Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1983 and 1987, a stepwise diagnostic programme was undertaken prospectively in 37 of 100 HIV-positive patients with 40 bronchopulmonary infections. It consisted chiefly of flexible bronchoscopy combined with lavage, transbronchial biopsy and/or removal of bronchial brush cells. Taking into account all examinations performed in life and at autopsy, 25 of the 37 patients had Pneumocystis carinii pneumonia (67.5%), 13 had bacterial pneumonia, six of these were mycobacterial infections (atypical mycobacteria in four), eight had neoplasms (pulmonary Kaposi's sarcoma in five, squamous-cell carcinoma in two, and Hodgkin's disease in one), and four patients had cytomegalovirus infection. Total diagnostic success of bronchoscopy was 78%; related to Pneumocystis pneumonia it was 91%.
 ...
PMID:[Pulmonary complications in acquired immunodeficiency syndrome. Results of a prospective study]. 336 74

Hyponatremia has been recognized as a complication in adults with acquired immunodeficiency syndrome (AIDS). We did a retrospective study evaluating the medical records of 86 children (age 4 months to 21 years) with human immunodeficiency virus (HIV-1) infection to determine the frequency and clinical associations of hyponatremia. Twenty-two children (26%) developed hyponatremia (serum sodium < 135 mEq/L; range 104 to 134 mEq/L; mean 130 mEq/L). Fourteen were male; 18 of the 22 patients were black and 4 were white. At the time of hyponatremia, the children frequently had comorbid associations, including 8 (35%) with AIDS encephalopathy; 3 (14%) with cardiomyopathy; 3 (14%) using diuretics; 1 (5%) using pentamidine; 3 (14%) with bacterial pneumonia; 2 (9%) requiring gastric lavage feedings; 2 (9%) with tuberculosis meningitis; 2 (9%) with gastroenteritis; 1 (5%) with infection caused by Mycobacterium avium-intracellulare; 1 (5%) each with brain tumor and tumor metastasis to brain. The cause of hyponatremia was attributed to syndrome of inappropriate antidiuretic hormone in 8 children; poor sodium intake and/or excessive diarrheal losses in 5; and the use of diuretics in 3 patients. Mild hyponatremia with no identifiable cause was found in 5 patients.
 ...
PMID:Hyponatremia in pediatric patients with HIV-1 infection. 748 60

Because AIDS patients frequently present with minimal symptomatology, radionuclide imaging with its ability to survey the entire body, is especially valuable. Gallium-67 citrate, the most commonly performed radionuclide study for localizing infection in these patients, is most useful for detecting opportunistic infections, especially in the thorax. A negative gallium scan, particularly when the chest X-ray is unremarkable, rules strongly against pulmonary disease. A negative gallium scan in a patient with an abnormal chest X-ray and Kaposi's sarcoma, suggests that the patient's respiratory distress is related to the neoplasm. Diffuse pulmonary parenchymal uptake of gallium in the HIV (+) patient is most often associated with PCP. While there are other causes of diffuse pulmonary uptake, the more intense or heterogeneous the uptake, the more likely the patient is to have PCP. Focal pulmonary uptake is usually associated with bacterial pneumonia although PCP may occasionally present in this fashion. Lymph node uptake of gallium is usually associated with Mycobacterium avium complex, tuberculosis, or lymphoma. When corresponding abnormalities are present on thallium scintigraphy lymphoma is likely. Gallium positive, thallium negative, studies suggest mycobacterial disease. Labeled leukocyte imaging is not useful for detecting opportunistic infections probably because of the inflammatory response incited by these organisms. Leukocyte imaging is, however, more sensitive for detecting bacterial pneumonia. In the abdomen, gallium imaging is most useful for identifying lymphadenopathy, while labeled leukocyte imaging is superior for detecting AIDS-associated colitides. In summary, radionuclide studies are valuable diagnostic modalities in AIDS. Their success can be maximized by tailoring the study to the individual's needs.
 ...
PMID:The role of gallium and labeled leukocyte scintigraphy in the AIDS patient. 755 45

