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

A mycobacterial DNA probe (designated X) was recently developed to help identify Mycobacterium avium complex (MAC) isolates that are nonreactive with probes specific for M. avium or Mycobacterium intracellulare. The prevalence of X probe-positive mycobacteria in clinical specimens and their role in causing disease is unknown. Using a DNA probe kit that includes the X probe, we characterized 100 consecutive clinical MAC isolates as M. avium, M. intracellulare, or X. Lysates from 81 of the isolates reacted with the M. avium probe, 13 with the M. intracellulare probe, 3 with the X probe, and 3 failed to hybridize with any of the probes. All three X-positive isolates were recovered from sputa of patients who were recent immigrants to the United States and who presented with hemoptysis. One isolate was from a Hispanic man infected with human immunodeficiency virus type 1 (HIV-1) and the other 2 were from Filipino patients with no HIV-1 risk factors. This study also showed a higher than expected number of M. intracellulare isolates from blood and cerebrospinal fluid of HIV-1-infected patients.
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PMID:Use of DNA probes to detect Mycobacterium intracellulare and "X" mycobacteria among clinical isolates of Mycobacterium avium complex. 160 95

Inpatient and community-based care can be complementary in relation to the management of HIV disease. Medical records from 200 inpatients of Chikankata Hospital near Lusaka, Zambia and 200 home based patients were examined and compared for the common symptoms of presentation of HIV disease, associated opportunistic infections, and treatment protocols. Drug costs of both groups were also compared. The most common respiratory symptoms in the 2 groups are cough, chest pains, weight loss, and hemoptysis. Treatment employed for these symptoms were cortimoxazole, penicillin V, erthromycin, and tetracycline. Acetyl saliclic acid and paracetamol were used for pain relief in both groups. Gastointestinal system symptoms for both groups were diarrhea, weight loss, abdominal pain, and vomiting. Cotrimoxazole and metronidazole were used in treating diarrhea. Additional treatment protocol for the 2 patient samples included oral rehydration therapy for dehydration, antacid or bismuth subsalicylate for diarrhea and enteritis, and mycostatin for oral candidiasis. Central nervous system symptomatology included headache, dementia, neckace, and lethargy. Chloramphenicol was employed in treating bacterial meningitis. Diazepam and chlorpromazine were effective for restless patients. Genito-urinary system symptomatology for the 2 groups included dysuria, genital ulcers, hematuria, viral warts, and buboes. Antibodies were used for sexually transmitted diseases and infections. Skin symptomatology included rash and dermatitis, herpes zoster, abscess, kaposi's sarcoma, ulcers, furunculosis, and discharging anal sinus. In treating these symptoms, hospital based care and home based care were similar. Overall, it was found that hospital treatment protocols were detailed, expensive, and time consuming. Furthermore, hospital treatment for HIV positive patients is more expensive than HIV negative patients; hospital costs for 50 HIV negative patients totaled US$415.94 compared to US$1204.98 HIV positive/PTB negative patients and US$1705.62 for HIV positive/PTB positive patients. Drug cost/patient admission is increased by 469% if HIV positive. (author's modified).
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PMID:Clinical care as part of integrated AIDS management in a Zambian rural community. 248 94

HIV-associated tuberculosis (TB) poses an immediate and serious threat to public health, especially in the developing world. Moreover, atypical clinical presentation and unfavorable outcome have been observed in HIV-infected patients with TB. The authors report their findings from an investigation of the impact of HIV infection upon the clinical presentation, response to treatment, and outcome of pulmonary TB. The symptoms, radiographic pattern, sputum direct smear, drug susceptibility, treatment outcome, and adverse reactions of 88 HIV-infected patients seen during January-October 1993 at the Central Chest Hospital, Nonthaburi, Thailand, with newly-diagnosed, culture-proven, untreated pulmonary TB were compared with those of age- and gender-matched HIV-seronegative patients. There were 82 men and six women in each group of mean age 35.6 years, with the majority being aged 16-40. Heterosexual contact was the most common risk factor for HIV infection, with homosexuality implicated in only 1% of all cases of infection. No difference was observed between the two groups in the frequency of pyrexia, dyspnoea, cough, or hemoptysis, although cavitary lesions and upper zone infiltrates were observed significantly less often in the HIV-infected group. Direct smear positivity was comparable in the two groups. Resistance rates to anti-TB drugs were not different except for Streptomycin which was higher among the HIV-infected patients. Cutaneous hypersensitivity reactions and drug-induced hepatitis occurred more often in the HIV-seropositive group, but the difference was not statistically significant. Default was much higher among the HIV-infected, although the culture conversion rate was satisfactory among those who completed treatment. Twelve HIV-infected patients died during the course of treatment, four due to TB. The authors that their findings lead physicians to suspect TB among HIV-seropositive patients and provide them with the appropriate and timely short-course chemotherapy.
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PMID:Clinical aspects and treatment outcome in HIV-associated pulmonary tuberculosis: an experience from a Thai referral centre. 774 73

