Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019209 (hepatomegaly)
 5,798 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Physicians examined the records of 47 adults with visceral leishmaniasis (VL) and HIV-1 infection who were patients at 3 urban teaching hospitals in the Andalucia region in southern Spain between January 1986 and November 1991. They wanted to identify the clinical, biological, and epidemiological features of VL in HIV-1 positive patients. 96% of the cases were diagnosed with both infections during the last 2 years of the study period and 79% between January and November 1991. All the patients had risk factors for HIV infection (65.9% IV drug use, 21.3% sexual contact, and 12.8% blood transfusion). 70% exhibited the classic symptoms of VL (fever, enlarged liver and spleen, and depressed counts of blood cells). Most patients were already very immunocompromised when VL was diagnosed. 87% had a total lymphocyte count of less than 1000 x 1 million/1 and a CD4 lymphocyte count of less than 200 x 1 million/1. In fact, 66% had full blown AIDS prior to diagnosis of VL. VL was the first severe infection in 10 cases. 68% also suffered from opportunistic infections, especially candidiasis, extrapulmonary tuberculosis, and Pneumocystis carinii pneumonia. Microscopic examination of Leishmania amastiogotes in tissue samples led to a diagnosis in 94% of cases, isolation of motile amastigotes in culture of bone marrow aspirate in 2%, and microscopic and culture in 4%. Just 46% completed a full course of treatment (pentavalent antimony, allopurinol, and/or pentamidine). Only 38% had a microbiological response. Immunofluorescence detected sizeable titers (1:40) of antileishmanial antibodies in just 31% of cases. 17% experienced clear clinical improvement. Physicians in endemic areas should consider VL in every HIV-1 infected patient with fever, hepatosplenomegaly, or hematological abnormalities to avoid underdiagnosis of leishmaniasis.
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PMID:Visceral leishmaniasis in HIV-1-infected individuals: a common opportunistic infection in Spain? 136 80

Local hepatic tuberculosis is an unusual form of extrapulmonary tuberculosis. The authors describe the case of a 39-year-old woman with this disease who posed diagnostic difficulties. She presented with abdominal pain, minimal constitutional symptoms, hepatomegaly and radiologic findings of a focal hepatic lesion. Laparotomy was required for diagnosis. A literature review revealed that most individuals with local hepatic tuberculosis have fever, night sweats and weight loss. Hepatomegaly is often the only abnormal physical sign. Minimally elevated serum bilirubin and alkaline phosphatase levels are common. Ultrasonography and computerized tomography will demonstrate a lobulated, hypoechoic liver mass. Definitive diagnosis requires demonstration of acid-fast bacilli in biopsy material obtained by percutaneous techniques or at laparotomy. Cultures of the diseased liver are usually negative. Antituberculous drug therapy appears to be the preferred method of treatment.
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PMID:Local hepatic tuberculosis, the cause of a painful hepatic mass: case report and review of the literature. 309 51

An outpatient HIV clinic was opened in March 2005 in Binh Thanh District, a poor section of Ho Chi Minh City, Vietnam. Over 1500 patients were seen in the first year. The average age of patients was 27 years. Men represented 77% of the clinic population, women, 23% and children under the age of 16 years of age, 5% of the population. The most common risk factor among men was being an injecting drug user (IDU), 76%, and among women, being married to an IDU HIV-positive man, 35%. Physical signs of disease were uncommon: lymphadenopathy in 24% and hepatomegaly and splenomegaly in 4% and 3%, respectively. Men and women were anaemic at presentation, with a mean haemoglobin of 11.9 g/dL and 11.1 g/dL, respectively. An overwhelming majority of patients had profound immunodeficiency. The mean CD4+ cell count was 164 cells/mL and the median was 69 cells/mL. No correlation was found between the World Health Organization's stage of disease and the CD4+ cell count. Thus, the former is a poor predictor of immunity in this population. Data regarding opportunistic infections diagnosed at the first visit were studied. Candidiasis of the oral pharynx, oesophagus or vagina was found in 34.5% of the patients, and pulmonary and extrapulmonary tuberculosis was found in 32% of the patients. Pneumocystis carinii pneumonia (PCP) was diagnosed in only 3% of the patients. Cotrimoxazole prophylaxis is advocated for HIV-infected Vietnamese, but the incidence of PCP is negligible and resources could be spent elsewhere. The various opportunistic infections seen in this resource-poor clinic setting is likely to be a pattern of presentation of HIV-infected Vietnamese for some time to come.
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PMID:Clinical features of HIV/AIDS patients presenting to an inner city clinic in Ho Chi Minh City, Vietnam. 1762 7

Hepatic involvement is common in miliary and extra-pulmonary tuberculosis but is usually clinically silent. Therefore, it is rarely diagnosed. We report the case of a patient that presented with prolonged fever and hepatomegaly. Liver biopsy revealed non-necrotizing granulomas that led in turn to the diagnosis of generalized tuberculosis and HIV infection. The patient reported an old untreated tuberculosis and depression of the immune system provoked the reactivation of this old tuberculosis focus. We describe the clinical course of the disease and the challenges associated with the complexity of the treatment. Diagnosis of hepatic tuberculosis requires a high degree of suspicion especially in AIDS patients who show atypical presentations. However, it is a potential curable disease and good results have been obtained with the four drug regimen.
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PMID:Liver tuberculosis in an HIV patient: diagnosis and management. 2104 14

An adult, female, pig-tailed macaque (Macaca nemestrina) of Indonesian origin presented with profound weight loss, anemia (PCV, 29%; normal, 36% to 45%), hypoalbuminemia (1.0 g/dL; normal, 3.5 to 5.2 g/dL), elevated alkaline phosphatase (1990 U/L; normal, 26 to 98 U/L), and an elevated erythrocyte sedimentation rate (75 mm/h; normal, less than 20 mm/h). Abdominal ultrasonography demonstrated an enlarged liver with hyperechoic areas. Euthanasia was performed. Grossly, the liver had multifocal, effacing, white masses throughout and was enlarged with rounded edges. There were 2, small nodules in the right lung lobes. Histologically, the hepatic masses were densely fibrous-encapsulated granulomas with vast central necrosis. The lung nodules also were maturing granulomas, and one kidney and one atrium had small, early granulomas. Fite acid-fast stains of liver and lung revealed very few acid-fast bacilli. PCR analysis of paraffin-embedded liver identified Mycobacterium tuberculosis complex. Culture of the liver was negative twice. This macaque had 16 negative intradermal tuberculin skin tests over the course of 6 y. We hypothesize that the animal arrived with a latent hepatic or enteric infection that later recrudesced and disseminated. Primary hepatic mycobacteriosis is not a typical presentation of tuberculosis in macaques. Negative tuberculin skin tests can be seen with latent infections and extrapulmonary tuberculosis such as Pott disease. This case underscores the problems associated with current surveillance procedures and the risks associated with latent mycobacterial infections in macaques.
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PMID:Primary hepatic Mycobacterium tuberculosis complex infection with terminal dissemination in a pig-tailed macaque (Macaca nemestrina). 2143 22