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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1982 and 1986 in western Zaire, a pediatrician collected data on 206 children under 5 years old presenting at the Institute Medical Evangelique, a 400-bed mission hospital (60 pediatric beds), in Kimpese with persisting fever despite chloroquine therapy for falciparum malaria, a negative or scanty positive thick film for malaria, and no clear localizing signs of infections. The pediatrician suspected that these cases had an extraintestinal Salmonella infection and took blood, synovial fluid, and/or cerebrospinal fluid samples for diagnostic analyses. Salmonella serotypes other than Salmonella typhi (non-S. typhi) were responsible for most bacteremia cases (83%). The clinical features of non-S. typhi and S. typhi infections were basically the same. The case fatality rate for non-S. typhi and S. typhi an S. typhi infections were 22.7% and 29.4%, respectively. Infants under 6 months old had a significantly higher case fatality rate than older children (relative risk [RR] = 1.7; p .0005; e.g., 66% and 100% for infants under 3 months old). Meningitis was significantly associated with increased mortality, regardless of age (RR = 4.68). Jaundice was the only clinical sign significantly linked to increased mortality (RR = 2.35), especially among children who had S. typhi infection (80%). Mortality occurred significantly more often when children fell ill with Salmonella bacteremia in the late rainy season, coinciding with the peak of malnutrition, than in the dry season (RR = 2.62). Chloramphenicol-resistant non-S. typhi isolated were significantly associated with increased mortality (RR = 3.19). Hemoglobin levels below 6 g (i.e. severe anemia) has a strong link to increased mortality (RR = 1.77). Salmonella bacteremia will become more difficult to treat as antibiotic resistance and the prevalence of HIV infection increases in African countries.
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PMID:Salmonella bacteraemia among young children at a rural hospital in western Zaire. 768 45

A clinical failure of pneumococcal vaccine is reported. A 22 year old African woman was given 23-valent pneumococcal vaccine at her initial presentation with HIV infection. She was asymptomatic and had a CD4+ lymphocyte count above 500 cells/mm3. Eighteen months later she died of meningitis and septicaemia due to Streptococcus pneumoniae type 9 (an antigen included in the 23-valent vaccine). Pneumococcal antibody levels performed on stored blood demonstrated no serological response to the vaccine. This is the first reported case of clinical failure of pneumococcal vaccine in an HIV infected patient who received vaccine whilst at the asymptomatic stage of HIV infection and with relatively intact immune function. The literature pertaining to pneumococcal vaccination in the context of HIV infection was reviewed. Pneumococcal vaccination is recommended for HIV positive patients in the UK by the Departments of Health. It is likely that many physicians are not aware of these recommendations or are concerned about the poor efficacy of the vaccine, and it may consequently be underused in clinical practice. But the potential gain to the HIV positive patient is such that the vaccine should be offered to all HIV positive patients as soon as they present for medical care, irrespective of the stage of HIV disease. Physicians and patients should be aware that the vaccine is not fully protective and that episodes of sepsis, pneumonia and meningitis could still be pneumococcal in origin and should be treated appropriately. Awareness of the substantial risks of pneumococcal disease in HIV infected patients with prompt diagnosis and effective treatment is the most important strategy to decrease morbidity and mortality.
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PMID:Pneumococcal vaccine and HIV infection: report of a vaccine failure and reappraisal of its value in clinical practice. 774 16

Tuberculosis is a major global public health problem with 8 million new cases of pulmonary tuberculosis in the world per year and 2.89 million deaths. In India in 1989, the approximate morbidity of tuberculosis was 2%, i.e., there were 15 million cases of pulmonary tuberculosis. Of these 25% were sputum positive, posing a serious threat of transmitting the infection to children. Of the 4 million infectious patients, over 1 million would be considered as chronic or relapsing cases who have been partially treated. The Indian National Tuberculosis Program (NTP) has now completed 25 years. Every year, 1 million new cases of adult tuberculosis are detected. 70% of these patients do not complete standard regimens and 45% do not complete short course regimens. In 1983 about 80.71 million children under 16 years old in India were infected. In a survey carried out in 1990 in urban and rural areas of Delhi, BCG vaccination coverage was 90% in the urban and 84.7% in the rural areas. Impact of BCG vaccination has demonstrated that classical or generalized tuberculosis meningitis, miliary TB, disseminated tuberculosis, and other serious complications of primary infections go on occurring in malnourished BCG-vaccinated children. The variable efficacy of the present BCG vaccine observed in different prospective human trials has shown the necessity of conducting research of immunoregulatory mechanisms, and developing newer vaccines for global control of tuberculosis. Other topics include immune responses to the present BCG vaccine (cellular immunity, macrophage, T-lymphocytes); BCG vaccination and tuberculin test; BCG vaccination by nebulization (aerosol BCG vaccine) by the respiratory route; a booster dose of BCG vaccine in the preschool period; protein energy malnutrition and delayed hypersensitivity reaction; BCG test in non-vaccinated and vaccinated children; HIV infections or their symptoms as a contraindication to BCG vaccination; and BCG lymphadenitis in children (7% in seropositive HIV children).
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PMID:BCG vaccination in India and tuberculosis in children: newer facets. 774 45

