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Query: UMLS:C0017160 (gastroenteritis)
 11,398 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present two cases of patients with acquired immunodeficiency syndrome who, in the course of their disease, suffered multiple intestinal perforations that were directly related to cytomegalovirus infection. Biopsy and surgical specimens and autopsy findings in both cases revealed extensive lesions of gastroenteritis; the gastroenteritis was characterized by randomly distributed deep ulcers, resulting in multiple perforations. The main characteristic histopathologic finding was the association of intestinal lesions with a severe form of cytomegalovirus-related occlusive vasculitis. This report provides evidence that supports the contention that cytomegalovirus is the primary causal agent of gastrointestinal lesions affecting immunocompromised patients.
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PMID:Multiple cytomegalovirus-related intestinal perforations in patients with acquired immunodeficiency syndrome. Report of two cases and review of the literature. 131 13

Adenoviruses are among the many pathogens and opportunistic agents that cause serious infection in the congenitally immunocompromised, in patients undergoing immunosuppressive treatment for organ and tissue transplants and for cancers, and in human immunodeficiency virus-infected patients. Adenovirus infections in these patients tend to become disseminated and severe, and the serotypes involved are clustered according to the age of the patient and the nature of the immunosuppression. Over 300 adenovirus infections in immunocompromised patients, with an overall case fatality rate of 48%, are reviewed in this paper. Children with severe combined immunodeficiency syndrome and other primary immunodeficiencies are exposed to the serotypes of subgroups B and C that commonly infect young children, and thus their infections are due to types 1 to 7 and 31 of subgenus A. Children with bone marrow and liver transplants often have lung and liver adenovirus infections that are due to an expanded set of subgenus A, B, C, and E serotypes. Adults with kidney transplants have viruses of subgenus B, mostly types 11, 34, and 35, which cause cystitis. This review indicates that 11% of transplant recipients become infected with adenoviruses, with case fatality rates from 60% for bone marrow transplant patients to 18% for renal transplant patients. Patients with AIDS become infected with a diversity of serotypes of all subgenera because their adult age and life-style expose them to many adenoviruses, possibly resulting in antigenically intermediate strains that are not found elsewhere. Interestingly, isolates from the urine of AIDS patients are generally of subgenus B and comprise types 11, 21, 34, 35, and intermediate strains of these types, whereas isolates from stool are of subgenus D and comprise many rare, new, and intermediate strains that are untypeable for practical purposes. It has been estimated that adenoviruses cause active infection in 12% of AIDS patients and that 45% of these infections terminate in death within 2 months. In all immunocompromised patients, generalized illness involving the central nervous system, respiratory system, hepatitis, and gastroenteritis usually have a fulminant course and result in death. Treatments for adenovirus infections are of little proven value, although certain purine and pyrimidine analogs have shown beneficial effects in vitro and may be promising drugs.
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PMID:Adenoviruses in the immunocompromised host. 132 83

A variant of simian immunodeficiency virus (SIVSMM/PBj), isolated from a chronically infected pig-tailed macaque has been shown in previous studies to produce acutely fatal disease uniformly in pig-tailed macaques and in some rhesus macaques. The present study extends investigation of SIVSMM/PBj pathogenesis in rhesus and cynomolgus monkeys. Cynomolgus and rhesus macaques were found to be uniformly susceptible to infection, but as previously reported, the rhesus were found to not be uniform in their response during the acute disease. Homogenized tissues from a rhesus that died acutely from SIVSMM/PBj were passaged to 6 rhesus monkeys in an attempt to increase lethality. Five of 6 rhesus monkeys receiving intravenous inoculation of either spleen (10(3) TCID50) or lymph node (10(5) TCID50) homogenate developed acute disease; 4 died (days 8-10), 1 recovered, and one rhesus remained asymptomatic. Three of 3 cynomolgus macaques and 4 of 4 pig-tailed macaques receiving the same inoculum died acutely within 9 days. Clinical disease in macaques that died was characterized by diffuse lymphadenopathy within 5 days of inoculation and severe diarrhea beginning 1 to 3 days before death. Anorexia, lymphopenia (< 1000 cells/mm3), and mild hypoalbuminemia preceded onset of diarrhea by 24 h. Viral p27 was detected in circulation by day 6 postinfection, with all animals dying acutely having detectable serum p27 and no detectable humoral response. Acute lethality was attributed to severe metabolic acidosis (pH < 7.20) which was observed 24-48 h prior to death in the pig-tailed and cynomolgus macaques. Immunohistochemistry revealed numerous SIV antigen-positive lymphocytes and macrophages in the lymph nodes, spleen, gut-associated lymphoid tissues and gastrointestinal lamina propria. Histopathologic lesions included marked to severe hyperplasia of the T-cell-dependent areas in lymphoid tissues and diffuse nonulcerative lymphohistiocytic gastroenteritis. Surviving rhesus developed strong humoral immune responses to the major SIV proteins.
AIDS Res Hum Retroviruses 1992 Sep
PMID:Infection of rhesus and cynomolgus macaques with a rapidly fatal SIV (SIVSMM/PBj) isolate from sooty mangabeys. 145 9

