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

A 28 year-old homosexual man had one month history of intermittent high fever, nonproductive cough and progressive shortness of breath. He not only had immunity deficits, with decrease CD4 cells decreased CD8 cells and inverted CD4/CD8 ratio, but also presented with evidence of human immunodeficiency virus infection (positive ELISA antibody tests and Western blot tests). Chest X-ray showed diffuse pulmonary infiltration. The arterial blood gases revealed hypoxemia. The PaO2 was 69 mmHg. Spirometry showed FVC 2.28 L (45% predicted), FEV1 2.21 L (49% predicted), FEV1/FVC 93%, and MMEF 4.41 L/sec (90% predicted). The configuration of the Flow-Volume loop was consistent with a restrictive ventilatory defect. Transthoracic lung biopsy demonstrated pneumocystis carinii pneumonia (PCP). He had inadvertent steroid therapy and showed some clinical, pulmonary function and chest X-ray improvement before the diagnosis was established. Steroids might be as adjunctive therapy for a short period of time in treatment of PCP associated with acquired immunodeficiency syndrome (AIDS) at respiratory failure.
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PMID:Pneumocystis Carinii pneumonia in an AIDS patient with dramatic response to inadvertent steroid therapy--a case report. 278 91

A pneumothorax occurred in a 29-year-old HIV-positive woman with rapidly progressive dyspnoea at rest and left-thoracic pain, dry cough and fever. Sputum test revealed Pneumocystis carinii pneumonia. Treatment was started with 20 mg/kg trimethoprim and 100 mg/kg sulfamethoxazole, but was poorly tolerated and changed for pentamidine, 4 mg/kg i.v. from the fifth day onwards. A chest drain was inserted, but pleurodesis became necessary after two further lung collapses. After three weeks secondary prophylaxis of the Pn. carinii pneumonia was started with pentamidine inhalations (60 mg every two weeks). The patient gradually improved under this regimen. Pneumothorax is a rare complication of Pn. carinii pneumonia, but should be considered in patients with rapid respiratory deterioration. In addition, Pn. carinii pneumonia should be considered in HIV-positive patients with pneumothorax.
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PMID:[Pneumothorax as a complication of Pneumocystis carinii pneumonia]. 280 85

Lymphocytic interstitial pneumonia is a common complication of HIV infection in children, but uncommon in adults. It is characterized clinically by the presence of cough and dyspnea, diffuse pulmonary infiltrates on chest x-ray, restrictive pulmonary dysfunction, and hypoxemia. This constellation of findings usually erroneously suggests PCP, and a lung biopsy is necessary to establish the diagnosis. Typical microscopic findings include diffuse infiltration of the pulmonary interstitium with a mixture of lymphocytes and plasma cells; immunohistologic studies reveal that in association with HIV infection, these lymphocytes are T cells. The pathogenesis of LIP in patients with HIV infection is not known. It is believed that it represents a tissue response to EBV infection, HIV infection of the lung, or both. Although patients with LIP may respond dramatically to corticosteroid therapy, others may improve with no treatment. Unfortunately, most patients eventually succumb to other complications of HIV infection.
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PMID:Lymphocytic interstitial pneumonia. 304 82

Infections with human immunodeficiency virus are common in areas of the world where laboratory testing and sophisticated diagnostic facilities are unavailable. A World Health Organization clinical case definition for acquired immunodeficiency syndrome was developed in 1985 for use in such areas. In 1987, we tested this definition on 1328 inpatients and outpatients in 15 hospitals throughout Uganda. Five hundred sixty-two patients (42%) were positive by enzyme-linked immunosorbent assay for human immunodeficiency virus antibody. The World Health Organization definition had a sensitivity of 55%, a specificity of 85%, and a positive predictive value of 73%. Modification of the case definition by excluding a known cough from tuberculosis as a minor criteria decreased sensitivity slightly to 52%, but specificity and positive predictive value increased to 92% and 83%, respectively. Amenorrhea, although not specifically asked about, was a symptom noted by many female patients (26% of females who were positive by enzyme-linked immunosorbent assay); as a symptom indicative of human immunodeficiency virus infection, amenorrhea had a specificity of 99%, with a positive predictive value of 89%. These findings support the generalizability of the World Health Organization clinical acquired immunodeficiency syndrome definition and its use (especially the modified version) in areas of Uganda without sophisticated facilities.
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PMID:Evaluation of the WHO clinical case definition for AIDS in Uganda. 305 90

