Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A study on AIDS subjects carried out at the Calmette Hospital in Phnom-Penh between the 1st January 97 and the 30th December 98. The objective of this study was to describe the most frequent clinical manifestations as well as the opportunistic infections according to the 1993 CDC classification (purely clinical classification). Three hundred and fifty six AIDS patients hospitalized in medicine B were included in our study. A complete file was prepared for each subject, specifying his/her social and family situation, profession, sexual behavior and history. The clinical condition was specified and the paraclinical examinations were recorded. The average age was 35 years with 250 men and 106 women, i.e. a M/F sex ratio of 2.4. The majority of male contaminations were due to sexual relationships with multiple partners, 82%, and women with a single partner was of 78%. The use of condoms was of 60% (versus 40% occasional); the extent of drug-addiction was 1.12% (4 cases). A history of STD was found in 56% of cases. The presenting symptoms most frequently found were asthenia, anorexia, fever and weight-loss. In decreasing order, the clinical manifestations often associated were: weight-loss > 10% or a catechetic condition 58.70% (209/356), fever > 38 degrees C >1 month 53% (189/356), diarrhea (> one month) 41.60% (148/356). The most frequent opportunistic infections were: oral candidiasis 51.40% (183/356) and 40% are oro-oesophageal (oral candidiasis + dysphagia or odynphagia), pulmonary and extrapulmonary tuberculoses (TB) 43.50% (155/356) (pulmonary TB in 65.16%, TB of the lymph nodes 23.22% and disseminated TB and cerebral TB 11.61%), cryptococcal meningitis 11.80% (42/356) and pneumocystosis 6.50% (23/356), CMV retinitis 1.12% (4/356). The other opportunistic manifestations such as toxoplasmosis and Kaposis sarcoma are much more rarely encountered due to the difficulties of the paraclinical diagnosis. The mortality in the department was of 17.40% (62/356). In conclusions, tuberculosis is the most frequent of the opportunistic infections in Cambodia. Cryptococcal meningitis is in 3rd place for opportunistic infections. It is the first diagnosis that should be evoked in a meningeal irritation.
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PMID:[Clinical aspects of AIDS at the Calmette hospital in Phnom Penh, Kingdom of Cambodia A report on 356 patients hospitalized in the Medicine "B" Department of the Calmette Hospital]. 1131 28

HIV is a very common infection in Thailand, affecting about one million of the population already, with 99,555 persons with full blown AIDS at the end of 1999. The first case of AIDS was reported in Thailand in 1984. Gastrointestinal involvement is very common, the commonest presentations are diarrhea, esophageal symptoms, hepatobiliary symptoms, and weight loss. When the CD4+ T cell count falls below 200, the body becomes highly susceptible to opportunistic infections and neoplasms. Almost all AIDS patients will have GI symptoms at sometime during the course of their illness. This is because the GI tract contains an abundant quantity of lymphoid tissue and is likely to function as a reservoir of HIV infection. In chronic diarrhea cases, apart from other investigations, small bowel biopsy and aspiration may help to find the cause. If oral candidiasis is present, one should keep HIV in mind and look for oral hairy leucoplakia, dysphagia and odynophagia as one-third of patients with AIDS will develop dysphagia or odynophagia in the course of their disease. Those with esophageal candidiasis will usually have oral candidiasis and odynophagia while 18 per cent of the patients will not have oral thrush. CMV esophagitis and HIV ulcer (or idiopathic oesophageal ulcer) are also common. Upper gastrointestinal endoscopy and biopsy are helpful in finding the exact cause of the oesophageal symptoms. Hepatobiliary manifestations are present with jaundice, hepatomegaly, and pain. ERCP is very helpful in diagnosing and classifying these conditions. Papillary stenosis and dominant biliary stricture can be treated by endoscopy but long term results are still poor due to late manifestation of these conditions.
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PMID:Endoscopy in HIV infected patients. 1152 42

