Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nervous system opportunistic infections are seen in about one fifth of AIDS cases and account for over 40% of the patients with neurological manifestations. Serious infections are seen in severely immunosuppressed patients, usually with CD4 counts of 200 ml-1 or less. The commonest is CMV, which can produce acute encephalitis, sometimes with focal hemisphere or brain-stem signs, dementia, retinitis, optic neuritis and an ascending radiculomyeloencephalitis. Cryptococcal meningitis is the most frequent fungal disease; a high degree of clinical suspicion is required in patients with fever, malaise, headache or seizures. Only CSF cultures are always positive; both serum and CSF cryptococcal antigen tests are highly sensitive and specific. Treatment with amphotericin B and flucytosine is successful in at least 70% of first episodes but side-effects are common. Without maintenance therapy 50% of patients relapse; fluconazole is recommended. Cerebral toxoplasmosis can present with focal cerebral or spinal cord signs but also as a diffuse encephalopathy; negative T. gondii serology is exceptional but positive serum titres are usually unhelpful. Treatment with sulfadiazine, pyrimethamine and folinic acid achieves good results in 90% of the first episodes, but side-effects are common. Appearances on CT scan or MRI may take several weeks to improve. The value of an empirical approach to treatment is well-established; an initial cerebral biopsy is difficult to justify. Without maintenance therapy a relapse rate of 50% can be expected; therapy with sulfadiazine and pyrimethamine may also prevent pneumocystosis. HIV disease appears to increase the likelihood of neurosyphilis, and the risk of relapse after conventional penicillin doses, in patients with syphilis; at least 3-4 weeks of appropriate therapy are recommended. A number of other diseases caused by viruses, fungi, bacteria and parasites are less common; these include progressive multifocal leukoencephalopathy, herpes simplex and zoster infections and tuberculosis.
 ...
PMID:Central nervous system opportunistic infections in HIV disease: clinical aspects. 134 47

There are several protozoan infections that cause relatively benign illness in normal individuals but result in severe disease manifestations in patients with AIDS. These diseases include Pneumocystis carinii pneumonia, CNS toxoplasmosis, cryptosporidiosis, and isosporiasis. Pneumocystis carinii pneumonia (PCP) caused by Pneumocystis carinii, is the most common opportunistic infection in AIDS. It is seen in more than 80% of individuals with this syndrome. Although historically classified as a protozoan, this organism shares many biochemical characteristics with fungi. The onset of PCP may be insidious, and cough and dyspnea are the most common presenting symptoms. Auscultation of the lungs is often unremarkable, but diffuse infiltrates are commonly seen on chest radiographs. The diagnosis of PCP can be confirmed by identifying the organism on specimens obtained by sputum induction or bronchoalveolar lavage. Trimethaprim-sulfamethoxazole is the treatment of choice but is unfortunately associated with leukopenia and rash in many individuals. Both trimethaprim-sulfamethoxazole and aerosolized pentamidine are used prophylactically in patients at high risk for initial or relapsing infection. The appropriate use of these agents has resulted in improved survival for AIDS patients with PCP. Toxoplasmosis, due to Toxoplasma gondii, affects the central nervous system in patients with AIDS. Headache is a common presenting symptom, and both seizures and paresis can occur. A diagnosis of toxoplasmosis is strongly suspected in symptomatic individuals with ringed mass lesions noted on head CT. Patients with this condition are treated with a combination of sulfadiazine, pyrimethamine, and folinic acid. Cryptosporidiosis and isosporiasis are coccidian protozoan diseases that can result in severe, acute, and chronic diarrhea in immunocompromised individuals. Cryptosporidiosis is the more common of the two and is caused by an unknown species of the genus crytosporidium. Isosporiasis is due to infection with Isospora belli. Dehydration and weight loss are a common result of infection with either agent. A definitive diagnosis can be made by examining an acid fast stain of a diarrheal stool specimen and demonstrating oocysts that are specific for each of these organisms. Fluid replacement and general supportive care are essential in the treatment of both of these diseases. Spiramycin is an unproven treatment modality that is often used in patients with cryptosporidiosis. Isosporiasis responds to initial therapy with trimethaprim-sulfamethoxazole, followed by prophylaxis with pyrimethamine. The adoption of safe sexual practices that minimize fecal-oral contamination should decrease the future prevalence of these diseases and other enteric parasitic infections.
 ...
PMID:Parasitic diseases. Diseases associated with acquired immunodeficiency syndrome. 201 33

