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

Primary effusion lymphoma (PEL) is a recently described rare type of non-Hodgkin's lymphoma occurring almost exclusively in HIV infected people. Human herpesvirus 8 (HHV-8), has been linked with PEL, and a causative relationship has been suggested. In the vast majority of PEL cases Epstein-Barr virus (EBV) has been found in the tumour cells. We describe here an elderly human immune deficiency (HIV) seronegative man with intractable chest pain and pleural effusion. The diagnosis of malignant lymphoma was suggested cytologically and confirmed histologically following pleural biopsy. No lymphadenopathy or organ involvement with lymphoma was found. Systemic chemotherapy with a modified CHOP regimen with G-CSF support gradually led to the resolution of the chest pain and ultimately resulted in a complete clinical remission (CCR). The presence of HHV-8 was demonstrated by PCR using paraffin-embedded tissue samples from the involved pleura, whereas EBV-associated genetic material was absent. The patient remained in CCR for 18 months and died of an unrelated cause (cerebrovascular event). Only 11 other cases with clinical and virological features similar to those of our patient have been reported in the literature. Analysis of these rare cases suggests HIV-negative EBV-negative PEL to be a distinct clinical entity with epidemiological features resembling classical KS and supports an EBV-independent role for HHV-8 in the pathogenesis of PEL.
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PMID:Primary effusion lymphoma (PEL) in HIV-negative patients--a distinct clinical entity. 1137 60

We report three HIV-negative patients with spontaneous pneumothorax as clinical manifestation of active tuberculosis acute chest pain and dyspnea was the cause of admission. Chest roentgen grams showed lung collapse and parenchymal cavitation in two of therm and hydropneumothorax in the other. Outcome was favorable with antituberculous drug therapy and placement of chest tube. Although spontaneous pneumothorax is frequent in fibrosis pulmonary tuberculosis, it seldom complicated active tuberculosis in spite of increase of its incidence.
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PMID:[Spontaneous pneumothorax and active pulmonary tuberculosis]. 1159 82

Incidence of pericarditis has increased in sub-Saharan Africa, because of the HIV infection pandemia. We have done a retrospective study in the cardiology unit of the national hospital of Ouagadougou (Burkina Faso), in order to describe epidemiological, clinical, and therapeutic aspects of pericarditis occurring in HIV infected patients. Inclusion criteria were pericarditis proved by echography, and positive HIV serology. We have included forty patients (28 men and 12 women), mean aged of 34.45 years. General signs were fever (87.5%), and weight loss (70%). Thirty-six patients (90%) were in CDC stage C AIDS classification, three (7.5%) in stage B, and one (2.5%) in stage A. The symptoms described by the patients were dyspnea (92.5%), cough 77.5%), chest pain (65%), liver effort pain (27.5%), and palpitations (20%). Heart failure was present in 80% of the patients who had myocarditis. Pericardial effusion was small in 21%, moderate in 31,6%, and large in 47.4% of the patients. Tamponade occurred in for cases (10%). The etiology was tuberculosis in 75% of cases. Pericardial puncture (done in six patients) showed purulent fluid in two cases. Before hospital discharge, eight patients died, giving a mortality rate of 20%. Symptomatic pericardial involvement is frequently associated with stage C of HIV infection. Myocarditis is often associated (37.5%). Mortality rate is high.
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PMID:[Pericarditis in HIV infected patients: retrospective study of 40 cases in Ouagadougou, Burkina Faso]. 1164 Oct 80

