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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this discussion of infection control in patients with acquired immune deficiency syndrome (AIDS), attention is directed to nursing. Due to the fact that the majority of individuals who suffer with AIDS will be homosexual, intravenous drug users, or both, it is essential that the nurse historian be aware of his/her own feelings about the lifestyles of these patients. History-taking should be done in a nonjudgmental manner. A major pitfall to be avoided when taking a history is making assumptions about an individual's sexual preferences or activities based on the response to a simple question about marital status. It is important to note whether or not the person has a monogamous relationship or leads a polyandrous lifestyle. Another area that should be tactfully but explicitly explored when interviewing an individual who is homosexual or bisexual is the number of different sexual partners that he/she has been involved with on a weekly or monthly basis. Whether the patient has a history of sexually transmitted diseases should be determined. The use of recreational drugs should be explored. When taking the history of a client who uses intravenous drugs, it is important for the nurse to record the agents and sites of injection as well as to note whether the individual uses his/her own equipment. When reviewing the major body systems and the presence or absence of related symptoms, the nurse should note whether the client has experienced skin rashes/lesions, swollen lymph nodes, fever, extreme fatigue, weight loss, shortness of breath, changes in bowel habits, cuts or bruises that do not heal, and headaches, dizziness, blurred vision, or stiff neck. The physical examination of the individual with AIDS and an opportunistic infection usually will reveal positive findings in the central nervous system, respiratory system, gastrointestinal system, and/or the integumentary system, as well as the lymphatic system. As the leading cause of morbidity in the compromised host is infection, infection prevention should be regarded as a pragmatic necessity. 2 major things that nurses can do in the acute care setting to control infection are to limit the frequency of invasive or traumatic procedures and to reduce the acquisition of new potential pathogens.
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PMID:Infection control in the patient with AIDS. 608 77

42 homosexual or bisexual men with persistent generalised lymphadenopathy not attributable to an identifiable cause have been followed longitudinally since February, 1981. Lymphadenopathy was accompanied by fatigue, low-grade fever and/or night sweats (57%), splenomegaly (29%), leucopenia (40%), hypergamma - globulinaemia (76%), and diminished proportion and absolute numbers of helper T cells (95%). Of the 26 patients who had lymph node biopsy, all showed benign reactive hyperplasia. After 15-30 (median 22) months, 8 patients have met criteria for the diagnosis of acquired immunodeficiency syndrome (AIDS). This outcome was associated with previous heavy nitrite inhalant use, with the presence of night sweats, with leucopenia, and with the triad of constitutional symptoms, splenomegaly, and leucopenia. In addition, a lower mean absolute helper T cell count and an increased frequency of anergy to mumps intradermal antigen and of herpes simplex virus isolation distinguished these patients from those remaining in the cohort, who seem to be stable and in some cases to have improved.
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PMID:Longitudinal study of persistent generalised lymphadenopathy in homosexual men: relation to acquired immunodeficiency syndrome. 614 74

The acquired immunodeficiency syndrome (AIDS) is a new, serious condition of major public health concern. It is most prevalent among young homosexuals and may be present with Kaposi's sarcoma and serious opportunistic infections. Physicians dealing with male homosexuals should be aware of this diagnostic possibility in any patient with unusual skin lesions or unusual clinical findings indicating infection. AIDS may be preceded by persistent generalized lymphadenopathy which may be accompanied by fatigue, low grade fever, night sweats and weight loss. The prognosis is poor with high mortality rates and no indication of spontaneous recovery of cellular immunocompetence.
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PMID:Acquired immunodeficiency syndrome (AIDS) in homosexual men--a new public health concern. 630 68

Observations of 12 patients with AIDS at this institution from March 1981 to April 1984 are reported. Ten patients were homosexuals and two were bisexual. The majority had travelled abroad (USA, Haiti) and reported multiple anonymous sexual contracts. Eleven patients reported symptoms and signs, of 2-12 months' duration, frequently seen in pre-AIDS: fatigue (10), weight loss (10), diarrhea (7), night sweats (5), fever (4), and generalized lymphadenopathy (1). Laboratory studies showed anemia (10), lymphopenia (9), leukopenia (7), decreased T-helper/T-suppressor ratio (10) and cutaneous anergy to multiple skin-test antigens (9). P. carinii pneumonia was diagnosed in three patients, P. carinii pneumonia and Kaposi's sarcoma in one patient and Kaposi's sarcoma in six patients. Another patient had a chronic mucocutaneous infection with herpes simplex and another an intestinal cryptosporidiosis and Kaposi's sarcoma. Alpha-A-interferon was used to treat patients with Kaposi's sarcoma and three patients with limited disease showed a favorable response. Six patients with advanced disease died.
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PMID:[Acquired immune deficiency syndrome in the region of Zurich. Report on 12 cases]. 649 67

The profound psychological impact of the acquired immunodeficiency syndrome (AIDS) epidemic on gay men needs to receive greater attention from mental health professionals. The specific treatment approach depends upon the individual's location on the AIDS-related conditions continuum. For men already diagnosed with AIDS, psychological themes include fears of death and dying, guilt, concerns about exposure of a homosexual life-style, fear of contagion, loss of self-esteem, decreased social support and increased dependency needs, stigmatization, loss of occupational and financial security, confusion over medical treatment options, and severe depression. The integration of a mental health service into AIDS special care hospital wards and participation in support groups are particularly useful for men with AIDS. Anxiety is the major clinical symptom among those who have not developed full-blown AIDS, but show signs of immune suppression. Issues for men in this "gray zone" include isolation, poor social and occupational functioning due to fatigue, shame, and frustration of achievement needs. Stress- reduction techniques are especially important with this population, to eliminate further compromise to the immune system or even to strengthen it. Many asymptomatic gay men ("the worried well") are manifesting acute psychological symptoms such as panic, generalized anxiety, obsessional thinking about AIDS, and somatization. Training in the negotiation of safe-sex agreements can reduce some of this anxiety. In general, the AIDS epidemic has introduced an existential component to psychotherapy with gay men, with a concern over issues such as the meaning of life and death.
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PMID:The psychological impact of AIDS on gay men. 650 91