A 31-year-old white male homosexual was healthy until March 1984, when he developed Pneumocystis carinii pneumonia, which resolved with treatment. In April 1984 he developed fever, followed by hepatosplenomegaly, headaches, blurred vision, pancytopenia and pulmonary infiltrates. On June 11, intracytoplasmic yeast were noted within leukocytes on a peripheral blood smear, and amphotericin B was started. The patient developed progressive respiratory and renal insufficiency and died on June 13, 1984. Autopsy histopathology demonstrated disseminated histoplasmosis and Histoplasma capsulatum was cultured from numerous tissues. Ocular histopathologic examination using special fungal stains and electron microscopy revealed numerous budding yeasts characteristic of Histoplasma capsulatum in the choroid, retina and central retinal vein. Their identification as H. capsulatum was confirmed by immunofluorescent staining.
 ...
PMID:Disseminated bilateral chorioretinitis due to Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome. 241 18

This article presents electronmicroscopy evidence of retrovirus-like particles with bar shaped cores in salivary and prostate glands as well as testicles of 2 acquired immunodeficiency syndrome (AIDS) patients. The 1st case, a 38-year old black male homosexual, presented in 1982 with diarrhea, malabsorption, and weight loss. In the following 1 1/2 years, he experienced recurrent Candida esophagitis, cutaneous and pulmonary Kaposi's sarcoma, Pneumocystis carinii pneumonia, and cytomegalovirus. Autopsy in 1984 revealed residual Kaposi's sarcoma, disseminated cytomegalovirus, and M avium-intracellulare. The 2nd case, a 31-year old white male homosexual, presented in 1984 with Pneumocystis carinii penumonia and subsequently developed persistent fever, hepatomegaly, headaches, blurred vision, progressive liver function deterioration, and disseminated histoplasmosis infection. Autopsy in 1984 revealed an overwhelming disseminated histoplasmosis infection. Tissues taken at postmortem were examined by electron microscopy. Particles that conformed with the morphologic characteristics of AIDS retrovirus (a size of about 140 nm, a round shape with a double membrane, and an elongated core) were detected in the prostate gland of patient 2 and in the salivary glands and testes of both patients. This finding suggests that saliva and semen may be body fluids by which transmission of the AIDS virus occurs.
 ...
PMID:Retrovirus-like particles in salivary glands, prostate and testes of AIDS patients. 298 94

The HIV epidemic probably arose in Africa at about the same time as in the West, and there is a significant seroprevalence of HIV in the central African region. However, the epidemiology and clinical course of AIDS are different in Africa and in the West. In Africa males are infected as often as females, and the commonest means of transmission is heterosexual intercourse. Many HIV-infected people are symptomless, but many others present with or progress to generalized lymphadenopathy, pruritus, herpes zoster, herpes simplex, cellulitis, and oral candidiasis. The World Health Organization developed a clinical case-definition of AIDS in Africa, which was found to have a specificity of 90% and a sensitivity of 59% when tested in Zaire. The Kaposi's sarcoma seen in African AIDS patients is more aggressive than that seen in the West and is often visceral. Gastrointestinal AIDS (the "slim" disease) with weight loss and diarrhea is common in Africa, as are oral and esophageal candidiasis. In Africa Pneumocystis carinii pneumonia is rare, but pulmonary tuberculosis is common. Neurological manifestations include cerebral toxoplasmosis, cytomegalovirus infection, headache, and terminal encephalopathy. About 60% of infants born to seropositive women are infected and die within the 1st year of life. Lack of drugs and diagnostic facilities make both diagnosis and treatment of opportunistic infections difficult.
 ...
PMID:Clinical aspects of HIV infection in developing countries. 305 40

In 8 of 18 homosexual men with the acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP) treated with intravenous co-trimoxazole (trimethoprim-sulphamethoxazole) apparent drug-related complications developed during the course of acute therapy. A symptom complex of fevers and increasing malaise, often with nausea and headaches, developed usually after 9 days of therapy at a daily dosage of 20 mg/kg of trimethoprim and 100 mg/kg of sulphamethoxazole. These symptoms were associated with a diffuse erythematous maculopapular eruption and peripheral cytopenias. A similar picture was noted in two children with suspected AIDS-associated PCP. The high frequency of adverse reactions to co-trimoxazole therapy for PCP seems to be characteristic of AIDS patients.
 ...
PMID:Complications of co-trimoxazole in treatment of AIDS-associated Pneumocystis carinii pneumonia in homosexual men. 613 45

