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

Nontuberculous mycobacteria (NTM) infection is a frequent opportunistic infection in patients infected with the human immunodeficiency virus. However, NTM infection may also occur in nonimmunocompromised hosts. In order to determine the spectrum of mycobacterial infection in the nonacademic setting, we analyzed the demographic and clinical characteristics of all patients presenting to a suburban multispecialty clinic during a 24-mo period. Twenty-one patients presented with active mycobacterial lung infections during the study period. Of these, only one had Mycobacterium tuberculosis. The remaining 20 had lung infections with NTM. One patient was infected with M. kansasii, three had M. abscessus, and 16 had M. avium complex. One patient with disseminated M. avium infection met the diagnostic criteria for the acquired immunodeficiency syndrome. The remaining 19 were largely normal at presentation and were predominantly elderly (mean age, 71 +/- 11 yr), female (79%), nonsmokers (89%) who presented with cough (94%) and localized radiographic infiltrates (84%), often in the right middle lobe and/or lingula (73%). The predominance of nontuberculous mycobacteria over M. tuberculosis in our practice was mirrored by results of an 11-yr review of experience from a nearby suburban hospital, where 65% of mycobacterial infections in the previous 5 yr were with NTM. We conclude that infection with NTM represents a previously underappreciated cause of chronic lung infection among elderly middle-class patients in the community setting.
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PMID:Nontuberculous mycobacteria. An underappreciated cause of geriatric lung disease. 788 97

Previous reports of infection due to Mycobacterium kansasii among patients infected with human immunodeficiency virus (HIV) have conflicted with regard to the significance of the isolate; the clinical, radiographic, and laboratory features of the disease; and the response to therapy. To clarify the spectrum of M. kansasii infection in this population, we conducted a retrospective study of 35 patients. Twenty-eight of these patients were believed to have disease due to M. kansasii, while the remaining seven patients were probably colonized with the organism. All but two patients presented with advanced HIV infection; the median CD4 cell count was 12/microL. Most patients with pulmonary disease presented with fever, cough, and dyspnea, but only eight of these 22 patients had radiographic findings of either pulmonary cavitation or predominantly upper-lobe disease. Ten patients had M. kansasii isolated from blood or bone marrow. The majority of patients with pulmonary or disseminated disease responded to therapy. However, 11 patients died either before mycobacterial infection was diagnosed or early in the course of treatment, and two had a relapse of infection during therapy.
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PMID:Mycobacterium kansasii among patients infected with human immunodeficiency virus in Kansas City. Kansas City AIDS Research Consortium. 801 22

We present the pulmonary findings in 36 autopsies of children affected by the acquired immunodeficiency syndrome (AIDS). Twenty-three patients were male and 13 were female, ranging in age between 3 days and 13 years. Twenty children had human immunodeficiency virus (HIV)-positive parents or parents who were at high risk of exposure (intravenous drug abusers and prostitutes), five had a history of transfusion, and one had a history of renal transplantation and blood transfusion. Clinically, the patients presented with recurrent infections, failure to thrive, hepatosplenomegaly, fever, cough, and/or hemoptysis. Histologically, specific infectious processes were the most common finding (75% of cases), with Pneumocystis carinii pneumonia being the most prevalent type of infection, followed by bacterial pneumonia. Neoplastic conditions and lymphoid interstitial pneumonia were less frequent (approximately 10% of cases). In addition, in approximately 10% of the cases the pulmonary findings were non-specific (ie, pulmonary edema and atelectasis) and probably unrelated to HIV infection. Our findings suggest that specific infectious conditions constitute the most common type of pulmonary pathology in children with AIDS. However, because there is a small percentage of children with nonspecific findings, a transbronchial biopsy is important for proper evaluation before institution of therapy.
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PMID:The spectrum of pathological changes in the lung in children with the acquired immunodeficiency syndrome: an autopsy study of 36 cases. 808 62

We enrolled 1,353 subjects in a multicenter study to evaluate the spectrum of pulmonary complications associated with human immunodeficiency virus (HIV) infection and the feasibility of detecting pulmonary infections in asymptomatic members of this group. There were 1,171 who were HIV-seropositive; the remaining 182 were HIV-seronegative, but they belonged to high-risk transmission groups (homosexual/bisexual, or injection drug users). Single-breath carbon monoxide diffusing capacity (DLCO) was measured serially (at 3- to 12-month intervals) in a prospective fashion to determine whether a decline of > or = 20% predicted the presence of Pneumocystis carinii pneumonia or other pulmonary infections in the absence of new pulmonary symptoms and no new abnormalities on chest roentgenograms. In 64 subjects (6% of the group who had two or more measurements) DLCO declined > or = 20% from a prior value within 2 yr of entry, unassociated with fever, increased cough or dyspnea, or new chest roentgenogram abnormalities. Induced sputum was analyzed for the presence of P. carinii and mycobacteria in 44; fiberoptic bronchoscopy was performed with bronchoalveolar lavage in 14, six of whom also had transbronchial lung biopsy. All 64 subjects with the asymptomatic decline in DLCO were followed for an additional 3 to 12 months with additional clinical evaluations, chest roentgenograms, and DLCO determinations, or until death (one subject). In no case was the decline in DLCO due to P. carinii pneumonia or other pulmonary infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A decline in the pulmonary diffusing capacity does not indicate opportunistic lung disease in asymptomatic persons infected with the human immunodeficiency virus. Pulmonary Complications of HIV Infection Study Group. 810 43

