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 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical features, microbiology, treatment, and outcome in 24 children diagnosed with lung abscess at Harare Central Hospital during 1979-88 were reviewed retrospectively. This condition is rare in children, and the present study is the first to address lung abscess in Zimbabweans. 17 (71%) of the 24 patients were male and their mean age was 4.9 years. The most common presenting symptoms were fever, cough, and breathlessness. Abnormal chest signs (e.g., localized dull percussion note, with amphoric or bronchial breathing) were detected in 18 cases. Foremost among the predisposing factors were measles (25%), empyema thoraxis (17%), and unconsciousness (13%). Bacteria were isolated from 18 children, with Staphylococcus aureus (8 cases), group A beta hemolytic streptococci (4 cases), and Pseudomonas aeruginosa (3 cases) the most common. Treatment consisted of bronchoscopy to aspirate pus from the bronchus and exclude foreign bodies as well as antibiotic administration. There were 6 deaths (25% case fatality rate). The prevention or prompt treatment of measles is urged to reduce further the incidence of this rare health condition. However, the spread of human immunodeficiency virus infection among children in sub-Saharan Africa is likely to be accompanied by pediatric lung abscess cases secondary to pneumonia.
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PMID:Lung abscess in children in Harare, Zimbabwe. 147 6

Corticosteroids are beneficial in the treatment of some forms of tuberculosis, but their role in TB affecting HIV-positive patients is not clear. During a cohort study of tuberculosis patients in Lusaka, Zambia, prednisolone was prescribed for specific indications. Six of 47 (13 per cent) of patients who received prednisolone early in treatment developed herpes zoster, compared with 2 of 118 (2 per cent) of those who did not. Three patients who received prednisolone developed Kaposi's sarcoma, compared with none who did not. At 2 months patients who had received prednisolone showed a greater improvement in generalized lymphadenopathy and cough. Controlled studies of the risks and benefits of administration of corticosteroids to HIV-positive TB patients are urgently needed.
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PMID:Use of prednisolone in the treatment of HIV-positive tuberculosis patients. 148 47

The aim of this study was to evaluate whether the amount of Pneumocystis carinii organisms found at fiberoptic bronchoscopy (FB) performed on HIV-positive patients correlated to the character of the P. carinii pneumonia (PCP). A consecutive series of 105 patients presented with 131 episodes of pulmonary symptoms requiring FB, and in 75 of these episodes a diagnosis of PCP was made. Specimens were stained with Giemsa and methenamine silver nitrate and the number of parasites found was given as: numerous, many, few or none. The following signs and symptoms were registered: cough, dyspnoea, fever, loss of weight, chest radiograph, haemoglobin, WBC, CD4 cell count, PO2 and HIV p24 antigen. The PCP was characterized by the clinical course: mild, moderate, severe, and by the outcome: pulmonary healthy, pulmonary insufficiency and death. No correlations between the number of P. carinii organisms and the clinical course or outcome of the PCP, the symptoms before the FB or the paraclinical examinations were found. In conclusion, the routinely obtained quantitative results of the microbiological examinations of material from the lungs were not correlated to the severity of the PCP.
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PMID:Pneumocystis carinii pneumonia in AIDS patients: clinical course in relation to the parasite number found in routine specimens obtained by fiberoptic bronchoscopy. 150 34

Purulent bronchitis was identified in 19 of 422 patients undergoing fiberoptic bronchoscopy during a 32-month period because of suspicion of an opportunistic lung infection complicating acquired immunodeficiency syndrome or human immunodeficiency virus infection. Five patients had Pneumocystis carinii pneumonia, but other opportunistic lung infections were excluded in the remaining 14 patients. Characteristics of these 14 patients included fever (greater than 38.3 degrees C), cough, and dyspnea in 14 of 14 patients; purulence of expectorated sputum (11/14); and widened alveolar-arterial oxygen gradient (13/14). Rapid (2 +/- 1.4 days) clinical response (defervescence and resolution of pulmonary symptoms) occurred with antibiotic therapy in 10 of 14 patients. In three patients, there was no improvement, and adult respiratory distress syndrome developed. Bacterial isolates from bronchoalveolar lavage included Streptococcus viridans (n = 12), Haemophilus influenzae (n = 7), Staphylococcus aureus (n = 3). Roentgenographic features of bronchiectasis were present in seven patients. Differential cell counts revealed greater than 50% neutrophils in the bronchial washings of all patients with purulent bronchitis. Neutrophil percentages in bronchoalveolar lavage were as follows: patient with purulent bronchitis without P carinii pneumonia (n = 14), 54.53% +/- 29.18%; patients with purulent bronchitis and concomitant P carinii pneumonia (n = 5), 62% +/- 31.9%. In a control group of 17 patients with P carinii pneumonia who did not have purulent bronchitis, the neutrophil percentage was 6.8% +/- 6.17% (p = less than 0.00001, t-test). Purulent bronchitis appears to be a distinct, treatable entity in patients with HIV infection and may accompany bacterial pneumonia, bronchiectasis, and P carinii pneumonia.
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PMID:Bronchitis mimicking opportunistic lung infection in patients with human immunodeficiency virus infection/AIDS. 151 86