This article reports a case of needlestick transmission of human T-lymphotropic virus type III (HTLV-III) infection to a health care worker in the UK from a patient who was presumably infected while in Africa. The patient, a white woman who had lived in central southern Africa, presented at the hospital with general malaise, dry cough, and fever. Lung biopsy revealed Pneumocystis carinii pneumonia infection, and the patient was seropositive for HTLV-III infection with a titer of 260. The patient reported that she had been unwell for 2-3 years. She had none of the accepted risk factors for acquired immunodeficiency syndrome (AIDS), and neither she nor her husband had visited the US, the Caribbean, or Zaire. Serum from the husband was positive for HTLV-III antibodies at a titer of 450. Despite intensive management and treatment with pentamidine, the patient died. During management of this case, a nursing staff member sustained a needlestick injury to the finger while resheathing a hypodermic needle. A small amount of blood was probably injected. 13 days later, the health care worker developed a severe flu-like illness with sore throat, headache, myalgia, and facial neuralgia. A macular rash and generalized lymphadenopathy were also noted. Serum drawn 27 days after the incident was negative for anti-HTLV-III infection, but titers on days 49 and 57 were 12 and 24, respectively. This contrasts with experience in the US, where needlestick injuries in health care workers have not resulted in either disease or transmission. It is assumed that the patient acquired AIDS in Africa, and that the infection was transmitted heterosexually. This case raises the possibility of differences in infectivity and other characteristics between HTLV-III viruses of US and African origin.
 ...
PMID:Needlestick transmission of HTLV-III from a patient infected in Africa. 615 Mar 72

The clinical presentation, radiological and laboratory evaluation, treatment, and risk factors of sinusitis in a cohort of 376 human immunodeficiency virus (HIV)-infected children from a placebo-controlled clinical trial of intravenous immunoglobulin (IVIG) as prophylaxis for infections were examined. Ninety-five episodes of sinusitis were described in 60 patients; one-third of the patients had two or more episodes. Sinusitis episodes were commonly associated with nonspecific, chronic symptoms (67.4%, persistent nasal discharge; 54.7%, nocturnal or persistent cough), whereas symptoms more specific to acute sinusitis were less frequent (17.9%, headache or facial pain; 9.5%, periorbital swelling; 25.3%, temperature of > or = 102 degrees F; 9%, total white blood cell count of > or = 15,000/mm3). The sinuses primarily involved were the maxillary sinus (85.9%) and the ethmoidal sinus (42.3%); 36% of episodes involved two or more sinuses. Preceding respiratory infections did not appear to increase the risk of sinusitis, and CD4+ lymphocyte counts in children with and without sinusitis did not differ. Neither monthly IVIG prophylaxis nor three times weekly trimethoprimsulfamethoxazole prophylaxis for Pneumocystis carinii pneumonia decreased the risk of sinusitis. Sinusitis in HIV-infected children is most often subacute and recurrent. Evaluations of new modalities for prophylaxis for sinusitis are needed.
 ...
PMID:Sinusitis in children infected with human immunodeficiency virus: clinical characteristics, risk factors, and prophylaxis. National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. 858 39

A 38-year-old hemophiliac, who had been infected with HIV by the administration of blood products and had been diagnosed as AIDS by the onset of Pneumocystis carinii pneumonia, was admitted to our hospital with the complaints of headache and vomiting. After he was diagnosed as cryptococcal meningitis using the microscopy, cryptococcal antigen detection and culture of cerebrospinal fluid, treatment with amphotericin-B and fluconazole was started. As there was no clinical improvement, spinal drainage was performed and acetazolamide administered in order to reduce the intracranial pressure. Treatment was changed from AMPH-B and FLCZ to a combined therapy of AMPH-B and itraconazole. As his clinical features showed improvement, he was discharged home on a maintenance dose of ITCZ and acetazolamide after having been hospitalized for three months. This case-report may be of use in the management of cryptococcal meningitis in patients with AIDS.
 ...
PMID:[A case of AIDS with intractable cryptococcal meningitis]. 879 10

This study was carried out in 60 AIDS patients who presented toxoplasma encephalitis in Martinique (French West Indies). Diagnosis was based on a combination of fever, neurologic signs, and characteristic CT-scan images in patients with positive HIV serology. There were 46 males and 14 females with a mean age of 40 years. The mode of transmission was heterosexual in most cases (68.3%). The incidence of drug-related transmission was low (6.7%). Neurotoxoplasmosis was the most frequent presenting symptom of AIDS (53.3%) followed by esophageal candidosis (20%) and pneumocystosis (10%). Clinical symptoms were headache (56.5%), fever (48.3%), hemiparesia (36.6%), and confusion (36.6%). CT-scan showed most lesions to be multiple (70%), hypodense (89%), and subject to contrast uptake (93%). Mean lymphocyte level was 1128/mm3 with 88 CD4/mm3 and a CD4-to-CD8 ratio of 0.14. Conventional treatment using a combination of pyrimethamine and sulfadiazine led to skin rash and neutropenia and had to be discontinued in 30% of cases. Clinical symptoms and mean survival (327 days) were the same as comparable findings from Europe and North America.
 ...
PMID:[Cerebral toxoplasmosis and AIDS in Martinique]. 951 53


1 2 3 Next >>