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

Tuberculous infection of the oesophagus is rare. This is confirmed by our present review of cases managed in our teaching hospitals over a period of 18 years which uncovered only 11 patients. The main presentation is that of dysphagia whose algorithm of investigation should seek to differentiate tuberculosis from carcinoma, the more common cause of this symptom. Of the 11 patients, 9 presented with dysphagia while 2 had haemorrhage; 7 had an abnormal plain chest radiograph, of whom 4 had a mediastinal mass lesion (3 were lymphadenopathy and one an abscess). All but one had an abnormal radio-contrast oesophagogram, including a mediastinal sinus in two and a traction diverticulum in another two. The mainstay of investigation was oesophagoscopy through which diagnostic biopsy material was obtained in half of the patients. In the other half diagnosis was by either biopsy of associated mediastinal (3) or cervical (1) lymph node masses or by acid fast bacilli positive sputum (1). The diagnosis was established post-mortem in one patient. Treatment was primarily non-operative with standard anti-tuberculosis drug therapy. Two patients underwent a diagnostic thoracotomy and one a drainage of mediastinal abscess together with resection and repair of oesophago-mediastinal sinus during the early part of the series. Outcome of management was very rewarding in 9 patients and death occurred in 2 patients, one of whom had his anti-tuberculosis drug therapy interrupted by severe hepatitis B virus infection. The other death occurred in a patient whose haemorrhage from an aorta-oesophageal fistula was not established ante-mortem. It is recommended that when biopsy material of the oesophagus is unobtainable or non-diagnostic in patients with dysphagia, especially with an abnormal chest radiograph or human immunodeficiency virus infection, effort should be made to obtain biopsy material from associated lymph nodes, even by thoracotomy if necessary, or culture of biopsy from the radiologically abnormal part oesophagus and sputum for mycobacteria, in order to establish the diagnosis of this rare but eminently treatable cause of dysphagia. Clinicians should be aware of tuberculosis of the oesophagus as a possible cause of haematemesis in patients with otherwise unexplained upper gastrointestinal haemorrhage.
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PMID:Oesophageal tuberculosis: a review of eleven cases. 157 Feb 50

Thoracic disease in the HIV negative immunocompromised host is most frequently caused by infection. Patterns of involvement produced on the chest radiograph include (1) lobar or segmental consolidation, (2) nodules with rapid growth and/or cavitation, and (3) diffuse lung disease. The lung also may be directly involved by lymphoma, metastases, drug reactions, radiation pneumonitis, or nonspecific interstitial pneumonitis. The lung is a frequent target organ for opportunistic infections in AIDS patients, particularly of Pneumocystis carinii pneumonia and tuberculosis. Computed tomography may be particularly helpful in these patients in the detection of early disease and in the characterization of patterns and extent of involvement as well as complications.
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PMID:Thoracic disease in the immunocompromised patient. 157 Mar 94

The role of local immunity in relation to the frequent and heterogeneous pulmonary manifestations of HIV-1 infection in children is poorly understood. In order to examine lung immunity in pediatric AIDS patients, the cellular composition, immunoglobulin, and immune complex (IC) levels were evaluated in 23 samples of bronchoalveolar lavage (BAL) fluid and peripheral blood from 19 pediatric AIDS patients with acute pulmonary pathology. The patients were of two age groups: 4.0-21.5 months (N = 9) and 2.3-13.1 years (N = 10). In BAL, lymphocytes were elevated in 25-45% of samples, and neutrophils were elevated in 27-33%; BAL macrophages varied in percentage (28-99%) but had normal morphology. The blood differentials of pediatric AIDS patients undergoing BAL did not show significant differences when compared with a group of pediatric patients with tuberculosis, but leuko- and neutropenia was noted when compared with pediatric patients with pneumonia and no HIV disease. Of the immunoglobulins measured (IgG, IgM, IgA) only IgG was detectable in unconcentrated BAL fluid (1-37 mg/dl, equivalent to 12-630 mg/dl in the epithelial lining fluid after correction using urea as a marker of dilution). All patients were hypergammaglobulinemic and 83% had high levels of circulating IC (2-40 muEq/ml). Six BAL specimens (26%) also contained IC. The estimated level of IC in lung epithelial lining fluid (after correcting for dilution) was up to fivefold higher than IC concentration in corresponding sera. Specific antibodies to HIV-1 were demonstrated in 35% of the BAL samples by ELISA and in 65% by Western blotting.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Characterization of cells, immunoglobulins, and immune complexes present in the bronchoalveolar lavage of pediatric AIDS patients. 157 Dec 28

