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

Percutaneous liver biopsy (PLB) is an useful tool in accurately diagnosing difuse hepatopathy and systemic procedures like fever of unknown origin (FUO) and human immunodeficiency virus infection. Present job compares two different PLB procedures, automatic tru-cut needle versus Menghini needle. We have achieved 143 PLBs,74 of them through Menghini needle and 69 with automatic tru-cut technique. No differences were observed about diagnostic efficiency and secondary complications but we have noted a significant presence of pain reactions when Menghini needle is used. So we conclude that tru-cut technique is as safe as Menghini needle with the same diagnostic efficiency and better tolerance.
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PMID:[Percutaneous liver biopsy: comparative study on the efficacy of and tolerance to the automatic tru-cut technique]. 913 31

A 26-year-old human immunodeficiency virus-positive man presented with fever of unknown origin, pancytopenia, and elevated liver function tests. Numerous diagnostic tests and empiric therapeutic interventions remained unsuccessful. Splenectomy eventually established the diagnosis of Epstein-Barr virus-associated hemophagocytic syndrome. Treatment with foscarnet, acyclovir, prednisone, and vinblastine resulted in complete recovery. Three months later, Hodgkin's disease, a previously reported complication of the Epstein-Barr virus-associated hemophagocytic syndrome, was diagnosed. Fever, pancytopenia, and hepatic dysfunction are common complication of advanced human immunodeficiency virus infection and can be caused by a variety of opportunistic pathogens. A high index of suspicion is critical for the management of this otherwise fatal disorder because once the diagnosis is made, even patients with advanced disease benefit from aggressive therapeutic intervention, as demonstrated in the case presented.
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PMID:Epstein-Barr virus--Associated hemophagocytic syndrome. A cause of fever of unknown origin in human immunodeficiency virus infection. 927 14

A case of multiple myeloma associated with HIV disease and hepatosplenomegaly presented to us as pyrexia of unknown origin, is reported. Because of paucity of such cases in the literature, the case is dealt in detail and the literature reviewed briefly.
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PMID:Multiple myeloma complicating HIV-infection. A case report. 935 21

Many conditions may present as fever of unknown origin in the HIV-infected patient, and their relative frequency is influenced by multiple factors. The history and physical examination may provide some useful clues for the diagnosis. Haematological, biochemical, and conventional radiological tests are rarely diagnostic; even serological and/or microbiological tests have some limitations in these patients. The geographical setting and the local prevalence of diseases are of the utmost importance. Infections that have a world-wide distribution, such as tuberculosis, should be intensively searched for, particularly in areas of high prevalence. The measurement of the CD4+ cell count is essential, as there is a strong association between this count and certain opportunistic diseases that may manifest as fever of unknown origin. Imaging procedures, such as CT and radionuclide scans, are useful for the location of inflammatory and neoplastic lesions. Liver and bone marrow biopsies are helpful in certain subsets of patients and the efficacy of empirical treatments has been clearly documented in certain infections. Some HIV-infected patients with fever of unknown origin remain undiagnosed after a thorough investigation; these individuals should be managed conservatively. Finally, symptomatic treatment is the best option for terminally ill patients in whom benefit from a detailed investigation of the cause of fever is not expected.
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PMID:Fever of unknown origin in the HIV-infected patient: new scenario for an old problem. 936 Feb 45

Bone marrow cultures (BMCs) and blood cultures (BCs) are frequently obtained in the evaluation of fever of unknown origin (FUO). However, the low yield of clinically significant isolates leads to questions about their cost-effectiveness. We retrospectively compared BMC with BC and studied the usefulness of bone marrow trephine biopsy (BMTB) histopathology in detecting infection in an unselected population of 61 patients with FUO, among whom 215 BMCs had been performed. For patients who had undergone BMTB, the histopathology was evaluated for granulomas and microorganisms. Only 1 BMC had a clinically significant isolate, Mycobacterium avium complex (MAC), which was also identified by BC. Rhodotorula rubra was found in the BMC of another patient and classified as a contaminant. Both patients had HIV infection. No growth occurred in BCs for the other 59 patients. Culture results for all 26 BMTB specimens were negative; 4 contained nonnecrotizing granulomas, including the case with MAC. BMCs are probably not justified for routine initial evaluation of FUO, but may be valuable after culture results for blood and easily obtainable tissues have been negative. Bone marrow histopathology and special stains for microorganisms in the absence of granulomas were noncontributory.
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PMID:The diagnostic usefulness of bone marrow cultures in patients with fever of unknown origin. 970 12

Tuberculoma of the spleen has been an extremely rare entity during the last decades in the Western world. We describe a case in a young, HIV-negative woman who was evaluated for fever of unknown origin. The workup was initially negative, and she was treated successfully with steroids and nonsteroidal anti-inflammatory analgesics. Recurrence of the fever and an abnormal CT of the abdomen lead to an exploratory laparotomy, which revealed a subcapsular caseous material containing splenic abscess. The very few cases reported in the literature, and the increasing incidence of extrapulmonary tuberculosis due to the alarming numbers of immunodeficient patients that a surgeon may encounter are also discussed.
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PMID:Tuberculoma of the spleen: a rare but important clinical entity. 992 45

