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

In an ongoing prospective study of homosexual men conducted in Vancouver since November 1982, 87 cases of human immunodeficiency virus (HIV) seroconversion have been documented to date. Comparison of laboratory results obtained a mean of 4.9 months before and 5.4 months after the estimated date of seroconversion revealed that a significant increase in the serum IgG level (from 1149 to 1335 mg/dl on average) and in C1q binding (from 8.8% to 14.2% on average) was associated with early HIV infection (p less than 0.001). A marginally significant decrease in the ratio of helper to suppressor (CD4 to CD8) cells (from 1.55 to 1.29 on average) was also noted (p = 0.025). A marked decrease in absolute number of CD4 cells was not seen with seroconversion, which suggests that profound loss of these cells may be a long-term effect of HIV infection. The occurrence of symptoms (including fatigue, fever, night sweats, unintentional weight loss, diarrhea, joint pains, cough unrelated to smoking, shortness of breath, oral thrush, herpes zoster and rash) did not increase with seroconversion. This finding suggests that most cases of HIV seroconversion may be asymptomatic or associated with relatively minor symptoms. On the other hand, generalized lymphadenopathy was found to develop after HIV seroconversion in about 50% of cases.
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PMID:The Vancouver Lymphadenopathy-AIDS Study: 7. Clinical and laboratory features of 87 cases of primary HIV infection. 364 8

Illness associated adenovirus infection is described in 15 immunocompromised patients. Patients were immunocompromised by severe underlying disease, immunosuppressive or corticosteroid therapy or by age (prematurity). Evidence of adenovirus infection was obtained by either viral isolation or, in two cases, characteristic adenovirus inclusion bodies at postmortem study. All clinical illness was associated with high fever (temperature greater than 39 degrees C). Eighty per cent of the patients had severe systemic complaints including malaise, lethargy, fatigue and night sweats; a similar number of gastrointestinal symptoms. Pulmonary complaints were described in 11 of 15 cases and included cough (67 per cent) and tachypnea (53 per cent). Roentgenologic evidence of pneumonia was demonstrated in 12 of 15 patients (80 per cent). Elevation of serum hepatic enzyme levels (serum glutamic pyruvic transaminase (SGPT)) occurred in eight of 11 patients (73 per cent) and was moderate to severe (serum glutamic pyruvic transaminase greater than 450 IU/liter) in five of 11 (45 per cent). Nine patients died; seven after a rapid downhill course and two after a prolonged illness. Evidence of adenovirus infection microscopically by autopsy in the lung, liver or both is demonstrated in four patients with fulminant systemic illness. Adenovirus infection should be considered in the etiology of severe overwhelming illness in the immunocompromised host.
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PMID:Adenovirus infection in the immunocompromised patient. 624 99

Because of declining prevalence of tuberculosis in the United States, standard laboratory tests detect fewer actively infected patients. Of 6,884 cultures for Mycobacterium tuberculosis (MTB) in three years at our hospital, only 2% were positive. To select other effective screening variables, we retrospectively reviewed patients in whom cultures were ordered. Charts of 79 patients with active tuberculosis and 226 patients whose cultures were negative were reviewed for 45 signs, symptoms, and laboratory tests determined at the time of initial contact. Those variables which distinguished the MTB-active from the nonactive were: history of weight loss, prior exposure, night sweats, fever, abnormal chest roentgenogram, positive skin test (PPD) (at P less than .001), and cough and abnormal pulmonary examination (at P less than .05). An algorithmic analysis suggests that weight loss and/or cough, followed by abnormal chest x-ray film and/or positive PPD, would detect 77% of the MTB-infected persons in whom these tests were done. The classic signs and symptoms of pulmonary tuberculosis continue to be excellent screening variables. When combined with the chest x-ray film and PPD, they may allow use of the culture as a confirmatory test, rather than its current inappropriate use as a screening test, for a disease of low prevalence.
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PMID:Clinical determinants of tuberculosis screening. 678 Oct 72

A study was made of the presenting features of 100 consecutive Australian patients with pulmonary tuberculosis. A clinical diagnosis of pulmonary tuberculosis was suspected at the time of first presentation in only 52 patients and the initial provisional diagnosis was that of a non-tuberculous chest condition in a further 32 patients. In another 16 there was a delay in diagnosis because pulmonary tuberculosis was suspected only after chest X-rays were taken for screening purposes--for example, prior to elective surgery. A non-cavitating lesion in an upper lobe was the radiological appearance most often associated with failure to suspect tuberculosis at the time of presentation. The most common symptoms or change in pre-existing chest complaints were cough (55), loss of weight (52) and shortness of breath (43) followed by fever or night sweats (23) and haemoptysis (10) while 16 were asymptomatic.
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PMID:Presentation of pulmonary tuberculosis. 694 41