Cadavers may pose infection hazards to people who handle them. None of the organisms that caused mass death in the past--for example, plague, cholera, typhoid, tuberculosis, anthrax, smallpox--is likely to survive long in buried human remains. Items such as mould spores or lead dust are much greater risks to those involved in exhumations. Infectious conditions and pathogens in the recently deceased that present particular risks include tuberculosis, group A streptococcal infection, gastrointestinal organisms, the agents that cause transmissible spongiform encephalopathies (such as Creutzfeldt-Jakob disease), hepatitis B and C viruses, HIV, and possibly meningitis and septicaemia (especially meningococcal). The use of appropriate protective clothing and the observance of Control of Substances Hazardous to Health regulations, will protect all who handle cadavers against infectious hazards.
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PMID:The infection hazards of human cadavers. 774 55

Funeral directors, control of infection officers, chief environmental health officers, and consultants in communicable disease control were surveyed to identify the sources and nature of advice about infectious hazards from the deceased available to undertakers. They were asked about management responsibilities, policies, particular activities (viewing, hygienic preparation, bagging, embalming, and final disposal by burial or cremation), specific diseases (hepatitis B, HIV infection, tuberculosis, meningitis, septicaemia, and salmonellosis), and repatriation. A wide range of opinions and advice was received on each topic. Medical personnel need a greater understanding of the work of funeral directors. Policies based on a realistic assessment of risk should be agreed.
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PMID:Infection in the deceased: a survey of management. 774 56

Identification of cryptococcal infection while it is still in its pulmonary phase might improve the prognosis for patients with AIDS who contract cryptococcosis. Since cryptococcal pneumonia is infrequently diagnosed in the AIDS patient, especially compared with the frequency of diagnosis of cryptococcal meningitis, this retrospective study was designed to investigate the frequency of pulmonary complaints in the months before diagnosis of cryptococcal meningitis. The medical records of 18 patients diagnosed with cryptococcal meningitis were analyzed. Of 18 patients, 14 (78%) had respiratory symptoms during the 4-month period before meningitis appeared, as compared with nine of 18 (50%) at the time of diagnosis and four of 16 (25%) in the 4 months following diagnosis. Seven of the 14 cases of pulmonary disease prediagnosis were of unknown etiology; three were eventually diagnosed as cryptococcal infections during evaluation of the meningitis. The remaining eight infections were attributed to bacteria, respiratory viruses, or Pneumocystis carinii, although three of these cultures also contained yeast, presumed to be Candida species, which were not further examined. Our data suggest the importance of singling out AIDS patients who may have pulmonary cryptococcosis. Cryptocococcsis should be included in the differential diagnosis of pulmonary infection in HIV-positive patients with CD4+ lymphocyte counts < 200/mm3, and full identification of yeasts recovered from sputum or bronchoalveolar lavage fluid cultures should be done. A larger study should be undertaken to better define the incidence of clinically recognizable pulmonary cryptococcosis in AIDS patients.
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PMID:Cryptococcal pneumonia in AIDS: is cryptococcal meningitis preceded by clinically recognizable pneumonia? 774 94

