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

We report on an HIV positive patient with a disseminated Penicillium marneffei infection. A 35-year-old Swiss homosexual male with HIV-associated immunodeficiency with a CD4 cell count of 90/mm3 presented with a two-month history of malaise, intermittent fever, loss of weight, unproductive cough and widespread molluscum contagiosum-like skin lesions, mainly on the face. The patient had travelled extensively and had last visited Thailand 19 months before admission. The chest X-ray showed bilateral diffuse reticulonodular markings. The diagnosis was suspected in bronchoalveolar lavage, which showed round-to-oval intracellular yeast cells but also elongated sausage-shaped extracellular forms. The diagnosis was confirmed on culture. Penicillium marneffei was further isolated from the following specimens: blood cultures, bone marrow, stool, skin and tracheal mucosa biopsy. Intravenous amphotericin B therapy led to a complete subsidence of all symptoms and the skin lesions healed without leaving a scar. The infection, with its clinical presentation, epidemiology, diagnostic problems and therapy is reviewed. We stress that since Penicillium marneffei is an increasingly important pathogen in HIV positive patients in Southeast Asia, this fungus can also be imported to Europe by travellers. If immunocompromised patients have molluscum contagiosum-like skin lesions, pneumonitis and a history of travelling in Southeast Asia, disseminated Penicillium marneffei infection should be considered in differential diagnosis.
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PMID:[HIV-associated Penicillium marneffei infection]. 845 67

Between August and December 1991 in Tanzania, a study to determine the prevalence of Pneumocystis carinii and of tuberculosis occurred among 83 18-38 year old HIV seropositive people living in the rural area of Malenga Makali in Iringa district. The adults had difficulty breathing, cough, fever of at least 2 weeks duration, or overt pneumonia. 3.6% of the sputum samples were confirmed positive for P. carinii. 38.5% of preparations and 13.2% of cultures tested positive for Mycobacterium tuberculosis. All these isolates were completely sensitive to standard antibiotics. 2 of the 3 patients testing positive for P. carinii also had pulmonary tuberculosis. These findings showed that sputum contains many mycobacteria. They also confirmed that TB is associated with HIV infection in several African countries and that P. carinii infection occurs less frequently than it does in Europe and the US, but occurs nevertheless. A possible explanation for the low prevalence of P. carinii infection in Africa is that more virulent infections kill AIDS patients before P. carinii pneumonia has a chance to develop. The researchers admit that their inability to use more suitable specimens obtained by bronchoalveolar lavage or transbronchial biopsy could have resulted in considerable underdiagnosis. They recommended further clinical research to determine the real importance of P. carinii in developing countries.
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PMID:Pneumocystis carinii pneumonia and tuberculosis in Tanzanian patients infected with HIV. 846 96

Atypical pulmonary manifestations of Pneumocystis carinii infection and fair numbers of extrapulmonary and disseminated infections have lately been documented in patients with human immunodeficiency virus infection treated prophylactically with inhalative pentamidine. We report the case of a 32-year-old homosexual patient who was assessed for complaints of night sweats, weight loss, and progressive malaise. The patient denied any respiratory tract symptoms such as cough, sputum production, pleuritic chest pain, or shortness of breath. Chest X-ray revealed two large round noncavitating lesions in the lower lobe of the right lung. Pneumocystomas were diagnosed by fine-needle aspiration. A 3-week course of intravenous high-dose cotrimoxazole resulted in amelioration of symptoms but no change in the radiographic appearance of the pulmonary lesions. Four months later the patient is alive and stable and is being treated with pentamidine inhalation of 300 mg per 2 weeks and two tablets of pyrimethamine sulfadoxine per week.
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PMID:A novel variety of atypical Pneumocystis carinii infection after long-term prophylactic pentamidine inhalation in an AIDS patient: large lower lobe pneumocystoma. 847 17

We report a retrospective study of 12 caucasian men infected with HIV who had developed Mycobacterium kansasii infection (Mk). All patients had a low blood lymphocyte CD4 count (1-130, mean 15/mm3) and ten met the diagnostic criteria for AIDS. The 12 patients had pulmonary symptoms (dyspnea, cough) and fever. On chest X-ray, nodular, interstitial or diffuse parenchymal infiltrates, mediastinal and hilar adenopathies were observed. Two patients had pleural effusion, but none had cavitary lung disease. Mk was isolated by culture of sputum (n = 7), blood (n = 3), bronchial biopsy (n = 2) or bone marrow (n = 1). No patient had clinical extra-pulmonary disease. Survival after diagnosis was in average 7 months. Potential for therapeutic response is reviewed and documented.
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PMID:[Mycobacterium kansasii infection in patients with human immunodeficiency virus infection]. 852 54