This paper presents a case in which treatment of acquired immunodeficiency syndrome (AIDS) was attempted with thymic humoral factor (THF). The capacity of THF for immunoenhancement and modulation of the immune response has been demonstrated in other conditions. The patient, a 24-year old black male homosexual from San Francisco, had experienced fever spikes, malaise, fatigue, anorexia, gradual vision loss, and weight loss over an 8-month period. Lymphopenia, T cell deficiencies, and imbalances in T cell subpopulations established the diagnosis of AIDS. Treatment with arabinoside A and fibroblast interferon was not effective. THF was then administered by daily injections for 3 weeks. At the end of the 2nd week of treatment, increased alertness and appetite were noted. Also documented was a transient increase in circulating lymphocytes, T cells, and helper cells. However, at the end of the 3rd week, the patient developed bronchopneumonia followed by renal failure and died in an acute encephalopathic state. Only 1 other (unsuccessful) attempt to treat an advanced case of AIDS with a thymic hormone has been reported. It is suggested that THF treatment might be more effective if offered at a very early stage of AIDS. It is hypothesized that a sufficient pool of precursor T cells is required to serve as target cells for immune modifiers such as THF. This precursor pool probably shrinks beyond rescue in the advanced stages of AIDS. The authors are currently involved in trials of immunomodulation with THF at early stages of immune impairment in pre-AIDS patients.
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PMID:Attempted treatment of acquired immunodeficiency syndrome (AIDS) with thymic humoral factor. 654 6

Since November 1982, patients with symptoms suggesting a lymphadenopathy syndrome (LAS) or acquired immune deficiency syndrome (AIDS), as well as their contacts and persons in high risk groups were examined as out-patients. The examinations have now been concluded in 101 patients. The patients were divided into 3 groups according to clinical symptoms and the OKT4+/OKT8+ ratio: 30 patients with normal ratio (group I), 59 patients with LAS and a ratio of less than 1 (group II) and 12 patients with fully developed AIDS (group III). During a follow-up time of 18 months, 3 patients of group I developed LAS and 1 patient in group II developed toxoplasma encephalitis. In a further 2 patients with LAS, uncharacteristic symptoms such as fever, tiredness and loss of weight increased, while at the same time the number of OKT4+ cells and thus the ratio fell significantly. In 4 cases the immunological parameters and the clinical picture improved. In 52 patients the clinical picture and the laboratory findings did not change. The demonstration of retrovirus HTLV III would seem to provide the cause of LAS and AIDS. Nonetheless, follow-up observation of contacts and patients with LAS remain important.
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PMID:[Clinical aspects and observations on patients with lymphadenopathy syndrome]. 654 58

This article provides a clinically-oriented overview of palliative care for patients with AIDS. Indicators of decreased survival time are divided into categories of infections/illnesses, clinical signs and symptoms, immunological and serological markers, and psychosocial factors. Primary symptoms in AIDS are discussed according to etiology and treatment. However, treatments of opportunistic infections per se are not directly addressed in this article. Problems discussed include pain, confusion, depression and anxiety, fatigue, fever, dyspnea, nausea and vomiting, diarrhea, wasting, and dehydration. The article also briefly addresses clinical and ethical questions and challenges presented by AIDS to hospice or palliative care providers, and the various stages of HIV infection.
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PMID:Palliative care for patients with acquired immunodeficiency syndrome. 749 35

The Karnofsky Performance Status (KPS) is the most widely used health status measure in human immunodeficiency virus (HIV) medicine and research. Because there are limited data on KPS metric properties in this setting, we present evidence of the construct validity of the KPS in a sample of HIV-infected persons using data from the AIDS Time-Oriented Health Outcome Study (ATHOS). The sample consisted of 160 primarily white, homosexual/bisexual men with a mean age of 45 years and a mean KPS score of 82 (range, 40-100). Ninety percent were classified in Centers for Disease Control (CDC) clinical category B or C. Pearson's product-moment correlations were strong between the KPS and measures of global health status, physical disability, numbers of symptoms, CDC clinical category, social function, days off work, and energy/fatigue (r = 0.39-0.52, p < 0.0001). Correlations with measures of mental health and cognition were less impressive but statistically significant. Analysis of variance followed by Student Newman-Keuls test showed significant differences among three KPS groupings for global health status but not for physical disability. Regression analysis indicated three significant variables accounting for KPS variance: visual analogue global health status (27%), days off work (10%), and energy/fatigue (1.7%). We conclude that the upper range of the KPS reflects global health status better than physical performance and much better than psychosocial constructs, in persons with HIV infection. Further research examining the ability of the KPS to detect clinically significant change over time is needed.
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PMID:Validity of the Karnofsky Performance Status in an HIV-infected sample. 889 76

The first case of disseminated Mycobacterium bovis infection with meningitis in an AIDS patient is reported. A 54-year-old male HIV-positive patient was admitted for evaluation of fever, weight loss, inappetence, fatigue and malaise. Mycobacterium bovis (non-BCG) was isolated from blood, bone marrow, stool, urine, sputum, abdominal lymph nodes and cerebrospinal fluid. Antituberculous therapy using a five-drug regimen plus steroids resulted in complete recovery.
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PMID:A case of disseminated Mycobacterium bovis infection in an AIDS patient. 761 65


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