Pleuropulmonary amebiasis is the common and pericardial amebiasis the rare form of thoracic amebiasis. Low socioeconomic conditions, malnutrition, chronic alcoholism, and ASD with left to right shunt are contributing factors to the development of pulmonary amebiasis. Although no age is exempt, it commonly occurs in patients aged 20 to 40 years, with an adult male to female ratio of 10:1. Children rarely develop thoracic amebiasis: when it does occur there is an equal sex distribution. The infection usually spreads to the lungs by extension of an amebic liver abscess. Infection may pass to the thorax directly from the primary intestinal lesion through hematogenous spread, however. Lymphatic spread is one possible route. Inhalation of dust containing cysts and aspiration of cysts or trophozoites of E histolytica in the lungs are some other hypothetical routes. The lung is the second most common extraintestinal site of amebic involvement after the liver. Usually the lower lobe, and sometimes the middle lobe of the right lung, are affected, but it may affect any lobe of the lungs. The patient develops fever and right upper quadrant pain that is referred to the tip of the right shoulder or in between the scapula. Hemophtysis is common. The diagnosis of thoracic amebiasis is suggested by the combination of an elevated hemidiaphragm (usually right), hepatomegaly, pleural effusion, and involvement of the right lung base in the form of haziness and obliteration of costophrenic and costodiaphragmatic angles. Infection is usually extended to the thorax by perforation of a hepatic abscess through the diaphragm and across an obliterated pleural space, producing pulmonary consolidation, abscesses, or broncho-hepatic fistula. Empyema develops when a liver abscess ruptures into the pleural space. Rarely, a posterior amebic liver abscess can burst into the inferior vena cava and develop an embolism of the inferior vena cava and thromboembolic disease of the lungs with congestive cardiac failure or corpulmonale. Diagnosis by finding E histolytica in stool specimens is of limited value. In a limited number of cases amebae might be found in aspirated pus or expectorated sputum. "Anchovy sauce-like" pus or sputum may be found. Presence of bile in sputum indicates that the pus is of liver origin. Serological tests are of immense value in diagnosis. Liver enzymes are usually normal and neutrophilic leucocytosis may or may not be found. ESR is invariably elevated. Anti-amebic antibodies can be detected by ELISA, IFAT, and IHA. Amebic antigen can be detected from serum and pus by ELISA. Detection of Entamoeba DNA in pus or sputum may be a sensitive and specific method. Pleuropulmonary amebiasis is easily confused with other illnesses and is treated as pulmonary TB, bacterial lung abscesses, and carcinoma of the lung. A single drug regimen with metronidazole with supportive therapy usually cures patients without residual anomalies. Aspiration of pus from empyema thoracis may be needed for confirmation and therapeutic purposes. The pericardium is usually involved by direct extension from the amebic abscess of the left lobe of the liver, sometimes from the right lobe of the liver, and rarely from the lungs or pleura. An initial accumulation of serous fluid due to reactive pericarditis followed by intrapericardial rupture may develop either (1) acute onset of severe symptoms with chest pain, dyspnea, and cardiac tamponade, shock, and death, or (2) progressive effusion with thoracic cage pain, progressive dyspnea, and fever. Chest radiograph, ultrasound examination, and CT scan usually confirm the presence of a liver abscess in continuity with the pericardium and fluid within the pericardial sac with or without the fistulous tract. Echocardiography may demonstrate fluid in the pericardial cavity. Patients should be cared for in the ICU and ambecides should be started without delay. Pericardiocentesis usually confirms the diagnosis and improves the general condition of the patient. Aspiration of the accumulated fluid should be performed urgently in cardiac tamponade; repeated aspiration may be needed. Surgical drainage should be done if needed. Acanthamoeba, a free-living ameba, may also infect the lungs in the form of pulmonary nodular infiltration and pulmonary edema in association with amebic meningoencephalitis in immunocompromised patients. It usually spreads to the meninges of the brain by way of the blood from its primary lesion in the lung or skin. Early diagnosis and institution of treatment may be life saving for these patients. A literature review shows that HIV/AIDS patients are not prone to infection with E histolytica. It is now clear that there are an increasing number of HIV-seropositive patients among amebic liver abscess patients, however, which suggests that although the incidence of intestinal infection is not high among HIV-seropositive or AIDS patients they are more susceptible to an invasive form of the disease.
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PMID:Thoracic amebiasis. 1209 41

Health workers have four main tools at their disposal for detecting tuberculosis (TB) in patients: clinical symptoms, tuberculin testing, x-ray of the chest, and sputum smear microscopy. The two main detection tools for children are tuberculin skin test and chest x-ray. Signs and symptoms of TB to look for in adults are persistent cough (3 weeks), blood in the sputum, persistent chest pain (1 month), increasing weakness and weight loss, and past history of TB or treatment for cough. TB treatment should not begin until a positive sputum smear is confirmed in cases of pulmonary TB. Health workers should suspect TB if children younger than 5 are in close contact with someone who has confirmed TB, have a strongly positive tuberculin test, and have clinical signs and symptoms. Further tests are usually needed to confirm the diagnosis. In many areas, tests are impossible so health workers need to diagnose TB based on history, physical examination, and clinical symptoms. TB is difficult to diagnose in children because TB is either limited inside the lung or located outside the lungs. Malnourished children with TB usually have a negative tuberculin test. Malnourished children displaying signs of TB or whose X-ray suggests TB should be treated. A recent BCG vaccination can yield a weak positive tuberculin test result. TB signs and symptoms in children are nonspecific. General signs to look for are: unexplained weight loss, anorexia, failure to thrive and gain weight, at least 2 episodes of unexplained fever, swollen lymph nodes (especially in children with HIV), and persistent cough or wheeze (2 weeks). Specific signs depend on the site of infection: whole body, brain or spine, lungs, bones and joints, skin or mucous membranes. This article contains instructions on how to do the tuberculin skin test and sputum smear microscopy.
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PMID:How to detect and diagnose TB. 1229 65

We report two cases of myocardial infarction, in young HIV positive patients seen in the Emergency Department. These patients were under treatments: for one, an association of nucleosidic inhibitors, and for the other one, the combination of nucleosic analogue inhibitor with a non nucleosic analogue; in the last case, the patient underwent, few months before, a treatment containing a protease inhibitor. In both cases, the pain wasn't typical and didn't refer to a coronary heart disease. Lipid tests were normal. The diagnosis has been made quickly and allows a coronary angioplasty with a favourable issue. Authors are arguing the characteristics of this cardiac pathology, recently discovered in HIV positive patients, and do insist on the need to think at a coronary heart disease in front of any chest pain symptom even unusual.
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PMID:[Myocardial infarction in AIDS]. 1249 11