PRESENTING FEATURES: A 53-year-old man who had human immunodeficiency virus (HIV) presented to the Johns Hopkins Hospital with a 3-month history of increasing dysphagia, cough, dyspnea, chest pain, and an episode of syncope. His past medical history was notable for oral and presumptive esophageal candidiasis that was treated with fluconazole 6 months prior to presentation. Three months prior to presentation, he discontinued his medications, and his symptoms of dysphagia recurred. During that time he developed intermittent fevers and chills, progressively worsening dyspnea on exertion, and a cough productive of white sputum. He also reported a 40-lb weight loss over the past 3 months. On the day prior to presentation, he had chest pain and shortness of breath followed by weakness, dizziness, and a brief syncopal episode. He denied orthopnea, paroxysmal nocturnal dyspnea, lower extremity edema, jaundice, hemoptysis, hematemesis, melena, hematochezia, or diarrhea. There was no history of alcohol use, and he stopped smoking tobacco approximately 1 month previously. He smoked cocaine but denied injection drug use. The patient had never been on antiretroviral therapy and had never had his CD4 count or viral load measured. On physical examination, the patient was a thin, cachectic man who appeared older than his stated age. His vital signs were notable for blood pressure of 102/69 mm Hg, resting tachycardia of 102 beats per minute, resting oxygen saturation of 92% on room air, normal resting respiratory rate, and a temperature of 38.1 degrees C. His oropharynx was clear, with no signs of thrush or mucosal ulcers. His pulmonary examination was notable for diminished breath sounds in the lower lung fields bilaterally. Cardiac, abdominal, and neurologic examinations were normal. His skin was intact, with no visible petechiae, rashes, nodules, or ulcers. Laboratory studies showed a total white blood cell count of 3.2 x 10(3)/microL, with a total lymphocyte count of 330/microL, hematocrit of 30.2%, a serum sodium level of 129 mEq/L, and a serum lactate dehydrogenase level of 219 IU/L. The patient had an absolute CD4 count of 8 cells/mm3 and a HIV viral load of 86,457 copies/mL. His arterial blood gas on room air had a pH of 7.51, a PCO2 of 33 mm Hg, and a PO2 of 55 mm Hg. Electrocardiogram and serial serum cardiac enzymes were normal. A chest radiograph showed bilateral upper lobe patchy infiltrates with left upper lobe consolidation. Computed tomographic (CT) scan of the chest with contrast showed bilateral ground glass infiltrates with focal consolidation (Figure 1) and no evidence of pulmonary embolism. Induced sputum was negative for Pneumocystis carinii, fungi, or acid-fast bacilli. A bronchoalveolar lavage was performed. What is the diagnosis?
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PMID:Cases from the Osler Medical Service at Johns Hopkins University. Diagnosis: P. carinii pneumonia and primary pulmonary sporotrichosis. 1533 85

Superficial fungal infection of the mucous membranes (thrush) isolated to the larynx is neither widely reported nor well recognized clinically. Therefore, it is often associated with ineffective treatment and delay in diagnosis, and sometimes associated with unneeded surgical intervention. Eight cases of thrush isolated to the larynx, with no oral or oropharyngeal manifestations, are presented. Four of these were isolated to the vocal folds alone. All patients were adults, and 4 were smokers. Hoarseness was always present. Pain was present inconsistently, and there was no dysphagia or odynophagia, in contrast to other forms of upper aerodigestive tract candidiasis. On average, diagnosis was not made until 6 months after the onset of symptoms. Possible causative factors included use of systemic steroids (3 cases), broad-spectrum antibiotics (1 case), or inhaled steroids (5 cases); diabetes (2 cases); and neutropenia (1 case). In 3 cases, all with thrush isolated to the vocal folds, inhaled steroids were the only causative factor identifiable--a feature reported only twice previously. Three patients underwent surgical procedures that might have been avoided had an accurate diagnosis been made. All patients responded readily to oral fluconazole and removal of predisposing factors where possible. The signs, symptoms, predisposing factors, and treatment are compared to those of 14 cases reported in the literature over 35 years.
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PMID:Laryngeal thrush. 1596 23

A 75-year-old woman who had been healthy except for mild glycemia and lipidemia discovered three and a half months before admission experienced severe dysphagia secondary to oral and esophageal candidiasis. She eventually developed diabetic hyperosmolar syndrome and ketoacidosis. Since anti-GAD antibody was negative and her diabetes was controlled with a moderate dose of insulin, we made a diagnosis of type 2 diabetes. Her only risk factors for candidiasis were hyperglycemia, age, and continuous denture use. The fact that her diabetes developed in association with oral candidiasis supports the hypothesis that there is a bidirectional interrelationship between diabetes and oral infection.
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PMID:An elderly case of type 2 diabetes which developed in association with oral and esophageal candidiasis. 1740 3

A-58-year old man presented with fluctuating ptosis and dysphagia. When he was 53 years old, he developed oral candidiasis and serum human immunodeficiency virus (HIV) RNA was detected. After starting highly active antiretroviral therapy, serum HIV RNA became undetectable. Neurological examination revealed ptosis and bulbar symptoms. Myasthenia gravis was comfirmed by a positive edrophonium test, showing 20% decrement of the compound muscle action potential on repetitive stimulation. Anti-acetylcholine receptor antibodies were negative and anti-muscle specific tyrosine kinase (MuSK) antibodies were positive. The chest CT scan was normal. He experienced transient clinical remission with pyridostigmine bromide and prednisolone. However relapse occurred after he returned to work. Persistent clinical remission was first observed after cyclosporin administration. There are eleven reports in which patients had concomitant myasthenia gravis and HIV infection. Most of those cases were benign in clinical course and required only anticholinesterase therapy. In our case, however, anti-MuSK antibodies were positive, and symptoms of myasthenia gravis remained despite prednisolone administration. Cyclosporin is directly active against HIV, and thus, cyclosporine therapy may be helpful in patients with concomitant myasthenia gravis and HIV infection.
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PMID:[Anti-MuSK antibody positive myasthenia gravis with HIV infection successfully treated with cyclosporin: a case report]. 1904 51