Polymorphonuclear leukocytes (PMN) are the predominant inflammatory cells recruited in acute lung injury. This study compares the concentration of interleukin-8 (IL-8) to those of GRO alpha, both of which are CXC chemokines, in bronchoalveolar lavage fluid (BALF) in three acute pathologic states: bacterial pneumonia (BPN); adult respiratory distress syndrome (ARDS); and Pneumocystis carinii pneumonia (PCP). Levels of both IL-8 and GRO alpha were below 5 pg/ml in 16 nonsmoking volunteers who served as controls. Despite more than twice as many neutrophils in the BALF of the BPN group (n = 12) than in the group with ARDS (n = 13), both groups had similar levels of IL-8, of 569 +/- 120 pg/ml and 507 +/- 96 pg/ml, respectively. The GRO alpha concentrations in the BPN and ARDS patients were respectively 3.3 and 3.4 times those of IL-8, reaching 1,870 +/- 314 pg/ml for the BPN and 1,699 +/- 377 for the ARDS patients. In the PCP group (n = 48, 45 human immunodeficiency virus [HIV]-positive, 3 HIV-negative), GRO alpha levels (897 +/- 172 pg/ml) were sevenfold higher than IL-8 levels (123 +/- 40 pg/ml). In all pathologic states there was a good correlation between GRO alpha and IL-8 (r = 0.53, p = 0.0001). GRO alpha or IL-8 both correlate with the absolute neutrophil number/ml when all groups were studied together (r = 0.52, p = 0.0001). Only in the PCP and ARDS groups did IL-8 correlate with the PMN number.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:GRO alpha and interleukin-8 in Pneumocystis carinii or bacterial pneumonia and adult respiratory distress syndrome. 758 92

An increase in serum lactate dehydrogenase (LDH) activity is commonly taken to support the presumptive diagnosis of Pneumocystis carinii pneumonia (PCP), although the LDH level may also be increased in other lung infections and in a variety of extrapulmonary disorders. To assess its diagnostic value in patients with fever, lung infiltrates, and a high prevalence of HIV infection, we compared LDH levels in 42 hospitalized patients with PCP, 71 with disseminated tuberculosis (TB), 40 with pulmonary TB, and 37 with bacterial pneumonia. Peak LDH level was higher (p < 0.05) in patients with PCP (547 +/- 157 U/L) and disseminated TB (569 +/- 338 U/L) than in patients with pulmonary TB (258 +/- 66 U/L) or bacterial pneumonia (331 +/- 139 U/L). However, substantial overlap between groups limited its diagnostic value for individual patients. Expressing LDH as its ratio to simultaneous serum aminotransferases (AST or ALT) did not enhance its discriminatory value. Most patients in each group had abnormalities in other serum enzymes (AST, ALT, alkaline phosphatase, gamma-glutamyltransferase), making an isolated elevation of LDH level uncommon (21% of PCP cases). Serum LDH has a high sensitivity for PCP (100% in this series) but must be interpreted with caution given its lack of specificity.
 ...
PMID:Serum lactate dehydrogenase (LDH) in Pneumocystis carinii pneumonia, tuberculosis, and bacterial pneumonia. 763 77

Multiple defects in host defense mechanisms produce an increased incidence of community-acquired bacterial pneumonia in individuals infected with the human immunodeficiency virus. Clinical studies suggest that Staphylococcus aureus is an uncommon cause of such infections, though its incidence is increased in the setting of intravenous drug use, indwelling vascular catheter, and coexistent pulmonary Kaposi's sarcoma or pneumonia due to Pneumocystis carinii. The significantly higher incidence of S aureus pneumonia documented in autopsy series suggests that the infection frequently remains undiagnosed ante mortem. The clinical and radiologic presentation of staphylococcal pneumonia in HIV-seropositive patients is similar to that seen in immunocompetent hosts. However, atypical radiographic patterns can occur. We describe a case of S aureus pneumonia manifested as an infiltrate with focal predominance and multiple cavitary lesions. Such a radiologic appearance has not previously been described in this population. Given the likelihood that pneumonia due to S aureus is significantly underdiagnosed ante mortem, a high index of clinical suspicion is warranted.
 ...
PMID:Pneumonia due to Staphylococcus aureus in a patient with AIDS: review of incidence and report of an atypical roentgenographic presentation. 773 54