A 1994 study reported on cases of drug-resistant tuberculosis (TB) at the Chest Service at Bellevue Hospital, in New York City. 20 years of TB laboratory susceptibility tests were reviewed in 4681 cases. Combined resistance to isoniazid and rifampicin rose from 2.5% in 1971 to 16% in 1991. Over 75% of these cases in 1991 were resistant to rifampicin, isoniazid, streptomycin, and ethambutol. Most of the patients belonged to one or more of the following groups: young, Black or Hispanic, unemployed, homeless, male, HIV-infected, and drug abuser. Clinical characteristics were: anergy, fever, cough, night sweats, weight loss, radiograph bilateral infiltrates, adenopathy, cavities, miliary shadowing, and normal chest radiograph. Overall, in 1993 in the US, 3% of all new cases and 6.9% of recurrent cases were resistant to both rifampicin and isoniazid. This resurgence of TB in industrialized countries has been ascribed to: 1) immigration of foreign populations at high risk of developing TB, 2) coinfection with HIV, and 3) an increase in high risk groups. The WHO stresses the importance of identifying meaningful denominators when discussing both primary and acquired drug resistance rates. Restriction fragment length polymorphism (RFLP) is the molecular technique that differentiates individual strains of Mycobacterium tuberculosis. Three recent studies from New York used RFLP to demonstrate the clustering of multidrug-resistant TB. Solutions to the problem consist of adequate infrastructure, i.e., a national TB program; prescription of combined preparations; inducement or enforcement of compliance using directly observed therapy (DOT) (a DOT protocol employed in Denver, Colorado, used 2 weeks of therapy followed by 24 weeks of twice weekly intermittent therapy); prevention of nosocomial spread by isolation of smear-positive cases during the first 2 weeks of treatment; rapid diagnosis of TB and drug susceptibility (within 10-21 days using radiometric culture, nucleic acid probes, and high performance liquid chromatography of mycolic acids); and treatment by five or six drugs.
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PMID:Escalating threat from tuberculosis: the third epidemic. 757 Apr 62

Mycobacterium xenopi infections have rarely been reported among patients infected with the human immunodeficiency virus (HIV). We recently treated two HIV-infected men, neither of whom had a history of pulmonary disease or AIDS-defining conditions, and who had M. xenopi lung infections. Both patients presented with night sweats, cough, and pleuritic chest pain. Chest radiographs showed an upper-lobe nodule in the first patient and a perihilar cavitary infiltrate in the second patient. Both patients were initially believed to have pulmonary tuberculosis and were treated accordingly; however, only M. xenopi grew on cultures of multiple respiratory specimens. This diagnosis was confirmed by cultures of biopsied lung tissue from the first patient and of fluid from a peritracheal abscess in the second patient. Both patients' clinical conditions improved after multidrug therapy (isoniazid, rifampin, pyrazinamide, ethambutol, and ciprofloxacin in the first case; isoniazid, rifampin, and pyrazinamide in the second case). The second patient's condition improved despite in vitro resistance of his isolate to isoniazid and rifampin.
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PMID:Mycobacterium xenopi infection masquerading as pulmonary tuberculosis in two patients infected with the human immunodeficiency virus. 762 33

A previously healthy woman aged 53 years presented with cough, night sweats and weakness. Chest roentgenogram revealed a reticulonodular infiltrate of the right upper lung. Multiple sputum cultures were positive for Mycobacterium avium-intracellulare, with no immunodeficiency disease. Fibreoptic endoscopy showed multiple tracheal cartilaginous knobs from a tracheobronchopathia osteochondroplastica. The infiltrate improved after chest physiotherapy, but sputum cultures remained positive. Despite its low incidence, tracheobronchopathia osteochondroplastica can be associated with atypical mycobacterial disease.
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PMID:Mycobacterium avium-intracellulare associated with tracheobronchopathia osteochondroplastica. 774 87

We investigated the long-term health effects of HIV-1 infection in homosexual men not close to developing AIDS by comparing 916 HIV-1-seropositive (SP) men at least 1.67-3.67 years prior to a clinical AIDS diagnosis to 2,161 HIV-1-seronegative (SN) controls. The SP group reported a higher total of 12 distinct symptoms (fatigue, shortness of breath, night sweats, rash, cough, diarrhea, headache, thrush, skin discoloration, fever, weight loss, and sore throat/mouth) than did the SN group (p < 0.0001), corresponding to at least 5.6 more days/year of such symptoms. The SP group had lower body mass index (p < 0.0001) and lower hemoglobin (p < 0.0001). The SP group was more depressed, as measured by CES-D score (p = 0.047), before knowledge of one's serostatus was likely, and became even further depressed (p = 0.038 for increase in depression) after the HIV-1 serostatus test was accessible to high-risk groups. These associations remained unchanged in multivariate models, incorporating other covariates.
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PMID:Signs and symptoms of "asymptomatic" HIV-1 infection in homosexual men. Multicenter AIDS Cohort Study. 826 59

Atypical pulmonary manifestations of Pneumocystis carinii infection and fair numbers of extrapulmonary and disseminated infections have lately been documented in patients with human immunodeficiency virus infection treated prophylactically with inhalative pentamidine. We report the case of a 32-year-old homosexual patient who was assessed for complaints of night sweats, weight loss, and progressive malaise. The patient denied any respiratory tract symptoms such as cough, sputum production, pleuritic chest pain, or shortness of breath. Chest X-ray revealed two large round noncavitating lesions in the lower lobe of the right lung. Pneumocystomas were diagnosed by fine-needle aspiration. A 3-week course of intravenous high-dose cotrimoxazole resulted in amelioration of symptoms but no change in the radiographic appearance of the pulmonary lesions. Four months later the patient is alive and stable and is being treated with pentamidine inhalation of 300 mg per 2 weeks and two tablets of pyrimethamine sulfadoxine per week.
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PMID:A novel variety of atypical Pneumocystis carinii infection after long-term prophylactic pentamidine inhalation in an AIDS patient: large lower lobe pneumocystoma. 847 17

Chronic fatigue syndrome (CFS) is a chronic illness of uncertain aetiology characterized by at least six months of debilitating fatigue and associated symptoms. The symptoms of the syndrome are all non-specific and some (but not all) are also seen in psychiatric illness. The symptomatology suggesting an organic component to the illness includes its abrupt onset with an 'infectious-like' illness, intermittent unexplained fevers, arthralgias and 'gelling' (stiffness), sore throats, cough, photophobia, night sweats, and post-exertional malaise with systemic symptoms. The illness can last for years and is associated with marked impairment of functional health status.
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PMID:Clinical presentation of chronic fatigue syndrome. 849 Nov 6


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