Between 1984-1991, physicians at Hospital del Mar in Barcelona, Spain and the area with the highest prevalence of tuberculosis (TB) diagnosed active pulmonary nondisseminated TB in 57 HIV infected patients. 3 of these patients consistently had normal chest radiographs. All 3 patients had fever and cough. Case 1 was a 26 year old female intravenous (IV) drug user. She had generalized lymphadenopathy. Hematologic tests revealed an HIV positive status. Her CD4+ lymphocyte count was 782 x 10 to the 6th power/1. Her tuberculin skin test was negative. Mycobacterium tuberculosis in her sputum grew in Lowenstein medium. Acid fast bacilli were detected in her sputum with Ziehl-Nielsen stain. Physicians began antiTB therapy (isoniazid, pyrazinamide, rifampin, and ethambutol). She improved within a few weeks. Case 2 was an HIV positive IV drug user and 33 years old. The CD4+ lymphocyte count was 645 x 10 to the 6th power/1. Acid fast bacilli were detected in his bronchoalveolar lavage with Ziehl-Nielsen stain. M. Tuberculosis in the lavage grew in Lowenstein medium. The physicians started him on the same antiTB therapy as Case 1. His condition improved with therapy. Case 3 was a 50 year old bisexual man. Hematologic tests showed HIV positivity. His CD4+ lymphocyte count was 790 x 10 to the 6th power/1. Further his tuberculin skin test was negative. Fibre optic bronchoscopic samples were negative for acid fast bacilli, but M. tuberculosis grew in Lowenstein culture. Blood, urine, bone marrow and gastric aspirates tested negative for M. tuberculosis. He began the same antiTB therapy as Cases 1 and 2. His condition improved. In conclusion, physicians should aggressively pursue a diagnosis to TB in HIV infected patients presenting with fever and cough. Their rate of hospitalization should fall with early diagnosis and treatment which will in turn prevent the spread of TB among the population.
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PMID:Pulmonary tuberculosis in HIV-infected patients with normal chest radiographs. 154 71

In patients, urinary levels of pentamidine have been shown to reflect pulmonary deposition of aerosolized drug. Using urinary levels and air filter samples, we assessed factors responsible for health care worker (HCW) exposure. We measured serial urine samples in HCWs who administered aerosol pentamidine over an 11-month period and compared them with serial urine levels measured over 30 days in a normal volunteer in whose lungs a known amount of pentamidine (3.39 mg) had been deposited. Ambient exposure to pentamidine was determined by continuous high volume air sampling in the treatment room during routine therapy. In addition, the amount of pentamidine released by six HIV-positive subjects, performing tidal breathing with a Respirgard II nebulizer in an airtight booth, was measured by extracting air from the booth through a filter. The effect of adding noseclips, of coughing (with nebulizer shut down), and of removing the nebulizer from the patient's mouth without turning it off, were determined. Pentamidine in the urine of the normal volunteer reached a peak concentration of 9.5 ng/mg creatinine/ml and was detectable for 30 days following the exposure. In HCWs, pentamidine was detected intermittently in four of five individuals with levels as high as 18.2 ng/mg creatinine/ml. Samples of ambient treatment room air indicated small daily releases of pentamidine (0.013 +/- 0.02 mg per patient treated), but simultaneous urine levels in HCWs were negative. The data from the airtight booth revealed that removing the nebulizer from a patient's mouth without turning it off caused a 360-fold increased in pentamidine release compared to tidal breathing. Coughing resulted in a 6.9 (range 0.9-14.2)-fold increase in release, while the addition of noseclips had no significant effect. The pattern of intermittently positive urine tests and the low levels of ambient pentamidine detected in the air of the treatment room suggest that HCWs are being exposed to episodic but high concentrations of pentamidine. High level exposure is most likely to occur during treatment interruptions which are usually precipitated by coughing episodes. Because of the intermittent pattern of exposure and slow clearance of pentamidine, urine assay is useful for detecting high intermittent exposure. Random air sampling is a sensitive indicator of low level exposures but may not detect episodic high level releases.
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PMID:Exposure of health care workers to aerosolized pentamidine. 844 22