A 27 year old HIV infected man presented with two days of haemoptysis. Flexible bronchoscopy revealed a large carinal mass partially obstructing the left and right main stem bronchi. Rigid bronchoscopy was required to make the diagnosis of large cell immunoblastic lymphoma.
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PMID:Endobronchial HIV associated lymphoma. 801 80

We present the pulmonary findings in 36 autopsies of children affected by the acquired immunodeficiency syndrome (AIDS). Twenty-three patients were male and 13 were female, ranging in age between 3 days and 13 years. Twenty children had human immunodeficiency virus (HIV)-positive parents or parents who were at high risk of exposure (intravenous drug abusers and prostitutes), five had a history of transfusion, and one had a history of renal transplantation and blood transfusion. Clinically, the patients presented with recurrent infections, failure to thrive, hepatosplenomegaly, fever, cough, and/or hemoptysis. Histologically, specific infectious processes were the most common finding (75% of cases), with Pneumocystis carinii pneumonia being the most prevalent type of infection, followed by bacterial pneumonia. Neoplastic conditions and lymphoid interstitial pneumonia were less frequent (approximately 10% of cases). In addition, in approximately 10% of the cases the pulmonary findings were non-specific (ie, pulmonary edema and atelectasis) and probably unrelated to HIV infection. Our findings suggest that specific infectious conditions constitute the most common type of pulmonary pathology in children with AIDS. However, because there is a small percentage of children with nonspecific findings, a transbronchial biopsy is important for proper evaluation before institution of therapy.
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PMID:The spectrum of pathological changes in the lung in children with the acquired immunodeficiency syndrome: an autopsy study of 36 cases. 808 62

The causes of death in a group of HIV-seropositive patients suffering from congenital clotting disorders (cCD) were studied. During the past 6 years, we have followed 19 patients with cCD and HIV infection. Eight patients fulfilled revised CDC criteria for AIDS, 6 subjects reached stage III of CDC, and 5 remained asymptomatic (CDC stage II). All patients who developed AIDS died. In 5 patients, the terminal cause of death was a severe haemorrhage (hematemesis, melena or haemoptysis) after gastrointestinal or lung opportunistic infections. Two other patients died as a consequence of disseminated infections but without significant bleeding. Only one subject died due to neoplastic disease. In the first stages of CDC (II and III), no increase in bleeding symptoms were seen in cCD HIV infected patients. The risk of haemorrhages is, however, increased in AIDS patients. Adequate replacement therapy should be started early whenever severe opportunistic infections appear.
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PMID:Bleeding as a cause of death in HIV-seropositive patients with congenital clotting disorders. 824 99

The problem with the emergence of HIV-associated tuberculosis (which usually occurs in young adults) is that attention has been diverted away from the fact that, in the developed world, the elderly represent the biggest pool of tubercular disease and therefore the greatest pool of infection within the community. Although the incidence rate of tuberculosis continues to decline in most countries, there is evidence from parts of the developing world that rates may be beginning to increase. The presentation of the disease in the elderly is often uncharacteristic, e.g. disease tending to be more insidious in onset, pyrexia often absent and haemoptysis less common. Chest x-ray changes may also mislead the clinician in that disease is frequently present in the mid or lower zones. The elderly are probably at greater risk of extrapulmonary tuberculosis, which also presents in uncharacteristic ways. The diagnosis remains based on clinical presentation and the presence of smear and culture positivity, although some patients may be treated in the absence of microbiological proof. Standard treatment is with a combination of isoniazid, rifampicin and pyrazinamide, with or without a fourth drug such as ethambutol. The incidence of adverse effects in the elderly is much greater than that in younger patients, often resulting in the need to change the medication to drugs which are better tolerated. This may require changing to regimens which are less effective and therefore have to be taken for a longer period of time. The presence of concomitant disease such as liver or renal failure may also necessitate the administration of a suboptimal regimen. Mortality in elderly patients with tuberculosis is considerably higher than that in younger patients, even when treatment appears to have been started on time; even in the developed world mortality exceeds 30% in those patients over 70 years of age.
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PMID:Tuberculosis in the elderly. Epidemiology and optimal management. 873 27