Autopsy or biopsy findings in 10 human immunodeficiency virus (HIV)-positive persons from Bangalore, India, revealed a wide spectrum of pathological changes. Patients' mean age was 33.4 years and the mean duration between symptom onset and death was 27.13 days. Nine patients had evidence of neuro-acquired immunodeficiency syndrome (AIDS) and 8 of them succumbed to various opportunistic infections. Histologic examination showed diffuse cryptococcal meningitis in 5 cases; 2 cases showed disseminated systemic cryptococcosis. Pulmonary tuberculosis was present in 3 patients. Despite no signs of associated neurotuberculosis in any patient, 4 autopsied and 1 biopsied case showed evidence of systemic tuberculosis. Toxoplasma encephalitis was present in 2 cases; observed in this series was the first case, in India, of co-existent toxoplasma and acanthamoeba. Other bacterial infections such as meningococcal meningitis and psudomonas septicemia were found in 3 cases; pneumocystis carinii pneumonia was present in 1 case. Evidence of early HIV leukoencephalopathy was observed in the only asymptomatic HIV-positive individual (who died in a traffic accident). AIDS-associated bacterial infections caused by organisms other than Mycobacterium tuberculosis are often underdiagnosed and should be considered in developing countries. In cases of cryptococcal and tuberculosis meningitis or multiple parasitic infections, patients should be screened for associated HIV infection.
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PMID:Pathological lesions in HIV positive patients. 775 Oct 41

We report a 39-year-old male who presented with tuberculous meningitis and was found also to be HIV-infected. In the course of his illness, he developed multiple opportunistic infections such as herpes genitalis, oesophageal candidiasis, CMV retinitis and finally succumbed to Penicillium marneffei septicaemia.
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PMID:Penicillium marneffei infection in an AIDS patient--a first case report from Malaysia. 775 60

85 patients who displayed Streptococcus pneumoniae (S. pneumoniae) bacteremia during hospitalization at the CHUV between January 1990 and December 1991 are reviewed retrospectively to reassess the importance of this pathology after the introduction in Switzerland of antipneumococcal vaccination. The data were compared with those obtained from a similar study at Lausanne between 1974 and 1978. Epidemiology, underlying diseases (present in 82% of patients), clinical findings (78% pneumonia, 8% meningitis, 14% bacteremia without detected primary focus) and mortality (31%) were comparable in the two series. There were, however, points of difference. First, the incidence of pneumococcal bacteremia increased between 20 and 40 years, affecting HIV positive patients in particular, with high mortality. Second, nosocomial pneumococcal bacteremia was relatively frequent (7%) and particularly severe, with very high mortality. Third, 17% of strains proved resistant to one or more antibiotics. Finally, use of the antipneumococcal vaccine is not widespread since only one of the 85 patients had been vaccinated whereas 82% presented a recognized indication for the vaccine. In conclusion, pneumococcal bacteremia remains frequent, involves major mortality and is more often due to resistant strains. These are important arguments in favour of vaccinating patients at risk.
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PMID:[Pneumococcal bacteremia: what is new?]. 776 5

During November 1989-January 1990 in Ghana, medical officers clinically examined and took blood samples from 914 consecutive admissions to Komfo Anokye Teaching Hospital in Kumasi to determine seroprevalence of HIV and different clinical features of HIV infection as well as to assess the value of the World Health Organization (WHO) clinical case definition for AIDS. 12.6% of the admissions were infected with HIV-1 and/or HIV-2. Females were more than two times likely to be infected with HIV than males (17.6% vs. 8.8%). Overall, 25-29 year old women had the highest HIV infection rate (45%). 30-34 year old men had the highest HIV infection rate among males. 56.5% of HIV-infected females and 30.4% of HIV-infected males were infected with both HIV-1 and HIV-2. 7 cases (5 females and 2 males) were infected with just HIV-2. Their ages ranged from 35 to 75 years. When the researchers applied the WHO clinical case definition to all HIV seropositive cases, they found its sensitivity to be 32%, specificity to be 93%, and positive predictive value to be 42%. Sputum-positive tuberculosis (TB) accounted for much of the false positives (28/53). 15% of the 76 sputum positive TB cases were HIV infected. When the researchers excluded all confirmed or suspected TB cases from the analysis, the specificity and positive predictive value increased to a maximum of 97% and 61%, respectively; sensitivity was 28%. Many HIV seropositive cases were not diagnosed with HIV infection either by the case definition or clinically by ward physicians. They probably were asymptomatic. Clinicians should suspect patients diagnosed with pneumonia or meningitis to be HIV infected, as was the case in this study (20% and 17% of HIV seropositive cases who were case definition negative, respectively).
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PMID:The African AIDS case definition and HIV serology in medical in-patients at Komfo Anokye Teaching Hospital, Kumasi, Ghana. 780 36


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