Candidiasis, an often encountered oral disease, has been increasing in frequency. Most commonly caused by the overgrowth of Candida albicans, oral candidiasis can be divided into several categories including acute and chronic forms, and angular cheilitis. Risk factors for the development of oral candidiasis include immunosuppression, wearing of dentures, pharmacotherapeutics, smoking, infancy and old age, endocrine dysfunction, and decreased salivation. Oral candidiasis may be asymptomatic. More frequently, however, it is physically uncomfortable, and the patient may complain of burning mouth, dysgeusia, dysphagia, anorexia, and weight loss, leading to nutritional deficiency and impaired quality of life. A plethora of antifungal treatments are available. The overall prognosis of oral candidiasis is good, and rarely is the condition life threatening with invasive or recalcitrant disease.
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PMID:Oral candidiasis and angular cheilitis. 2059 42

We present herein a case report of a 59-year-old patient with HIV-1 infection who developed a CMV-induced pseudotumor of the duodenum. The patient presented with oral pain and dysphagia. Physical examination revealed oral thrush. An EIA and a Western blot assay for antibodies to HIV were positive. His CD4-positive lymphocyte count was initially 49/microL with an HIV viral load of 2.6 x 10(5) copies/mL. Cytomegalovirus (CMV) reactivation was detected with the CMV antigenemia assay. He had CMV retinitis in both eyes with unilateral blurring. An endoscopic study revealed candida esophagitis, and a tumor-like lesion with an irregular ulcer at the papilla of Vater. Histological and immunohistochemical studies revealed a CMV-induced pseudotumor and severely inflamed duodenal mucosa with infiltration of CMV-positive cells. The patient was treated with oral valganciclovir and fluconazole for three weeks. As the oral thrush and retinitis showed improvement, he began antiretroviral therapy (ART), consisting of raltegravir and TDF/ FTC. One month later the patient's CD4-positive cells increased to 130/microL and the level of HIV-RNA decreased to 160 copies/mL, The CMV retinitis had transiently worsened because of an ART-induced inflammatory response, immune reconstitution inflammatory syndrome (IRIS). Six months after the ART initiation, an endoscopic study revealed that the esophagitis and the lesion at the papilla had improved. Biopsy showed no CMV-positive cells in the epithelium. The patient was now in a relatively healthy condition. CMV-induced pseudotumors of the duodenum are rare, and sometimes resemble malignancy. However, because this tomor responds to medical treatment physicians treating severely immunocompromised patients should be aware of its presentation and treatment.
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PMID:[CMV-induced duodenal papillitis in a patient with HIV-1 infection]. 2398 94

Esophageal candidiasis (EC) is the most common type of infectious esophagitis. In the gastrointestinal tract, the esophagus is the second most susceptible to candida infection, only after the oropharynx. Immunocompromised patients are most at risk, including patients with HIV/AIDS, leukemia, diabetics, and those who are receiving corticosteroids, radiation, and chemotherapy. Another group includes those who used antibiotics frequently and those who have esophageal motility disorder (cardiac achalasia and scleroderma). Patients complained of pain on swallowing, difficulty swallowing, and pain behind the sternum. On physical examination, there is a plaque that often occurs together with oral thrush. Endoscopic examination is the best approach to diagnose this disease by directly observing the white mucosal plaque-like lesions and exudates adherent to the mucosa. These adherent lesions cannot be washed off with water from irrigation. This disease is confirmed histologically by taking the biopsy or brushings of yeast and pseudohyphae invading mucosal cells. The treatment is by systemic antifungal drugs given orally in a defined course. It is important to differentiate esophageal candidiasis from other forms of infectious esophagitis such as cytomegalovirus, herpes simplex virus, gastroesophageal reflux disease, medication-induced esophagitis, radiation-induced esophageal injury, and inflammatory conditions such as eosinophilic esophagitis. Except for a few complications such as necrotizing esophageal candidiasis, fistula, and sepsis, the prognosis of esophageal candidiasis has been good.
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PMID:Diagnosis and Treatment of Esophageal Candidiasis: Current Updates. 3177 27


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