We identified 31 patients with human immunodeficiency virus (HIV) infection and lung abscess. All patients had advanced HIV disease, and the mean CD4 cell count was 17/mm3 (range, 2-50/mm3). Twenty-two patients (71%) had previous opportunistic infections, and 24 (77%) had previous pulmonary infections. Symptoms at the time of presentation included fever (90% of patients), cough (87%), dyspnea (35%), pleuritic chest pain (26%), and hemoptysis (10%). The microbiological etiology was established for 28 patients, and the pathogens recovered were bacteria (65%), Pneumocystis carinii (6%), fungi (3%), and mixed microorganisms (16%). The pathogens included Pseudomonas aeruginosa (11), Streptococcus pneumoniae (6), P. carinii (5), Klebsiella pneumoniae (5), Staphylococcus aureus (4), Aspergillus species (3), viridans streptococcus (2), Haemophilus influenzae (1), Streptococcus milleri (1), Proteus mirabilis (1), and Cryptococcus neoformans (1). Mycobacterium tuberculosis was not isolated; two patients for whom a microbiological etiology was not established responded to antituberculous therapy. Patients were treated for 2-12 weeks; 25% of the patients received > 4 weeks of therapy. The outcome was poor: 36% of the patients had recurrences, and 19% died. In patients with AIDS, lung abscess is associated with advanced HIV infection, is due to a broad spectrum of pathogens, responds poorly to antibiotics, and has a poor prognosis.
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PMID:Lung abscess in patients with AIDS. 882 70

The case of a 25-year-old male agricultural laborer with HIV infection and Pneumocystis carinii pneumonia (PCP) is described, whose radiological lesions simulated pulmonary tuberculosis. He presented with loss of weight and appetite of 6 months' duration, cough with expectoration and minimal hemoptysis for 2 months, chest pain, diarrhea with fever, and odonophasia for 1 month. He had received antitubercular treatment (rifampicin 450 mg and isoniazid 300 mg) 2 months prior to admission. He had been promiscuous, having had multiple sexual contacts with prostitutes. General examination demonstrated marked emaciation, pallor, dyspnea, and oral candidiasis. Auscultation indicated fine medium pitched crackles in both infraclavicular regions. Blood for ELISA and immunocomb test were positive for HIV-1 antibodies. Hemogram revealed Hb 6 gm%, and TLC with polymorphs 63%, lymphocytes 30%, eosinophils 5%, and basophils 2%. The total lymphocyte count was 2100/cu. mm. Chest roentgenography revealed bilateral diffuse homogenous infiltrative lesions involving both lungs, with evidence of multiple bilateral cavitation. Therapy included antitubercular treatment with ethambutol, isoniazid, rifampicin, and pyrazinamide, along with Gentian violet mouth paint and ketoconazole orally, 200 mg bid. The patient developed progressive respiratory distress and died on the 7th day after admission. Limited autopsy of both lungs showed foamy eosinophilic material filling the alveolar space, and Grocett's methenamine silver staining showed cyst walls of P. carinii as black. There was no evidence of pulmonary tuberculosis. In the present case, the diagnosis of PCP should have been kept in mind to increase median survival time (25.9 vs. 12.6 months without treatment) with the treatment of choice of trimethoprim plus sulphamethoxizole in doses of 20 and 100 mg/kg/day. Early diagnosis and treatment will improve the mean survival time in cases of PCP with HIV infection.
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PMID:Pneumocystis carinii pneumonia simulating as pulmonary tuberculosis in AIDS. 901 80

The objective of this study was to identify the prognostic factors influencing the outcome of aspergillosis in two models of immunodeficiency, namely haematological malignancies and HIV infection. The study is based on a 5 year prospective logistic regression analysis of risk factors, clinical features, radiological findings and therapy affecting the prognosis of aspergillosis in 43 patients, i.e. 27 haematological neoplastic patients (group A) and 16 HIV infected patients (group B). Univariate analysis indicated that neutropenia (P = 0.02), haemoptysis (P = 0.03) and concomitant AIDS (P = 0.02), negatively influenced the prognosis of aspergillosis. Comparing the two groups of patients, significant differences emerged in the prognostic indicators. In particular respiratory failure (P = 0.02) and radiological bilateral involvement of the lungs were associated with a poor prognosis in group A (P = 0.04) and low (2100/mm3) T CD4+ cell count in group B (P = 0.02). At variance, a better prognosis was documented in patients treated with sequential therapy (amphotericin B and itraconazole) only within the group of haematological patients (P = 0.003). On multivariate analysis sequential therapy (P = 0.01) and AIDS (P = 0.03) were independent prognostic indicators of aspergillosis. In conclusion, our prospective study indicates that aspergillosis, although an uncommon event in patients with HIV infection, has a more severe prognosis in comparison to haematological patients. Future prospective clinical trials are necessary to confirm the real importance of the sequential therapy, with amphotericin B and itraconazole, in patients with aspergillosis.
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PMID:Comparative analysis of prognostic indicators of aspergillosis in haematological malignancies and HIV infection. 912 Mar 25


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