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A great variety of cardiac disorders have been reported in HIV-infected patients: pericarditis, myocarditis, cardiomyopathies, endocarditis, cardiac involvement through malignancies, pulmonary hypertension, arrhythmias and thromboembolic disease. In general, these disorders are asymptomatic and often diagnosed in echocardiographic studies or autopsies. Pericardial involvement is the most common disorder. Pericardial effusions are asymptomatic and non-specific in a great proportion, but in some instances opportunistic infections or malignancies may lead to cardiac tamponade and are associated with an increased risk of mortality. The etiopathogenesis of myocarditis and cardiomyopathies is uncertain. There is controversy about the role of HIV as the primary etiologic agent. Opportunistic infections, cardiotoxic substances, nutritional deficiencies and autoimmune reactions have also been implicated as etiologic agents of myocardial damage. Short-term prognosis worsens as clinical manifestations of heart failure appear. Valvular involvement usually presents as marantic or infectious endocarditis, the latter most frequently in IVDU. This article reviews the main cardiovascular manifestations in AIDS.
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PMID:[Heart pathology of extracardiac origin (I). Cardiac involvement in AIDS]. 941 63

Cardiac involvement with HIV infection has been documented worldwide in various forms among people with AIDS, including myocarditis, cardiomyopathies, pericardial effusions, ventricular tachycardia, neoplastic infiltration, and non-bacterial thrombotic endocarditis. Recent studies in Africa have reported that HIV may exhibit a cardiac tropism. The authors investigated whether clinical features, sex, age at onset, biological or echocardiographic variables influence the survival of African HIV-infected patients and the progression of AIDS. 157 consecutive Black African HIV-seropositive patients of mean age 38 years with neither cardiac lesions nor other AIDS-defining illnesses underwent physical, electrocardiographic, and Doppler echocardiographic examinations at the Heart of Africa Cardiovascular Center, Lomo Medical, Kinshasa, Congo, between July 1987 and July 1994. The sample was comprised of 89 men and 68 women. Cardiac lesions occurred in 87 patients (55%) during the 7-year follow-up. The onset of heart involvement was associated with a protection against opportunistic comorbidity. In the multiple regression model, cardiac mass/volume ratio, body temperature, deceleration time, body mass index, and socioeconomic status were each independently associated with AIDS outcome. The lowest socioeconomic status and pericardial effusion were the independent predictors of death in a multivariate analysis, while higher CD4 count and cardiac lesions outcome were associated with slower progression to AIDS. Dilated cardiomyopathy was associated with longer survival.
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PMID:Heart involvement and HIV infection in African patients: determinants of survival. 957 18

HIV and AIDS involve multiple organ systems. Lungs, brain, skin, gastrointestinal tract, kidneys, and heart are the major organs targeted by the direct effects of HIV infection and the secondary opportunistic complications of AIDS. Although most other organ system involvement has been extensively described in numerous studies and reviews, cardiac abnormalities related to HIV infection have remained less well characterized, partially because their pathogenesis was less clear and their clinical significance was uncertain. Most studies that have described cardiac complications in AIDS patients were postmortem, although some clinical series have been reported. It is now clear that cardiac involvement in AIDS patients is relatively common. Although most such conditions are clinically quiescent, some may have devastating and fatal outcomes. Pericardial effusion and myocarditis are among the most commonly reported abnormalities. Cardiomyopathy, endocarditis, and coronary vasculopathy have also been reported. In this review, we discuss the most common cardiac abnormalities in HIV-infected patients, as well as their clinical significance, clinical presentation, and management.
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PMID:Cardiac manifestations of HIV/AIDS: a review of disease spectrum and clinical management. 963 79