The spectrum of infection with Aeromonas and Plesiomonas included gastroenteritis, bacteremia, biliary tract infection, perirectal infection, and disseminated disease. Most patients (86%) with bacteremia were neutropenic (less than 500 PMN/mm3). Colonization of stools and sputum also occurred. Therapy with aminoglycosides, beta-lactams, trimethoprim/sulfamethoxazole, and the newer quinolones was effective in patients with AIDS and cancer.
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PMID:Spectrum of Aeromonas and Plesiomonas infections in patients with cancer and AIDS. 204 95

Eleven children were identified as being seropositive for HIV-1 at the Ethio-Swedish Children's Hospital, Addis Abeba, Ethiopia between January 1988 and September 1989. The diagnosis was confirmed by both ELISA and Western blot methods performed at the National Research Institute of Health, Special Laboratory for AIDS. The mean age was 2 years and 5 months, with a range of 1 week to 10 years. There were 7 boys and 4 girls. The most common admitting diagnoses were pneumonia (5), gastroenteritis (5), marasmus (5), disseminated tuberculosis (4), and abandonment (3). One patient had extensive facial molluscum contagiosum. Symptoms at admission or during hospitalization included diarrhoea (9), failure to thrive (8), fever (7), and cough (7). Physical findings included hepatosplenomegaly (5), lymphadenopathy (3), and oral candidiasis (2). No patient with an opportunistic infection or radiographic evidence of lymphocytic interstitial pneumonitis (LIP) was identified. Five patients were classified as marasmic and 4 as underweight. Evidence suggestive of encephalopathy (developmental delay and/or microcephaly) was present in 5 patients. The VDRL was non-reactive in the 5 patients in whom it was tested. Nine children were presumed to have acquired the infection by perinatal transmission, though the passive transfer of maternal antibodies or postnatally acquired infection could not be excluded. One child was thought to have acquired the infection by blood transfusion. Three children died during their hospital stay. Paediatric HIV infection exists in Ethiopia; however, these children do not present with characteristic opportunistic infections but with signs and symptoms reflecting the most common paediatric problems seen in the country. Prevention of HIV infection in children entails the prevention of infection in women of childbearing age, counselling of infected women, and effective screening of blood products.
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PMID:Clinical and epidemiological features of HIV-1 seropositive hospitalized Ethiopian children. 206 May 7

Two distinct processes contribute to the spectrum of human cytomegalovirus (HCMV)-induced pathology. In the first instance, cytopathic effects appear to occur as a direct result of virus replication. This type of disease is characterized by persistent HCMV infection of neural or gastrointestinal tissue, which results in HCMV retinitis, encephalitis, hepatitis, or gastroenteritis. Direct cytopathic effects of HCMV are associated with congenitally acquired or acquired immune deficiency syndrome-related manifestations of HCMV infection. A second type of HCMV-associated disease process is driven by immunopathologic mechanisms and results in variable mononucleosis-like syndromes and/or pneumonia in normal or partially immunosuppressed individuals. Human cytomegalovirus-associated interstitial pneumonia appears to derive from a combination of these two types of disease processes. Here, persistent viral infection, immunopathologic mechanisms, and virus-induced expression or repression of cellular genes each constitutes an important factor in pathogenesis. An understanding of the multiple underlying mechanisms of pathogenesis is crucial to devising optimum treatment approaches.
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PMID:Epidemiology and pathogenesis of cytomegalovirus disease. 216 Jan 29