We present a patient who collapsed with chest pain and dyspnoea on a transatlantic flight. She was found to have Pneumocystis carinii pneumonia (PCP) and human immunodeficiency virus infection. Platypnoea and orthodeoxia, which have not been previously reported in association with PCP, were major features of her illness. The PCP predominantly affected her lung bases and it is likely that gravity increased intrapulmonary blood flow through poorly ventilated lung bases with failure of pulmonary vasoconstriction to increase upper zone perfusion, exacerbating desaturation on sitting up. The partial DNA sequence of the infecting P carinii was identical to previously described isolates.
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PMID:Pneumocystis carinii pneumonia with pleurisy, platypnoea and orthodeoxia. 1288 3

Acute histoplasmosis is usually a benign, self-limited infection in endemic areas. Since protection against Histoplasma capsulatum infection requires specific, cell-mediated immunity, histoplasmosis is well documented in patients with acquired T cell deficiencies e.g. due to HIV infection. We report here for the first time a case of pleural effusion due to H. capsulatum infection in a patient with idiopathic CD4 lymphocytopenia (ICL). A 25-year-old woman presented with chest pain, dyspnea on exertion and a moderate weight loss. Chest X-ray showed a large left pleural effusion, and thoracentesis yielded an exudate. Histologic examination of pleural biopsies identified H. capsulatum. Laboratory tests revealed lymphocytopenia with low CD4+ T cell counts (<100/microl) and a decreased CD4/CD8 ratio. Serology, including HIV, was repeatedly negative. The diagnosis of pleural effusion due to H. capsulatum infection in a patient with idiophatic ICL was established. There was no evidence of any other opportunistic infection. Treatment with itraconazole was initiated and pleural effusion resolved within 2 weeks of treatment. Moreover, the patient was found to have idiopathic thrombocytopenic purpura, as confirmed by the detection of autoantibodies against thrombocytes. In a 1-year follow-up, the patient remained asymptomatic without relapse or any new infection. Treatment with itraconazole was given for 12 months. Because of persistent CD4+ T cell counts below 100/microl, prophylactic antibiotic treatment is continued.
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PMID:Pleural effusion due to Histoplasma capsulatum and idiopathic CD4 lymphocytopenia. 1258 5

The characteristics of cardiac tamponade in patients with human immunodeficiency virus (HIV) disease were examined by evaluating the cases, case series, and related articles, including autopsy series, identified through a comprehensive literature search. One-hundred eighty-five cases of cardiac tamponade have been reported in patients with HIV disease. Sex data were available in 176 patients, of whom 154 (87%) were males. The mean age was 34.7 +/- 10.4 years (range, 11 months to 61 years). Mean CD4 cell count was 98 +/- 95 cells/mm3 (range, 3 to 430 cells/mm3). The most common etiology of pericardial tamponade was mycobacterial infection (78 patients), including Mycobacterium tuberculosis, Mycobacterium avium-intracellulare, and Mycobacterium kansasii. A bacterial cause was found in 20 patients (11%). Staphylococcus aureus was the predominant bacteria, followed by streptococci, Pseudomonas aeruginosa, Listeria monocytogenes, Klebsiella pneumoniae, and Rhodococcus equi. Lymphoma was found in 15 (8%) patients and Kaposi sarcoma in 13 (7%) patients. Numerous unusual organisms, including Cryptococcus neoformans, Nocardia asteroides, Aspergillus species, cytomegalovirus, and herpes simplex were also associated with cardiac tamponade in HIV patients. Occasionally, HIV itself was involved in the pathogenesis. In 48 patients (26%), no cause was found or reported. The most common clinical presentation was dyspnea, followed by fever, cough, chest pain, and cardiac arrest. The predominant pericardial fluid color composition was serosanguineous. The majority of patients died during hospitalization or in the immediate follow-up period. Vigilance for cardiac tamponade in patients with HIV disease, especially in those with opportunistic infections and/or malignancies, and cardiac symptoms, may result in early and proper management of cardiac tamponade in these patients.
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PMID:Cardiac tamponade in patients with human immunodeficiency virus disease. 1293 67

A case of osseous Kaposi sarcoma in a 35-year-old man is described. The patient (HIV-positive for 8 years) suffered from cutaneous Kaposi sarcoma and presented with right-sided chest pain. He underwent a chest CT scan that revealed three osteolytic lesions involving rib and vertebra with large soft tissue masses, without cutaneous lesions at these sites. CT-guided core needle biopsy led to a histological diagnosis of Kaposi sarcoma.
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PMID:Osseous Kaposi sarcoma in an HIV-positive patient. 1474 62


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