Pneumocystis carinii pneumonia occurs at some point in the course of disease in approximately 85 per cent of patients with AIDS. Because of the frequency of P. carinii pneumonia and because it is readily treatable, prompt, accurate, and efficient diagnostic schemes are of extreme importance. The clinical presentation is generally characterized by fever, nonproductive cough, and shortness of breath. Such symptoms in a patient from a recognized HIV transmission category should prompt a diagnostic evaluation to identify P. carinii or other opportunistic infections. A chest radiograph usually provides an objective indication of lung disease. Pulmonary function tests, particularly the DLCO and lung imaging using 67Ga-citrate, are useful screening tests in patients with normal chest films. Examination of sputum induced by inhalation of a mist of hypertonic saline is a very useful means of identifying P. carinii. Bronchoalveolar lavage is nearly 100 per cent sensitive to the presence of P. carinii and should be performed in patients who have a nondiagnostic sputum examination. Transbronchial biopsy increases the overall yield for diagnoses other than P. carinii and should be performed in patients in whom bronchoalveolar lavage does not provide a diagnosis. Because of the effectiveness of sputum examinations and bronchoscopic procedures, open lung biopsy is rarely necessary. Measurements of circulating P. carinii antigen and antibodies are of no help in diagnosis.
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PMID:Diagnosis of Pneumocystis carinii pneumonia. 306 May 25

The clinical symptoms and signs were assessed in 20 consecutive patients developing infection with the human immunodeficiency virus (HIV). All were male homosexuals and all presented with a glandular-fever-like illness. Changes in laboratory values were compared with findings in 40 HIV negative male homosexual controls. In the 10 patients for whom date of exposure to the virus could be established the incubation period was 11-28 days (median 14). One or two days after the sudden onset of fever patients developed sore throat, lymphadenopathy, rash, lethargy, coated tongue, tonsillar hypertrophy, dry cough, headache, myalgia, conjunctivitis, vomiting, night sweats, nausea, diarrhoea, and palatal enanthema. Twelve patients had painful, shallow ulcers in the mouth or on the genitals or anus or as manifested by oesophageal symptoms; these ulcers may have been the site of entry of the virus. During the first week after the onset of symptoms mild leucopenia, thrombocytopenia, and increased numbers of banded neutrophils were detected (p less than 0.0005). The mean duration of acute illness was 12.7 days (range 5-44). All patients remained healthy during a mean follow up period of 2.5 years. Heightened awareness of the typical clinical picture in patients developing primary HIV infection will alert the physician at an early stage and so aid prompt diagnosis and help contain the epidemic spread of AIDS.
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PMID:Clinical picture of primary HIV infection presenting as a glandular-fever-like illness. 314 67

Diagnosis of clinical AIDS can be difficult for clinicians in Africa, where there is only limited access to the sophisticated bacteriological diagnostic facilities needed for diagnoses based on the criteria laid down by the Center for Disease Control in the US. The most common presentation of AIDS in Africa is as an enteropathic condition known as 'Slim.' Based on this and other common presentations of the disease in Africa, a group of clinicians in Bangui, Central African Republic, drew up a list of criteria for the diagnosis of AIDS in Africa which are based on patient history and examination and the exclusion of other conditions rather than on serological confirmation of HIV infection. The major criteria are 1) unexplained fever for longer than 1 month; 2) unexplained diarrhea for longer than 1 month; and 3) weight loss greater than 10% of previous weight. Minor symptoms are presence of a maculopapular rash, oral candidiasis or thrush, herpes zoster or shingles, aggressive or uncontrollable herpes simplex, unexplained cough for longer than 1 month, or enlarged lymph nodes in more than 1 extrainguinal site. The finding of 2 major symptoms and at least 1 minor one is enough for diagnosis. These criteria have been found to be useful. However, they do not cover all the presentations which have been associated with AIDS. Unusual presentations of HIV infected persons which have been seen in Africa include serially developing abscesses in pyomyositis, gall bladder diseases, pericarditis or myocarditis, diseases of the Central Nervous System (cryptococcal meningitis, toxoplasmosis, non-specific leuko-encephalitis, atraumatic paraplegia, acute psychosis or chronic deterioration in mental capacity, lymphoma of the brain), prodromal illnesses, swollen lymph nodes, herpes zoster or shingles in young adults, or tumours of the lymphatic system. Differential diagnosis is extremely important.
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PMID:Clinical manifestations of AIDS in tropical countries. 319 42