The clinical manifestations of cytomegalovirus (CMV) infection in persons with AIDS are described, and recent advances in the management of these syndromes with antiviral agents are reviewed. CMV infection is the most common serious opportunistic viral infection in AIDS patients. Clinical manifestations include chorioretinitis, gastroenteritis, hepatitis, pneumonia, CNS infection, adrenalitis, and a wasting syndrome. The diagnosis of CMV infection requires laboratory demonstration of a serologic response to the virus, detection of viral components or products, or isolation of the virus. Ganciclovir is an acyclic nucleoside analogue marketed for the treatment of CMV-related retinitis in immunocompromised hosts. After i.v. ganciclovir induction therapy, more than 80% of patients show improvement or stabilization of retinitis. Relapse is common in AIDS patients, however, and low-dose i.v. maintenance therapy is recommended. The most serious dose-limiting effect is neutropenia. Intravitreal injection of ganciclovir has been well tolerated and efficacious. Ganciclovir has shown some efficacy in the treatment of other life-threatening CMV infections, especially gastroenteritis, but data are limited. Ganciclovir-resistant strains have been reported. Foscarnet, a pyrophosphate analogue with activity against both human CMV and human immunodeficiency virus, is undergoing clinical trials. Foscarnet has shown promise in the therapy of CMV-related retinitis, but results for other CMV infections are disappointing. Nephrotoxicity is the major dose-limiting effect. AIDS patients with sight-threatening and rapidly progressive CMV-related retinitis should be treated with ganciclovir. Foscarnet may offer an alternative when it becomes available. More must be learned about the efficacy of these drugs in the treatment of CMV infection in patients with AIDS.
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PMID:Management of cytomegalovirus infection in patients with acquired immunodeficiency syndrome. 216 89

Cytomegalovirus (CMV) infection in patients with the acquired immunodeficiency syndrome (AIDS) can present as either disseminated disease, pneumonitis, retinitis, gastroenteritis, neuropathy, or a subclinical infection. We report a patient whose initial manifestation of CMV infection was severe central airways obstruction due to necrotizing tracheitis. At bronchoscopy, the lesion appeared deeply ulcerated, distinctly different from previously described airway lesions in patients with AIDS. Mucosal biopsies showed characteristic intranuclear and intracytoplasmic inclusions and cultures yielded only CMV. The patient responded partially to ganciclovir, steroids, and antibiotics against suspected anaerobic superinfection but died as a result of central nervous system disease believed due to toxoplasmosis or lymphoma. CMV infection of the upper airway should be considered in the patient with AIDS presenting with atypical cough or stridor and ulcerated endobronchial lesions.
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PMID:Central airway obstruction due to cytomegalovirus-induced necrotizing tracheitis in a patient with AIDS. 217 87

Human cytomegalovirus (CMV) has several possible roles in the pathogenesis of AIDS. CMV causes a number of clinical syndromes, including retinitis, pneumonitis, and gastroenteritis in patients infected with human immunodeficiency virus type 1 (HIV-1). In addition, CMV may potentiate the cellular immunodeficiency observed in patients with HIV infection either directly or through enhancement of HIV replication. Finally, CMV may predispose the host to bacterial or fungal infection by compromising the integrity of mucosal barriers to infection. Therapy with ganciclovir for CMV infection may result in a decrease in morbidity related to the virus, but problems with drug toxicity and resistance to the agent mandate the development of additional therapeutic approaches.
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PMID:Cytomegalovirus in the setting of infection with human immunodeficiency virus. 164 83

Between January 1985 and December 1987, seventy-five children of intravenous heroin-addicted parents (one or both) were studied. Their ages ranged from 4 days to 14 years. All patients had suffered from several pediatric diseases. Three major types of problems were found among the children studied: infectious diseases, nutritional diseases, and parental neglect and/or disinterest. The most common diagnoses at discharge were gastroenteritis (24%), pneumonia (21%), malnutrition (17%), upper airway infectious diseases (13%), septicemia (12%), child abuse (4%), acquired immunodeficiency syndrome (3%), and other infectious diseases (24%). Their parents reported hepatitis B virus infection, acquired immunodeficiency syndrome (AIDS), and alcoholism. The unemployment rate among the fathers was 37%. Sixteen percent of mothers were prostitutes. There was an imprisonment record of 19% for mothers and fathers combined. A multidisciplinary approach for this group of children would make prevention possible and care less expensive.
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PMID:Social and medical problems in children of heroin-addicted parents. A study of 75 patients. 239 28


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