The objectives were to describe the sexual practices of high school students; to describe the process of development of a school-based AIDS prevention program; and to evaluate the effect of this program on students' AIDS-related knowledge, attitudes and AIDS-preventive behaviors by means of self-administered questionnaires. A cluster-randomized, controlled trial with pretest/post-test evaluation was conducted in 4 demographically similar public high schools in a semi-urban district of Metro Manila, the Philippines. Of 845 high school students who participated in the baseline survey, 804 (95%) completed a postintervention questionnaire. An AIDS prevention program was developed by public high school teachers together with local AIDS experts, social scientists, and health educators to provide students with accurate information about AIDS, dispel misconceptions about casual contagion, to foster positive attitudes towards people with AIDS, and to develop skills aimed at assessing intended behavior. At baseline, 80 (11%) of 804 students reported ever having had sexual intercourse (mean age 14 years). 66 were male and 14 were female (p 0.001). Among these, condom use was low (24%). Reasons for failure to use condoms were: use of other method (26%) and loss of sensitivity (25%). After implementation of the AIDS prevention program, the intervention group was more likely to answer correctly that HIV cannot be transmitted by mosquito bites (p 0.01), through a cough or sneeze (p 0.01), or by shaking hands with an infected person (p 0.01). Students who had attended the AIDS education program were less likely to avoid people with AIDS and were more compassionate toward them (p = 0.01). Changes in knowledge about modes of HIV transmission were associated with improvements in preventive knowledge (p 0.001). While there was no statistically significant overall effect on intended preventive behavior, the program appeared to delay the students' intended onset of sexual activity. The program was successful in increasing AIDS-related knowledge and improving attitudes toward people with AIDS.
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PMID:Results of a model AIDS prevention program for high school students in the Philippines. 856 4

This article reviews the main clinical aspects and progression of HIV-related tuberculosis in Abidjan. HIV prevalence in tuberculosis patients is high, estimated at 46.2% in 1992, with a clear predominance of HIV-1 over HIV-2. More than 61% of co-infected tuberculous patients meet the WHO's clinical definition of AIDS (the Bangui definition) at the time of diagnosis of tuberculosis. This rates falls to 46-51% when cough is excluded from the definition. On X-rays, the signs of pulmonary tuberculosis in co-infected tuberculous patients are atypical in the advanced stages of HIV infection, when extra-pulmonary localization, mainly mediastinal adenopathy, is frequent. Short-course chemotherapy consisting of 2 months' unsupervised daily treatment with rifampicin/isoniazid/pyrazinamide, followed by 4 months of a daily combination of rifampicin/isoniazid, applied in the Ivory Coast since 15 July 1985, has proved successful in HIV-associated tuberculosis, with treatment effectiveness rates of more than 90%.
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PMID:[The new face of tuberculosis in the context of the tuberculosis-HIV association in Abidjan, Ivory Coast]. 859 70

Kaposi's sarcoma (KS) is the most common neoplasm in persons infected with the human immunodeficiency virus (HIV). However, information about the presenting features of pulmonary KS is limited. To describe the clinical, laboratory, and radiographic features of pulmonary KS, medical records and chest radiographs of 168 patients with pulmonary KS diagnosed by bronchoscopy during a 7-yr period were reviewed. All of the patients were HIV-seropositive males, of whom 95% identified homosexual or bisexual sex as a risk factor for HIV infection. The median CD4 lymphocyte count was 19 cells/microliter. The most common symptoms were cough, dyspnea, and fever. Patients with a concurrent opportunistic pneumonia had a higher median serum lactate dehydrogenase (LDH) concentration than did those with pulmonary KS alone (p<0.001). The most common chest radiograph findings were bronchial-wall thickening, nodules, Kerley B lines, and pleural effusions. The presence of granular opacities or cystic spaces usually indicated concomitant Pneumocystitis carinii pneumonia (p < 0.001). Twenty-six patients (15.5%, 95% CI = 10.2% to 20.8%) had pulmonary KS in the absence of mucocutaneous involvement. The presentation of pulmonary KS is characterized by symptoms that cannot be distinguished from those of a superimposed infection. An elevated serum LDH concentration or a chest radiograph with granular opacities or cystic spaces should raise the suspicion of concurrent opportunistic pneumonia. The diagnosis of pulmonary KS should be considered in an HIV-infected homosexual or bisexual male with respiratory symptoms even in the absence of mucocutaneous lesions.
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PMID:Presentation of AIDS-related pulmonary Kaposi's sarcoma diagnosed by bronchoscopy. 861 70