Splenomegaly was studied retrospectively at the University of California, San Francisco (UCSF), School of Medicine in 301 patients from 1963 to 1995 and compared with the UCSF service of the San Francisco General Hospital Medical Center (SFGH) in 148 patients from 1979 to 1994. The combined 449 patients were classified into several diagnostic groups and were studied by means of several clinical and laboratory associations. Hepatic disease in the percentage of patients at UCSF (with those at SFGH given in parentheses) was associated with splenomegaly in 29% (41%), hematologic disease, 32% (16%); infectious diseases, 16% (36%); congestive or inflammatory disease, 10% (4%); primary splenic disease, 6% (1%); other, 5% (1%); and cause unknown, 2% (1%). Massive splenomegaly occurred in 27% of the patients of the combined series, particularly in patients with hematologic diseases. The acquired immunodeficiency syndrome (AIDS) occurred in more than half of the patients with infectious diseases at SFGH and was four times frequent than in the patients at UCSF. The commonest diseases associated with splenomegaly were hematologic (lymphoma), hepatic (chronic liver disease), infectious diseases (AIDS and endocarditis), congestive (congestive heart failure), primary splenic (splenic vein thrombosis), and other (malignancy not metastatic to the spleen). In 11 patients with AIDS and massive splenomegaly, Mycobacterium avium complex occurred in 8 (73%). Splenectomy was performed in 117 patients (26%), primarily for hematologic amelioration. I conclude that for splenomegaly of unknown origin, the invasive procedure of choice for patients with hematologic associations may be a bone marrow biopsy; for hepatic association, a liver biopsy; and for infectious disease associations, a lymph node biopsy, before any consideration of a diagnostic splenectomy.
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PMID:Splenomegaly in 2,505 patients at a large university medical center from 1913 to 1995. 1963 to 1995: 449 patients. 973 89

A two month old Ugandan boy underwent surgery for an obstructive right ventricular vegetation associated with disseminated Staphylococcus aureus infection. Both the child and his mother subsequently tested positive for HIV infection. Very little is know about the incidence of endocarditis in paediatric patients with AIDS. To our knowledge this is the first case reported of disseminated S aureus infection associated with endocarditis and an obstructing vegetation in an HIV positive infant with a structurally normal heart. The initial signs and symptoms for endocarditis were atypical, a reflection of the overwhelming infection in an immunocompromised patient. Severe infections may have an atypical presentation in immunosuppressed patients. AIDS needs to be considered in these patients, especially if they come from populations with endemic HIV infection.
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PMID:Endocarditis as the first presentation of AIDS in infancy. 979 5

Acquired immunodeficiency syndrome is a serious problem worldwide. Recent advances in the knowledge about human immunodeficiency virus (HIV) replication and the treatment of HIV infection have improved survival in HIV patients. Because of the longer survival in HIV patients, the more manifestations of late-stage HIV infection will be seen, including HIV-related cardiac diseases. The common cardiac manifestations in patients with the acquired immunodeficiency virus are pericardial effusion, myocarditis, dilated cardiomyopathy, endocarditis, pulmonary hypertension, malignant neoplasms, and drug-related cardiotoxicity. This review focuses on these cardiac manifestations in patients with the acquired immunodeficiency syndrome.
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PMID:Cardiac manifestations of acquired immunodeficiency syndrome. 1092 47

OBJECTIVE - To evaluate the cardiac abnormalities and their evolution during the course of the acquired immunodeficiency syndrome, as well as to correlate clinical and pathological data. METHODS - Twenty-one patients, admitted to the hospital with the diagnosis of acquired immunodeficiency syndrome, were prospectively studied and followed until their death. Age ranged from 19 to 42 years (17 males). ECG and echocardiogram were also obtained every six months. After death, macro- and microscopic examinations were also performed. RESULTS - The most frequent causes of referral to the hospital were: diarrhea or repeated pneumonias, tuberculosis, toxoplasmosis or Kaposi sarcoma. The most frequent findings were acute or chronic pericarditis (42%) and dilated cardiomyopathy (19%). Four patients died of cardiac problems: infective endocarditis, pericarditis with pericardial effusion, bacterial myocarditis and infection by Toxoplasma gondii. CONCLUSION - Severe cardiac abnormalities were the cause of death in some patients. In the majority of the patients, a good correlation existed between clinical and anatomical-pathological data. Cardiac evaluation was important to detect early manifestations and treat them accordingly, even in asymptomatic patients.
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PMID:Cardiac abnormalities in the acquired immunodeficiency syndrome. A prospective study with a clinical-pathological correlation in twenty-one adult patients. 1075 83

Pseudomonas aeruginosa nowadays is encountered among the leading pathogen in (i) ICU pneumonia; (ii) nosocomial bacteremia and AIDS primary bacteremia; (iii) iv drug users endocarditis; (iv) exacerbations of cystis fibrosis; (v) malignant external otitis and 'swimmers's ear', and (vi) contact lenses keratitis and traumatic endophthalmitis. The most vulnerable nosocomial hosts are the neutropenics and the mechanically ventilated patients in whom mortality rate exceeds 30%. Virulence of P. aeruginosa is attributed to the elaboration of various enzymes and toxins. There is also worldwide emergence of multiresistant phenotypes to antipseudomonal antibiotics. Therapeutic guidelines should therefore be based on (i) continuous resistance surveillance; (ii) in vitro synergistic interactions of antibacterial agents; (iii) pharmacodynamic properties of antibiotics interpreted by optimal dosing and appropriate frequency of administration; and (iv) current information on the necessity for combination therapy using an aminoglycoside.
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PMID:Therapeutic guidelines for Pseudomonas aeruginosa infections. 1105 88