Mycobacteria are acid-fast, slow-growing microorganisms which have gained attention due to increasing prevalence in AIDS patients. Until the advent of AIDS, the only true pathogens of this group were Mycobacterium tuberculosis and M. leprae and the remaining mycobacteria were considered to be saprophytes or opportunistic pathogens. Infection with the MOTT (mycobacteria other than tuberculosis) bacilli was only seen in elderly or immunocompromised patients and was generally limited to caseating pulmonary granulomas, with rare extrapulmonary involvement. In AIDS patients, however, the incidence of mycobacterial infections ranges from 10 to 60% of HIV-positive persons, depending on location, method of identification, and patient population. Furthermore the pathogenesis of these mycobacterioses is distinct from that seen in non-AIDS patients because disseminated disease is the rule rather than the exception. Finally treatment of mycobacterial infections is increasingly difficult due to multiple drug resistances as well as the length of antimicrobial therapy required to cure the disease. Because of the prevalence and importance of these microorganisms, much research has been performed with the mycobacteria to develop new therapies and to understand their modes of pathogenesis.
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PMID:Mycobacteria and AIDS. 157 82

The incidence of tuberculosis in the Austrian Tyrol and Vorarlberg has been declining over decades. In 1989 a reversal in this trend was observed. The number of initial isolates of Mycobacterium tuberculosis at the Federal Public Health Laboratory in Innsbruck increased by 2.2% in 1990 (137 strains), as compared with 1989 (134 strains). The number of cases reported to the health authorities increased by 7.6%. This increase has continued in 1991, with 162 initial isolates registered. It seems that the increase is connected with the presence of greater numbers of ethnic groups from countries with a high incidence of tuberculosis. It is unlikely that the increase is due to additional cases of tuberculosis resulting from the HIV epidemic. Nevertheless, it is recommended that patients with tuberculosis undergo HIV antibody testing. A comparison of the results of animal tests and cultures for demonstrating the presence of mycobacteria showed that the culture procedure is at least equally efficient.
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PMID:Reversal of the decline in the incidence of tuberculosis in the Austrian Tyrol and Vorarlberg in 1989. 158 71

Immunoglobulin G (IgG) and IgM antibodies against the SL-IV antigen of Mycobacterium tuberculosis in the sera of patients with tuberculosis with negative serology for human immunodeficiency virus (HIV) infection (TB group; n = 97), patients with tuberculosis with positive serology for HIV infection (TB-HIV group; n = 59), and healthy controls (n = 289) were determined by enzyme-linked immunosorbent assay. All sera were obtained at the onset of tuberculosis, i.e., when clinical symptoms appeared. Clinical specimens were collected and cultured for the isolation of M. tuberculosis, and treatment with antituberculous drugs was started. Sera were also obtained from patients in the TB group at fixed intervals during treatment; sera were available from 13 patients in the TB-HIV group before the onset of tuberculosis. The best specificity and positive predictive values were obtained with the IgG assays. In the IgG assays at specificities above 96.0%, the sensitivities of the tests were 45.3 and 72.8% for the TB and TB-HIV groups, respectively, and the sensitivity was 51.9% when data from both groups were combined for analysis. For the TB group, results of this study indicated that the levels of IgG antibodies remain high during treatment. Thus, repetitive serological assays may not be useful for treatment follow-up. In the TB-HIV group, 12 of 13 patients had IgG-specific antibodies against the SL-IV antigen between 1 and 30 months before the onset of tuberculosis, so we suggest that the IgG antibody assay against SL-IV may be helpful for identifying tuberculosis in patients infected with HIV.
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PMID:Time course of anti-SL-IV immunoglobulin G antibodies in patients with tuberculosis and tuberculosis-associated AIDS. 158 5