In June 1993, in Taiwan, a woman admitted to a local hospital with cough, fever, chills, and difficult breathing who tested positive for HIV-1 infection was transferred to Taipei Veterans General Hospital. In January 1985, at a provincial hospital, then 46 years old, she underwent an anterior total hysterectomy and bilateral salpingo-oophorectomy during which she received two units of whole blood. One of the blood donors was an AIDS patient who had been treated at the same hospital in 1991 and who had died in 1993. In the interim between hospitalizations, she had two episodes of herpes zoster infection, including oral ulcers diagnosed as herpetic gingivostomatitis, and an episode of oral candidiasis. Physicians at the Taipei Veterans General Hospital diagnosed oral candidiasis, herpes simplex type 1 virus infection forming ulcers on her lips, and Pneumocystis carinii pneumonia in June 1993. Her CD4 count was 0 and her CD8 count was 20%. Treatment consisted of intravenous (IV) trimethoprim/sulfamethoxazole (TMP/SMX) and oral zidovudine, fluconazole, and acyclovir. She continued this medication after discharge in August 1993. She was readmitted to Taipei Veterans General Hospital in February 1994 for blurred vision. She was diagnosed with cytomegalovirus retinitis. Her CD4 count was up to 1% and her CD8 count was down to 8%. The candidiasis infection had extended from her oral cavity to the esophageal mucosa. She was put on IV ganciclovir, TMP/SMX, and fluconazole. She was discharged 3 weeks after admission. Her condition deteriorated thereafter, resulting in her death in August 1994. Up until this study, this HIV/AIDS case was listed with 79 other HIV/AIDS patients as unknown cause. During the 8 years between HIV exposure and her diagnosis of AIDS, she had unprotected sexual intercourse with her husband. Neither the husband nor any of her four children have AIDS. Screening for HIV-1 in Taiwan began in January 1988. The authors urgently recommend that anyone who received a blood transfusion between 1984 and 1987 in Taiwan and who currently suffers repeated episodes of opportunistic infections undergo an HIV-1 blood test.
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PMID:Transfusion-acquired AIDS in Taiwan. 864 96

Eighty initial episodes of HIV-associated Pneumocystis carinii pneumonia (PCP) diagnosed at Bordeaux hospital between 1985 and 1993 are reported (57 were men and 23 women). PCP revealed HIV infection in 29 patients (36%). Others cases were patients with poor medical follow up (10%), with a CD4+ lymphocyte count above 200/mm3 at last follow-up (9%), non compliant with PCP prophylaxis (9%), or using aerolized pentamidine (AP+) (20%). The main clinical symptoms were fever (90%), dyspnea (68%), non productive (63%) and productive (17%) cough. Radiographic infiltrates were purely interstitial (59%), acinar and interstitial (25%), purely acinar (5%) and absent (11%). Thirty-eight percent of AP+ had upper lobe preferential involvement and 13% a pleural effusion. In all cases, Pneumocystis carinii was detected in bronchoalveolar lavage. Extrapulmonary localizations of pneumocystosis were noticed (eye, liver, spleen, ascitis) in two AP+. Mean CD4+ count was 54/mm3 in patients not having received aerolized pentamidine (AP-) and 22/mm3 in AP+. P24 antigenemia was positive in 53% (AP-) and 88% (AP+). PaO2 LDH and albuminemia were similar in both groups. Antimicrobial therapy (Cotrimoxazole in 91% of the cases) was combined with corticosteroids in 45% and mechanic ventilation in 19%. After 30 days of follow-up, 17 deaths were observed (21%) and 14 attributed to PCP: mortality was worse in AP+ (31%) than in AP- (19%). The main conclusions of our study are the followings: HIV related PCP is still in 1995 frequent and severe; atypical features should not rule out diagnosis; preventive measures are neither sufficient nor efficient. PCP remains in 1995 a priority in HIV related public health and therapeutical research.
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PMID:[Pneumocystis carinii pneumonia in AIDS: retrospective analysis of 80 documented cases (1985-1993)]. 867 82

Diseases caused by opportunistic ambient mycobacteria (OAM) are common in HIV-positive patients, although they also occur in immunocompetent individuals. The objective of the present study was to describe the risk factors, clinical signs, course and microbiological spectrum of OAM that cause pulmonary diseases in non HIV-infected individuals in our community. We reviewed 29 consecutive patients with OAM-caused pulmonary disease between 1989-1994 (26 men and 3 women, mean age 58 +/- 14 years). Infections were by Mycobacterium kansasii, 19 (66%) cases; M. avium complex, 7 (24%) cases; M. chelonei, 2 (7%) cases, and M. flavescens, one (3%) case. Risk factors most often associated to infection were smoking and a history of pulmonary disease (chronic obstructive pulmonary disease or residual tuberculosis). Clinical signs were non specific, although toxic syndrome and unproductive cough predominated. Chest films were indistinguishable from those for infection by M. tuberculosis, with cavitated alveolar fibrosis being the main pattern. In vitro drug sensitivity tests showed that all strains were resistant to isoniazid, and that M. avium complex and M. chelonei strains were resistant to rifampicin, streptomycin and, to a lesser degree, to ethambutol. With prolonged medical treatment lasting from 12 to 24 months with first line drugs, outcome was good for the 17 patients for whom full follow-up information was available. Therapy failed to eradicate the bacteria in only 2 patients.
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PMID:[Lung diseases due to opportunistic environmental Mycobacteria in patients uninfected with human immunodeficiency virus. Risk factors, clinical and diagnostic aspects and course]. 868 13


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