Two species of the gram-negative bacilli Bartonella, B. henselae and B. quintana, cause disease in HIV-infected patients. If untreated, infection can be fatal. Manifestations include bacillary angiomatosis (BA), bacillary peliosis hepatis (BP), bacteremia, or a combination of these. BA and BP present as lesions, but bacteremia may be subacute and persist for months without diagnosis. Additionally, patients may acquire cat scratch disease (CSD), but this is more common in immunocompetent patients. BA lesions are usually vascular, friable, and bleed profusely when traumatized. They may be confused with Kaposi's sarcoma (KS), pyogenic granuloma, lymphoma and various subcutaneous tumors and infections. Lesions may affect almost any organ, and appear as angiomatous papules, dry scaling lesions, subcutaneous nodules, cellulitic plaques or deep, highly vascularized, soft tissue masses. Patients may have osseus BA lesions (frequently affecting the long bones); hepatic and/or splenic lesions; bacteremia; or endocarditis. To diagnose infection, lesions should be biopsied and examined. Hematoxylin and eosin staining reveal histopathologic changes; darkly staining organisms are evident after Warthin-Starry silver staining; and electron microscopy allows visualization of the bacillus. An indirect immunofluorescence antibody test (IFA) detects bartonella-specific IgG antibodies. Treatment with erythromycin for at least three months is recommended, or with doxycycline if erythromycin is not well-tolerated. Severely ill patients should receive IV doxycycline with either gentamicin or rifampin for at least four months. To prevent infection, HIV-infected people should avoid traumatic cat contact and exposure to the body louse.
AIDS Clin Care 1995 Dec
PMID:Bartonella-associated infections in HIV-infected patients. 1136 39

Infective endocarditis (IE) is one of the most severe complications of parenteral drug abuse. The incidence of IE in intravenous drug abusers (IVDAs) is 2% to 5% per year, being responsible for 5% to 20% of hospital admissions and 5% to 10% of the overall death rate. IVDAs often develop recurrent IE. The prevalence of HIV infection among IVDAs with IE ranges between 30% and 70% in urban areas in developed countries. The incidence of IE in IVDAs is currently decreasing in some geographical areas, probably due to changes in drug administration habits undertaken by addicts in order to avoid HIV transmission. Overall, Staphylococcus aureus is the most common etiological agent, being in most geographical areas sensitive to methicillin (MSSA). The remainder of cases is caused by streptocococci, enterococci, GNR, Candida spp, and other less common organisms. Polymicrobial infection occurs in 2% to 5% of cases. The tricuspid valve is the most frequently affected (60% to 70%), followed by the mitral and aortic valves (20% to 30%); pulmonic valve infection is rare (< 1%). More than one valve is infected in 5% to 10% of cases. HIV-positive IVDAs have a higher ratio of right-sided IE and S. aureus IE than HIV-negative IVDAs. Response to antibiotic therapy is similar among HIV-infected or non-HIV-infected IVDAs. Drug addicts with non-complicated MSSA right-sided IE can be treated successfully with an i.v. short-course regimen of nafcillin or cloxacillin for 2 weeks, with or without addition of an aminoglycoside during the first 3 to 7 days. Surgery in HIV-infected IVDAs with IE does not worsen the prognosis. The prognosis of right-sided endocarditis is generally good; overall mortality is less than 5%, and with surgery less than 2%. In contrast, the prognosis of left-sided IE is less favorable; mortality is 20% to 30%, and even with surgery is 15% to 25%. IE caused by GNB or fungi has the worst prognosis. Mortality between HIV-infected or non-HIV-infected IVDAs with IE is similar. However, among HIV-infected IVDAs, mortality is significantly higher in those who are most severely immunosuppressed, with CD4+ cell count < 200/microL or with AIDS criteria. Finally, IE in HIV-infected patients who are not drug abusers is rare.
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PMID:Infective endocarditis in intravenous drug abusers and HIV-1 infected patients. 1209 73


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