Surgeons managed the care of 39 patients with empyema thoracis at the University Teaching Hospital in Lusaka, Zambia between April 1989-March 1990. 33 patients were males. 26 (23 males and 3 females) tested seropositive for HIV and had AIDS. 19 patients (17 male and 2 females) had tuberculosis (TB) of the lungs. Only 2 did not test positive for HIV. The leading complaints of the 39 patients were cough (30), chest pain (29), and generalized lymphadenopathy (28). HIV positive patients stayed in the hospital longer than HIV negative patients (60 days vs. 5 days). Most patients with empyema thoracis (30) were between 16-40 years old, as were AIDS patients (22) and TB patients (19). 2 of the 4 0-5 year old patients with empyema thoracis suffered from AIDS. The leading surgical procedure for the patients with empyema thoracis was intercostal drainage (12). All 12 patients who underwent rib resection were those who suffered from AIDS. Rib resection was required because these patients presented to the hospital late at which time the aspirate had already become thick. The surgeons were able to aspirate the accumulated pus quite easily in 8 of the 9 patients with AIDS who underwent only intercostal drainage. 8 AIDS patients experienced dried up sinuses at 8 weeks. A home care team managed the rib resection patients at home which resulted in a shorter mean duration at the hospital than for intercostal drainage (8 days vs. 0 days). None of the AIDS patients died from the procedure. Yet 3 AIDS patients died within 2 weeks of entry into the hospital. 5 other AIDS patients died within 6 months of their 1st admission. All HIV negative patients recovered satisfactorily. Home care minimized the burden on hospital resources.
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PMID:Management of empyema thoracis at Lusaka, Zambia. 161 46

Over a period of 11 months, 37 patients infected with the Human Immunodeficiency Virus (HIV) presenting with symptoms of bronchopulmonary disease were investigated. Patients presented with cough, weight loss, fever and dyspnoea. Investigations included fibreoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. In eight patients (22%) Pneumocystis carinii was found. Pulmonary infiltrates were found on chest radiographs of six patients, while in the remaining two patients chest radiographs showed clear lung fields. P. carinii was found in two patients with pulmonary Kaposi's sarcoma. Infection with P. carinii often occurred with other pathogens: Streptococcus pneumoniae was found in four patients, Staphylococcus aureus in two and tuberculosis in two. P. carinii pneumonia does occur in patients with HIV infection in Africa and the diagnosis is relatively simple to make provided that transbronchial biopsy and bronchoalveolar lavage are carried out through a fibreoptic bronchoscope and specimens examined after appropriate staining. However, the prevalence of P. carinii in patients with HIV infection in Africa appears to be lower than that found in patients with HIV infection in Europe and North America.
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PMID:Pneumocystis carinii pneumonia in patients with AIDS in Central Africa. 169 54

In developed countries where tuberculosis is increasing in association with HIV infection, nosocomial transmission among patients and from patients to health care workers is being increasingly reported. Nosocomial tuberculosis among HIV-infected patients is difficult to prevent by conventional control measures because the clinical presentation of the disease may be atypical and confused with other respiratory infections, because the tuberculin skin test is less reliable, because cough generating procedures may increase the probability of transmission, because HIV-infected patients may progress rapidly from infection to disease, and because the organisms are increasingly drug resistant, making preventive therapy difficult. Substandard ventilation and the recirculation of air in many contemporary buildings has also been implicated in widespread nosocomial transmission. Source control through isolation and effective treatment of known or suspected cases remains the most effective strategy for preventing transmission. Dilution of infectious droplet nuclei through ventilation with outside air is important, but incompletely protective. Like ventilation with outside air, filtration of recirculated air may reduce the chance of infection by dilution, but it is expensive. Traditional surgical masks offer the wearer little or no protection. Finally, ultraviolet air disinfection may augment ventilation by inactivating organisms in the upper room air, or in ventilation ducts.
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PMID:Nosocomial tuberculosis in the AIDS era: strategies for interrupting transmission in developed countries. 175 91

The incidence of HIV related KS has increased 50-fold since it was first recognized in Zambia in 1983. The mean age at diagnosis is 35 years for men and 28 years for women, with a sex ratio of M:F = 5:1. The most common symptoms and signs are weight loss, symmetrical lymphadenopathy, oral plaques, skin plaques in a central distribution, oedema and cough with dyspnoea. Biopsy is needed to confirm the diagnosis if disease is confined to lymph nodes. Objective regression occurs in 80% of patients receiving adequate doses of actinomycin D and vincristine (median survival time greater than 3 years for stage I or II disease and 7.5 months for stage III); epirubicin with vincristine was more effective in a phase II trial. Both treatments give good relief of symptoms, allowing patients to return to work. Clinical, histological and biological features of HIV related KS do not support conclusively its classification as a "malignant tumour". Heterosexual and perinatal transmission of HIV in Africa ensures that KS affects families, not just individuals.
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PMID:Occurrence, clinical behaviour and management of Kaposi's sarcoma in Zambia. 182 24


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