of Na isethionate) every 28 days. From May to November 28, 1989, 160 patients have entered the trial. Inhalations were well tolerated, with only a 6% use of bronchodilators and a 15% incidence of cough. Until now five patients died, none of them drug related. So far, six patients have developed pneumocystis carinii pneumonia; four of these were on pentamidine, and two on placebo. Five of the six cases occurred before the second inhalation. Recruitment will continue until 250 patients are enrolled.
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PMID:Primary prevention of Pneumocystis carinii pneumonia by inhalation of pentamidine. Preliminary results from a placebo-controlled randomized trial. Swiss Group for Clinical Studies on AIDS. 219 36

In the first evaluation of an uncontrolled multicenter study on inhalative pentamidine prophylaxis (300 mg pentamidine-isethionate monthly) of pneumocystis carinii pneumonia in immunocompromised patients, 48 patients (all 48 patients HIV1-infected, 36 without preceding pneumocystis carinii pneumonia (primary prophylaxis), twelve after pneumocystis carinii pneumonia (secondary prophylaxis); age 20 to 68 years (median 38); 45 male, two female, one unknown; 22 patients AIDS) were observed for 0 to 8.5 months (mean 4 +/- 2 months, intended observation time twelve months). No proven pneumocystis carinii pneumonia was found in the observed patients. One patient was treated with cotrimoxazole because of a suggested pneumocystis carinii pneumonia-relapse, which could not be proven. Out of seven (14.6%) patients, whose therapy was discontinued, three patients died, three refused further therapy, one patient had a relapse of a cerebral toxoplasmosis. Six patients (12.5%) reported adverse reactions (cough, metallic or bitter taste, slight nausea). New opportunistic infections appeared in four patients (8.3%).
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PMID:[Preventive pentamidine inhalation of Pneumocystis carinii pneumonia in patients with immune deficiency. Preliminary evaluation of a multicenter study]. 219 37

Although fiberoptic bronchoscopy (FOB) has been traditionally used to evaluate nonresolving pneumonia, its efficacy is unknown. We, therefore, reviewed FOB in 35 consecutive patients who had (1) a roentgenographic infiltrate, (2) cough, (3) either temperature greater than 38.1 degrees C, leukocytosis, sputum production, (4) symptoms present for at least ten days, and antibiotic therapy for at least one week. Known lung cancer and AIDS were excluded. Fiberoptic bronchoscopy was diagnostic in 86 percent (12/14) in whom a specific cause was found. No patient had endobronchial cancer. Two patients with nondiagnostic FOB and persistent systemic symptoms had open lung biopsy specimens showing Wegener's granulomatosis and bronchiolitis obliterans with organizing pneumonia (BOOP). Twenty-one patients with nondiagnostic FOB had no final diagnoses other than community-acquired pneumonia. We conclude that FOB is extremely useful in finding a specific diagnosis for a nonresolving pneumonia when a specific diagnosis can be made. Fiberoptic bronchoscopy was most likely to yield a specific diagnosis in nonsmoking patients with multilobar infiltrates of long duration and could have been avoided in older, smoking, or otherwise compromised patients with lobar or segmental infiltrates with no decrease in diagnostic yield in our series.
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PMID:Utility of fiberoptic bronchoscopy in nonresolving pneumonia. 224 65


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