Drug users with HIV infection pose an important clinical challenge for primary care practitioners, the provider group that is particularly well situated to supply comprehensive care both for HIV-related conditions and substance-abuse problems. It is important for primary care clinicians to be familiar with the full spectrum of HIV-related disease in drug users, especially concerning bacterial infections, tuberculosis, and sexually transmitted diseases, and with the medical complications of drug use, which may mimic, mask, be obscured by, or simply coexist with HIV-specific conditions. Primary care providers must also be familiar with screening, diagnosis, and treatment of substance-use disorders, and can play a critical role in the identification of drug-use problems and the initiation of drug treatment. An understanding of the special issues of drug interactions, self-medication, and pain management is also important for the care of drug-using patients with HIV infection. Most importantly, providers' awareness of certain common behavioral patterns, problems, and shared concerns among drug users will also help to promote favorable patient outcomes and to minimize frustration and dissatisfaction among clinical staff.
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PMID:Diagnosis and treatment of substance users with HIV infection. 159 93

We present the immunoglobulin spectrum in a series of 156 HIV-infected patients who were affected of tuberculosis (TB) of different localization. Sixty-seven patients had lung TB, in 13 cases lung TB and an opportunistic infection were diagnosed simultaneously and in 76 cases TB was localized outside the lung. The cases were compared to 62 HIV-infected patients classified in stage 11 (CDC 1986) and to 85 cases of HIV-infected patients who suffered carinii pneumonia (PCP). The most outstanding differences were established between IgA of patients with lung TB and group PCP (p less than 0.001). IgG showed significant differences between lung TB patients and the PCP group (p less than 0.001).
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PMID:[A serum immunoglobulin study in patients with tuberculosis and human immunodeficiency virus infection]. 159 26

The overall tuberculosis situation in the world in 1990 and its recent trends are reviewed by an analysis of the case notifications to WHO and tuberculosis mortality reports. Estimates of the prevalence of tuberculosis infection and the incidence of tuberculosis disease and deaths predicted in 1990 were carried out with simple epidemiological models. Approximately one third of the world's population is infected with Mycobacterium tuberculosis. In the past decade, an average of 2.5 to 3.2 million cases were notified every year globally, the small decrease in notification rates in recent years being offset by population growth. In 1990, an estimated 8 million people developed tuberculosis worldwide and 2.6 to 2.9 million died. The majority of these cases and deaths occurred in Asia, with an increasing number among HIV-infected individuals, especially in Africa where an upward trend is clearly detectable. Data on tuberculosis cases notified by WHO Member States demonstrate the magnitude of the problem but must be interpreted with caution. Being less than the expected incidence, they reflect the inadequacies of tuberculosis control programmes. This review confirms the very high global magnitude of the tuberculosis problem and calls for an urgent revitalization of tuberculosis control programmes throughout the world.
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PMID:Tuberculosis: a global overview of the situation today. 160 May 78

In a continuing study on the occurrence of nontuberculous mycobacterial lung disease by screening sputum cultures and from clinical judgement, from 1979 to 1987, a second series of 42 patients were suspected of having pulmonary infection caused by nontuberculous mycobacteria. As identified by the WHO Collaborating Center for Mycobacteria in Prague, Mycobacterium avium complex was isolated from the greatest number of patients (21 or 50%); M. scrofulaceum from seven; M. kansasii from six, and M. gorgonae from four. The remaining four patients yielded one strain each of M. fortuitum, M. asiaticum, M. szulgai, and one with suspected M. simiae. However, clinical significance was confirmed in only 30 patients, 20 of whom had M. avium complex; three had M. scrofulaceum; three had M. kansasii, and one each had M. gordonae, M. asiaticum, M. szulgai, and suspected M. simiae. Retrospective analysis revealed that 24 of the 30 patients had pre-existing disease, including 20 who had tuberculosis. Blood examinations of 10 patients recalled so far proved negative for HIV infection. Diseases caused by nontuberculous mycobacteria is still rare in Thailand.
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PMID:Nontuberculous mycobacterial infection of the lung in a chest hospital in Thailand. 160 57


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