We observed 276 HIV-infected patients to determine the frequency, degree, and clinical presentation of the lymphocytic alveolitis in different stages of HIV disease, and also to identify the lymphocyte subsets involved. In 154 patients with proved lung infections or tumors (group A), bronchoalveolar lavage fluid showed lymphocytosis in 78 percent of cases. In 122 subjects (31 AIDS and 91 HIV-infected non-AIDS patients) without evidence of lung tumor or infection (group B), lymphocytic alveolitis was seen in 72 percent of cases. In 61 of 88 (69 percent) group B lymphocytic patients, we observed respiratory symptoms or diffuse interstitial opacities; however, we also observed such alveolitis in 27 of 46 (59 percent) group B patients free of respiratory symptoms and abnormality of chest x-ray film. This alveolitis was seen not only in AIDS or ARC patients but also at earlier stages of HIV infection. T-lymphocyte analysis showed a large majority (40 to 93 percent) of CD8 positive lymphocytes in the 37 patients tested. A dual fluorescence analysis revealed, in 18 subjects, that those cells were phenotypically cytotoxic (CD8 + D44 +). These findings suggest that, regardless of HIV-infection stages and of opportunistic lung infections, a CD8-positive T-lymphocyte alveolitis may be present in HIV-infected patients and could be responsible for cough, dyspnea, interstitial pneumonitis, and abnormalities of pulmonary function tests.
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PMID:Human immunodeficiency virus-related lymphocytic alveolitis. 326 11

Pneumocystis carinii pneumonia occurs at some point in the course of illness in approximately 85% of patients with AIDS. Because of the frequency of P. carinii pneumonia and because it is readily treatable, prompt, accurate, and efficient diagnostic schemes are extremely important. The clinical presentation is generally characterized by fever, nonproductive cough, and shortness of breath. Such symptoms in a patient from a recognized HIV transmission category should prompt a diagnostic evaluation to identify P. carinii or other opportunistic infections. A chest radiograph usually provides an objective indication of lung disease. Pulmonary function tests, particularly the DLCO and lung imaging using 67Ga-labeled citrate, are useful screening tests in patients with normal chest radiographs. Examination of sputum induced by inhalation of aerosolized hypertonic saline is a very useful means of identifying P. carinii. Bronchoalveolar lavage is nearly 100% sensitive to the presence of P. carinii and should be performed in patients who have a nondiagnostic sputum examination. Transbronchial biopsy increases the overall yield for diagnoses other than P. carinii and should be performed in patients in whom bronchoalveolar lavage does not provide a diagnosis. Because of the effectiveness of sputum examinations and bronchoscopic procedures, open lung biopsy is rarely necessary.
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PMID:Pneumocystis carinii pneumonia: diagnosis. 328 81

Acquired immunodeficiency syndrome (AIDS) is reviewed for dental practitioners, with an emphasis on oral findings; the clinical course, diagnosis, reporting, treatment, prognosis, transmission, and epidemiology are also covered. HIV infection has an incubation period that may be associated with glandular fever, a prodrome called AIDS-Related Complex (ARC) characterized by lymphadenopathy, low fever, weight loss, night sweats, diarrhea, oral candidosis, nonproductive cough and recurrent infections. AIDS is characterized by opportunistic infections. Over 50% present with pneumocystis carinii pneumonia, 21% with Kaposi's sarcoma, and 6% have both. The AIDS virus causes direct neurological symptoms in some cases. Oral candidosis (thrush) in a young male without a local cause such as xerostomia or immune suppression is strongly suggestive of AIDS. Other oral manifestations are severe herpes simplex, varicella-zoster, Epstein-Barr virus, cytomegalovirus, venereal warts, aphthous ulceration, mycobacterial oral ulcers, oral histoplasmosis, sinusitis and osteomyelitis of the jaw. Hairy leukoplakia, usually seen on the lateral border of the tongue, is probably caused by Epstein-Barr virus. Kaposi's sarcoma, an endothelial cell tumor, is characteristic of AIDS, and in 50% of patients is oral or perioral. Cervical lymph node enlargement will be seen in those with ARC as well as AIDS. No guidelines have been issued by the Department of Health and Social Security for dental surgeons in the UK for reporting AIDS cases. Although HIV virions have been isolated from saliva, there are no known incidents of transmission via saliva. HIV is less likely to be transmitted by needle stick injuries than, for example hepatitis B (25% risk), especially if the blood is from a carrier rather than a full blown AIDS case.
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PMID:Acquired immune deficiency syndrome: review. 352 29


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