The association of acute myeloblastic leukemia (AML) and HIV infection is rare. Only eight cases had been reported of coexistence until 1990, and the association may be due to chance. HIV infection is associated with T cell immunodeficiency, however, and may contribute to the development of AML in such patients either due to defective T cell regulation of hemopoiesis and/or due to failure of immune surveillance. Previous reports have been from relatively high HIV prevalence areas. The authors report two cases of coexistent HIV infection and AML from a low HIV prevalence area found in routine screening for HIV. An 18-year-old male presented December 1991 with fever and fatigue, and a 70-year-old male presented February 1993 with cough and expectoration. Experience is limited in managing AML with coexistent HIV infection. Complete remissions have, however, been documented after low-dose cytosine arabinoside and intensive combination chemotherapy. The younger of the two patients received chemotherapy and tolerated it like HIV-negative AML patients, but succumbed to possible fungal pneumonia and intracerebral infection while in remission. The authors stress in closing that coexistent HIV infection in patients with AML may be overlooked especially in low HIV prevalence areas. Routine HIV screening of AML patients should be considered.
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PMID:Human immunodeficiency virus (HIV) infection associated with acute myeloblastic leukemia in a low HIV prevalence area. 817 39

We describe a woman with lymphoid interstitial pneumonia diagnosed by open lung biopsy following a profile of unproductive cough, weakness and bilateral lung infiltrates. The patient was also diagnosed as having common variable immunodeficiency based on hypogammaglobulinemia, repeated sinusitis and persistent diarrhea. Exfoliative cytology of pleural effusion revealed the development of non-Hodgkin's lymphoma. We review the associations among these processes and consider the suggestion made by other authors that lymphoid interstitial pneumonia be considered a prelymphomatous process.
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PMID:[An association of lymphoid interstitial pneumonia, common variable immunodeficiency and non-Hodgkin's lymphoma]. 818 12

Aerosolized pentamidine is widely used in adult patients with human immunodeficiency virus as both prophylaxis and therapy for Pneumocystis carinii pneumonia. The aim of this study was to evaluate the safety of a monthly regimen of aerosolized pentamidine in human immunodeficiency virus-infected infants. Seven human immunodeficiency virus-infected infants, ages 3.5 to 11 months, were given a total of 45 monthly treatments of aerosolized pentamidine. The infant's dose of pentamidine was based on an adult dosage of 300 to 600 mg/month, adjusted for minute ventilation and weight. There were no discernible clinical side effects in 62% (28 of 45) of the treatments. Observed toxicity included mild to moderate coughing, mild wheeze and transient arterial desaturation as measured by pulse oximetry. Pulmonary function data revealed an increased tidal volume (P < 0.005) and an increased pulmonary resistance (P < 0.02) post-pentamidine treatment. Urinary pentamidine concentrations were obtained and pentamidine was detected in all tested samples suggesting pulmonary deposition and systemic absorption. In conclusion aerosolized pentamidine appears to be a relatively safe, well-tolerated treatment in infants, with side effects similar to those seen in adults.
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PMID:Aerosolized pentamidine for prophylaxis of Pneumocystis carinii pneumonia in infants with human immunodeficiency virus infection. 819 May 32

The clinical features, chest radiographs and computed tomographic (CT) images were evaluated in 11 cases with serologically proved adult measles complicated with pneumonia (10 were previously healthy and one had sarcoidosis). Pneumonia appeared during the rash period in all cases. Respiratory symptoms were cough (9/11), dyspnea (3/11), and hypoxemia (10/11). Pneumonia manifestations were detected in only 4 cases by chest radiograph; on the other hand, they were seen in all cases by CT scan and consisted of ground-glass opacities (73%), nodular opacities (64%) and consolidation (27%). CT seems to be a useful method to detect measles pneumonia if it is suspected. Measles pneumonia in previously healthy patients had a good prognosis, as the hypoxemia disappeared within 6 days in all cases. The sarcoidosis patient showed prolonged pneumonic shadows and period of hypoxemia. Measles pneumonia occurring in a host with cellular immunodeficiency may have a severe clinical course.
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PMID:[Clinical features of measles pneumonia in adults: usefulness of computed tomography]. 825 23

A case of cryptococcal retinochoroiditis associated with acquired immunodeficiency syndrome (AIDS) is reported. The patient was a 22-year-old man with hemophilia A. He was found seropositive for human immunodeficiency virus three years ago. He was admitted with complaints of fever and cough. CD4/CD8 ratio was 0.01 and CD4 lymphocyte count was 10/mm3. Two weeks later, ophthalmological examination revealed some yellowish white focal lesions at the posterior fundus. More detailed examinations were impossible because of his poor general condition. He died one month later. The autopsy showed disseminated cryptococcosis. Ocular histopathological examination revealed cryptococcal retinochoroiditis without any inflammatory reaction. This is the first report in Japan of this disease associated with AIDS and of a histopathological study of it.
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PMID:[A case of cryptococcal retinochoroiditis associated with acquired immunodeficiency syndrome]. 833 73

Treatment with ethambutol 15 mg/kg, rifabutin 6 mg/kg and amikacin 15 mg/kg (IV for 2-4 weeks) in 31 HIV infected patients with severe immunodeficiency and infection caused by Mycobacterium avium complex (MAC) was evaluated in a retrospective study. The patients had one or more of the following clinical features: fever 31, weight loss 13, cough 10, pleurisy I, pericarditis 2, diarrhoea 12, peritonitis I. MAC was cultured from blood in 29, bone marrow in six, sputum in nine, faeces in 15, bowel biopsy in six and liver biopsy in four patients. Twenty-two of the 31 patients showed treatment response after a median time of 14 days, and five had a relapse successfully treated with another course of amikacin. Median survival time was 8 months.
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PMID:Efficacy of triple drug regimen of amikacin, ethambutol and rifabutin in AIDS patients with symptomatic Mycobacterium avium complex infection. 838 30


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