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

In February 1991, a 30-year old single, Chinese male, who had not has sexual intercourse with another man but did have it with a woman while in another country 12 months earlier, sought medical care at Tan Tock Seng Hospital in Singapore. He had a productive cough for 3 months, lost 5 kg over 4 months, and had been gasping for breath for 3 days. Upon admission, he had a low grade fever and breathed very rapidly while resting. The apical segment of the right lower lobe of the lung had a 3 x 2 cm cavity which was filling with exudate. A sputum smear did not indicate acid fast bacilli in 2 of 3 samples and blood cultures did not yield aerobic or anaerobic bacteria. The Western blot test revealed HIV antibodies. The absolute CD4 lymphocyte count stood at 80/cu mm compared with more than 500/cm mm in healthy individuals. Physicians used a bronchoscope to do bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB), both of which disclosed cysts of Pneumocystis carinii. Treatment first consisted of trimethoprim/sulfamethoxazole for 7 days and antituberculosis chemotherapy for 2 weeks until the physicians realized he had Pneumocystis carinii. They switched the treatment to iv pentamidine isethionate because he still had a fever after 7 days. This treatment was successful. Physicians then administered Zidovudine (AZT) and aerosolized pentamidine each month. As of mid-1992 he was still healthy. In addition to the BAL/TBLB results indicating Pneumocystis carinii and excluding tuberculosis, other features excluding tuberculosis were a Mantoux reading of O, absence of hilar and/or mediastinal lymphadenopathy, response to pentamidine isethionate, and sputum and blood cultures that did not indicate Mycobacterium species.
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PMID:A case of cavitating pneumonia in AIDS. 141 78

Retrospective studies suggest that the mortality rate from HIV-1-associated tuberculosis is greater than that from tuberculosis alone, but it is not clear if this is due to failure of antituberculosis treatment or to the complications of HIV-1 infection. We have carried out a prospective cohort study of patients with tuberculosis in Nairobi, Kenya, to compare mortality rates, risk factors, and causes of death in HIV-1 positive and HIV-1 negative patients. One hundred seven HIV-1 positive and 174 HIV-1 negative patients with tuberculosis attending two tuberculosis treatment centers in Nairobi were enrolled and followed monthly. Mortality was significantly higher in HIV-1 positive than in HIV-1 negative patients within 6 months of the start of antituberculosis treatment after adjustment for age, sex, and education (rate ratio = 3.8; 95% confidence interval, 1.7 to 8.1; p less than 0.001). Most of the excess mortality occurred after the first month of treatment and was due to nontuberculous infections. Predictors for mortality differed greatly between HIV-1 positive and HIV-1 negative patients. Mortality was greater in HIV-1 positive patients treated with a "standard" regimen for tuberculosis than in HIV-1 positive patients receiving a "short-course" regimen (p = 0.08 when adjusted for all independent risk factors). Tuberculosis control programs in developing countries need to implement "short-course" regimens and train health workers to recognize and treat nontuberculous infections to maintain their effectiveness in the face of the HIV epidemic.
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PMID:Cohort study of human immunodeficiency virus infection in patients with tuberculosis in Nairobi, Kenya. Analysis of early (6-month) mortality. 141 9

Lymphadenitis is a common extrapulmonary manifestation of mycobacterial disease in persons with human immunodeficiency virus (HIV) infection. We compared the clinical, mycobacterial, and diagnostic characteristics of mycobacterial adenitis in 11 HIV-seropositive and 29 HIV-seronegative patients. Ninety-three percent of the HIV-seronegative patients and 54% of the HIV-seropositive patients were foreign-born. In contrast to the HIV-seronegative patients, seropositive patients were more likely to be febrile and have negative purified protein derivative skin tests and abnormal chest roentgenograms. Sputum samples were rarely diagnostic in either group. Mycobacterium tuberculosis was the most commonly isolated organism in both groups, although United States-born patients with HIV infection were more likely to be infected with nontuberculous mycobacteria. In contrast to results for seronegative patients, fine-needle aspiration was usually diagnostic in the HIV-seropositive population, especially in those at risk for M. tuberculosis infection. Similarly, the rate at which smears were positive for acid-fast bacilli was significantly higher in the HIV-seropositive group, a circumstance suggesting a higher burden of organisms in this population. Finally, although preceding opportunistic infections were uncommon in the HIV-seropositive group, both tuberculous and nontuberculous adenitis were associated with advanced immunosuppression.
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PMID:Comparison of mycobacterial lymphadenitis among persons infected with human immunodeficiency virus and seronegative controls. 142 Jun 73

Tuberculous infections of the breast are considered rare in the developed world. We describe a case of mammary tuberculosis in a woman who was not initially known to be seropositive for the human immunodeficiency virus (HIV) and who was thought to have a pyogenic breast abscess. This uncommon presentation of extrapulmonary tuberculosis as an AIDS-defining condition highlights the necessity for performing mycobacterial smears and cultures in such cases when patients are at risk for HIV infection.
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PMID:Tuberculosis of the breast as a presenting manifestation of AIDS. 142 Jun 82