We assessed the utility of bronchoalveolar lavage (BAL) in the diagnosis of pulmonary tuberculosis (PTB) in 50 consecutive HIV-negative patients with clinical and radiographic findings suggestive of PTB, but with negative microscopy for acid-fast bacilli (AFB) on sputum smear. Patients were grouped, using a scoring system, into relative likelihoods of having PTB (I-IV, in descending probability). Patients were started on anti-tuberculosis treatment according to the BAL results. Bacteriological diagnosis of PTB was confirmed in 22/50 BAL; 11 (91.6%), seven (37%) and four (40%) of groups I-III, respectively. In 13 cases, an early diagnosis of PTB was made by positive microscopy for AFB on BAL; an alternative diagnosis was made in six cases (bacterial pneumonia 4, carcinoma 2). A decision analysis model was created to assess the overall utility of BAL. This suggested that in a region of high PTB prevalence, and when the clinical diagnosis of PTB is likely, empirical treatment is the best course of action, with BAL being reserved for further investigation of non-responders. Early BAL should be considered when the diagnosis of PTB is uncertain.
 ...
PMID:Bronchoalveolar lavage in pulmonary tuberculosis: a decision analysis approach. 779 77

The epidemiologic shift in HIV-infected populations from homosexual men to intravenous drug users and their sexual partners, together with the wide application of antipneumocystis prophylaxis and a better understanding of the broad range of HIV-associated illnesses, has changed our concept of the spectrum of lung infections that occur in patients with HIV infection. Bacterial pneumonia, not PCP, is the most common lower respiratory infection. Newer therapies of mild-to-moderate PCP increase the treatment options. The worldwide increase in tuberculosis cases is attributable to coinfection with HIV, and multidrug-resistant tuberculosis is now a serious threat, especially in the inner cities. Fungal pneumonias occur with increased frequency in patients with HIV infection, depending on the geographic factors and the severity of immunodeficiency.
 ...
PMID:Pneumonia in patients with HIV infection. 807 69

We present the pulmonary findings in 36 autopsies of children affected by the acquired immunodeficiency syndrome (AIDS). Twenty-three patients were male and 13 were female, ranging in age between 3 days and 13 years. Twenty children had human immunodeficiency virus (HIV)-positive parents or parents who were at high risk of exposure (intravenous drug abusers and prostitutes), five had a history of transfusion, and one had a history of renal transplantation and blood transfusion. Clinically, the patients presented with recurrent infections, failure to thrive, hepatosplenomegaly, fever, cough, and/or hemoptysis. Histologically, specific infectious processes were the most common finding (75% of cases), with Pneumocystis carinii pneumonia being the most prevalent type of infection, followed by bacterial pneumonia. Neoplastic conditions and lymphoid interstitial pneumonia were less frequent (approximately 10% of cases). In addition, in approximately 10% of the cases the pulmonary findings were non-specific (ie, pulmonary edema and atelectasis) and probably unrelated to HIV infection. Our findings suggest that specific infectious conditions constitute the most common type of pulmonary pathology in children with AIDS. However, because there is a small percentage of children with nonspecific findings, a transbronchial biopsy is important for proper evaluation before institution of therapy.
 ...
PMID:The spectrum of pathological changes in the lung in children with the acquired immunodeficiency syndrome: an autopsy study of 36 cases. 808 62

Although the original opportunistic pathogens described in AIDS were protozoal and fungal organisms, bacterial infections are now recognized with increased prevalence and altered expression in patients with HIV infection. Especially since populations outside of North America and populations of i.v. drug abusers have been studied, bacterial infections have been shown to cause substantially increased morbidity and mortality both early and late in the course of HIV infection. Just as strategies have been developed for primary and secondary prophylaxis of classical HIV-related opportunistic infections, prevention of bacterial complications should be a high priority. Good hygiene and avoidance of unsterile needles in illicit drug use, tattooing, ear-piercing, or other cosmetic or ritual activities should be emphasized in patient education. Patients should be counseled to avoid uncooked or poorly cooked eggs and poultry and to avoid unpasteurized milk products. Pneumococcal vaccine is recommended for all HIV-seropositive patients and should be given as early as possible after recognition of HIV infection for maximal efficacy. Influenza vaccine is also recommended. It may have a role in preventing bacterial pneumonia secondary to influenza. Patient management should include regular dental care and nutritional evaluation. The use of intravenous or central catheters should be limited to essential therapies. When patients present with new febrile illness, a high index of suspicion for invasive bacterial disease is appropriate. The signs of serious bacterial infection in HIV-positive patients are subtle. Diagnostic evaluation should include cultures of blood and other relevant clinical specimens. Empiric antimicrobial therapy based on the clinical presentation may be life saving in patients with invasive bacterial disease complicating HIV infection.
 ...
PMID:Bacterial infections in HIV-infected patients. 808 71


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>