To characterize the clinical features of human immunodeficiency virus (HIV)-associated fever of unknown origin (FUO) in the United States, we performed a retrospective analysis of cases that fulfilled specific criteria (published by Durack and Street in 1991) at two medical centers in the United States between 1992 and 1997. Seventy cases met criteria for HIV-associated FUO; the mean CD4 cell count was 58/mm3, and the mean duration of fever was 42 days. A cause of FUO was found in 56 of the 70 cases; 43 were of a single etiology, and in 13 cases multiple conditions were established. The most common diagnoses were disseminated Mycobacterium avium infection (DMAC; 31%), Pneumocystis carinii pneumonia (13%), cytomegalovirus infection (11%), disseminated histoplasmosis (7%), and lymphoma (7%). In this United States series, FUO occurs most often in the late stage of HIV infection, individual cases often have multiple etiologies, and DMAC is the most common diagnosis.
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PMID:Human immunodeficiency virus-associated fever of unknown origin: a study of 70 patients in the United States and review. 1006 53

Nuclear medicine is an important tool in the diagnostic evaluation of patients with a variety of nonosseous infections. In the immunocompetent population labeled leukocyte imaging is the radionuclide procedure of choice, with Gallium imaging reserved for those situations in which the leukocyte study is nondiagnostic or cannot be performed. Fever of unknown origin is caused by infection in less than one-third of cases, and therefore the number of positive leukocyte studies will be relatively low. The negative leukocyte study is also useful, however, as it has been demonstrated that a negative study excludes, with a high degree of certainty, focal infection as the cause of an FUO. In the cardiovascular system, labeled leukocyte scintigraphy is very useful for diagnosing mycotic aneurysms and infected prosthetic vascular grafts, with a sensitivity of about 90%. The specificity of the study is somewhat more variable--false positive results have been described in perigraft hematomas, graft thrombosis, bleeding, and pseudoaneurysms. In the central nervous system, labeled leukocyte imaging can provide important information about the etiology of contrast enhancing brain lesions identified on computed tomography, i.e., distinguishing between neoplasm and infection. In the immunocompromised population, typified by the AIDS patient, Gallium scintigraphy is the radionuclide procedure of choice for diagnosing opportunistic diseases. In the thorax, a normal Gallium scan, in the setting of a negative chest X-ray, virtually excludes pulmonary disease. A negative Gallium scan in a patient with an abnormal chest X-ray and Kaposi's sarcoma study suggests that the patient's respiratory problems are related to Kaposi's sarcoma. Focal pulmonary parenchymal uptake is most often associated with bacterial pneumonia, although Pneumocystis carinii pneumonia can occasionally present in this fashion. Diffuse pulmonary parenchymal uptake of Gallium can be due to numerous causes, but in general, the more intense the uptake, the greater the likelihood that the patient has P. carinii pneumonia. Lymph node uptake is most often due to lymphoma or mycobacterial disease. In the abdomen, Gallium is also useful for detecting nodal disease. but is not reliable for detecting large bowel disease. Labeled leukocyte imaging should be performed when colitis is a concern. Both 18FDG PET and 201Tl SPECT imaging of the brain are useful for distinguishing between central nervous system lymphoma and toxoplasmosis in the HIV (+) patient. On both studies, lymphoma manifests as a focus of increased tracer uptake, whereas toxoplasmosis shows little or no uptake of either tracer.
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PMID:Radionuclide imaging of nonosseous infection. 1023 Feb 81

To evaluate the diagnostic utility, value and potential risk of fine needle aspiration biopsy of spleen (sFNAB) in patients with splenomegaly in pyrexia of unknown origin (PUO), a retrospective analysis of medical records and cytological material of 31 patients on whom FNAB was performed between April 1994 and October 1997 was done. The patients were HIV- and presented with PUO. All other relevant investigations were negative. The spleen was either palpable or detected to have space-occupying lesions on ultrasonography (USG). The splenic aspirates showed tuberculosis in 11 patients (35.4%) and inconclusive or reactive changes in nine patients (25.8%). One case out of this group proved to be Kaposi's sarcoma on autopsy. The other diseases encountered were leishmaniasis (n = 3), non-Hodgkin's lymphoma (n = 4), fungal infections (n = 2), Hodgkin's lymphoma (n = 1). The patients who were diagnosed as having tuberculosis had epithelioid cells, giant cells, necrosis and inflammatory cells in various combinations. AFB positivity was 63.6%. The other cases which showed granulomas but no AFB were diagnosed on empirical grounds and all responded to the anti-tuberculosis therapy. No complications were encountered with the procedure. Therefore the authors conclude that sFNAB is rewarding in patients where all other non-invasive modalities of diagnosis have failed.
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PMID:Fine needle aspiration biopsy of the spleen in pyrexia of unknown origin. 1039 68

A prospective study was conducted to determine the etiology, clinical features, and outcome in a series of 32 consecutively enrolled HIV-infected patients with prolonged fever in whom high resolution (7.5 Mhz) sonography revealed multiple splenic microabscesses. Conventional (3.5 Mhz) sonography showed no splenic abnormalities in any patients. The diagnoses were: tuberculosis (14), visceral leishmaniasis (7), disseminated Mycobacterium avium complex infection (5), Salmonella spp. bacteremia (2), lymphoma (2), disseminated Rhodococcus equi infection (1), disseminated Candida krusei infection (1) and Pneumocystis carinii pneumonia (1). Twenty-eight patients were followed up for six months and four were lost to follow-up. In 16 patients with a clinical cure and microbiological eradication, the findings on follow-up high resolution sonography were normal, and in two patients the microabscesses persisted; ten patients died. In conclusion, the findings suggest splenic microabscesses may be a frequent condition in HIV-infected patients with prolonged fever, being an unspecific manifestation of the opportunistic diseases causing fever of unknown origin in this population. They cannot be detected by conventional abdominal sonography, whereas high resolution sonography is a useful technique for their detection and follow-up.
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PMID:Etiology, clinical features and outcome of splenic microabscesses in HIV-infected patients with prolonged fever. 1042 Oct 38


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