The increase in the reported cases of tuberculosis in Rhode Island from 1985 to 1991 has been striking. This rise has occurred at a faster rate than that for the United States overall. Although the HIV epidemic is largely to blame for the resurgence of tuberculosis nationwide, its impact on tuberculosis locally has been muted. The rise in reported cases in Rhode Island is attributable mainly to increased cases among minority groups, particularly Southeast Asians. Blacks and Hispanics are likewise at an increased risk for developing active disease. Especially alarming is the dramatic rise in the number of tuberculosis cases reported in children in Rhode Island, a reflection of active disease transmission in the community. The Rhode Island Tuberculosis Control Program, already functioning at full capacity, must find ways of curbing the growing tuberculosis problem.
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PMID:Epidemiology of tuberculosis in Rhode Island. 142 85

In the United States, the incidence of tuberculosis (TB) is higher in elderly persons than in any other segment of the population, except in HIV-infected persons. The diagnosis of TB, however, is all too often not considered in geriatric patients. Although elderly nursing home residents are at a greater risk for TB than the aging population in the community setting, the majority (80%) of active TB cases in elderly persons occur in community dwellers. The diagnosis, treatment, and prevention of TB are reviewed in this article.
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PMID:Tuberculosis. 142 33

Tuberculosis is increasing in prevalence in North America, mainly due to HIV infection. We describe an unusual case of TB of the thymus in a HIV sero-negative Filipino immigrant who preoperatively was thought to have a thymoma. We describe the clinical, radiologic and pathologic findings and review the literature on TB of the thymus.
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PMID:Tuberculosis of the thymus. 142 2

This paper profiles the epidemiology of tuberculosis in a geographically defined area, the Eastern Health Board. In 1990, 191 new cases of the disease were notified, 15.5/100,000. One hundred and eighty five were from the indigenous population. Fifty four per cent were male. Nearly 50% of all cases occurring in females do so in those under 35 years and for males, 45% occur in those less than 45 years. One hundred and three (54%) had pulmonary tuberculosis alone and only 50 (26%) had a presumptive diagnosis. Although the lower social classes were overrepresented, cases occurred throughout all social classes and a significant proportion were either gainfully employed or in full time education. Data on BCG status was incomplete, however 28 cases were known to have had BCG at some stage of their life. Thirteen cases were also known to be HIV positive. The contact tracing process was responsible for locating 33 (17%) cases. Continuing surveillance both at national and local level is required in order to assist eradication.
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PMID:The epidemiology of tuberculosis in a geographically defined area. Eastern Health Board Tuberculosis Advisory Committee. 142 75

4 cases of Pneumocystis carinii pneumonia in HIV-infected patients studied at the University of Zambia Medical School, Lusaka, were verified by bronchoalveolar lavage. Pneumocystis is common in North American AIDS patients, but has been considered rare in Africa. One reason may be that facilities for diagnosis, bronchoscopy with bronchoalveolar lavage, are not usually available. 44 consecutive HIV seropositive patients who were unresponsive to a 10-day course of antibiotics, and whose sputum was negative for acid fast bacteria, underwent bronchoalveolar lavage from February 1990 to December 1990. HIV status was assayed with Welcozyme ELISA kits, and P. carinii was detected with toluidine blue O stain. The 1st case of confirmed P. carinii pneumonia was a 35-year old man who had a productive cough for 4 weeks, fever, and dyspnea. He was treated with co-trimoxazole and was symptom-free in 3 weeks, but developed severe Stevens-Johnson reaction. His cultures were positive for M. tuberculosis at week 8. He was lost to follow-up. The 2nd case was a 26-year old man with a 6-month history of cough and white sputum, treated without effect with antituberculous medication. He improved over 3 weeks with co-trimoxazole, but died of respiratory failure 2 months later. The 3rd case was a 30-year old woman being treated for pulmonary tuberculosis, who became progressively dyspneic 7 months later. She developed a generalized maculo-papular rash after taking co-trimoxazole, so was given dapsone 100 mg/day, prednisone 1 mg/kg/day, and trimethoprim 15 mg/kg for 1 week. She improve in 3 weeks. The 4th case was a 30-year old man with a 4-week history of dry cough and dyspnea and recent high fever. He was given co-trimoxazole, but developed generalized purpura after 5 days. His treatment was changed to Dapsone 100 mg/day, prednisone 1 mg/kg/day, and antituberculous medication. He improved after 3 weeks, and is being maintained on Fansidar 1 tablet/week. These cases are remarkable because 2 of them also had pulmonary tuberculosis, which is often the presumed diagnosis of pneumonia in African AIDS patients. Furthermore, 3 developed serious drug reactions to co-trimoxazole, also considered an uncommon occurrence.
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PMID:Pneumocystis carinii as a cause of pneumonia in HIV-infected patients in Lusaka, Zambia. 144 Aug 16

By September 1991 Cameroon had reported 650 cases of the acquired immune deficiency syndrome (AIDS). The results from the sentinnel surveillance system showed a seroprevalence of human immunodeficiency virus (HIV)1 of 1.3% among pregnant women, 2.5% in people attending sexually transmitted disease clinics and 3.5% in tuberculosis patients in 1990. The estimated number of persons infected with HIV varies between 10,000 and 30,000. The World Health Organization projection model was used to make a short-term projection of HIV infection and AIDS cases; it indicated that the number of persons infected with HIV will double by the year 1995, with an estimated 8500 AIDS cases. Even in a low prevalence country such as Cameroon, the impact of the HIV epidemic is important and will result in a burden for the health care system.
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PMID:A short term projection of HIV infection and AIDS cases in Cameroon. 144 Aug 29


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