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

We have presented the case of a 45-year-old HIV-positive man who had a 2-week history of shortness of breath and fever and who was found to have pneumonia due to an acid-fast bacillus. Despite treatment with isoniazid, rifampin, ethambutol, and clofazimine, he died of the infection. Culture results obtained after his death showed the organism to be Mycobacterium kansasii. Mycobacterial infections are common in patients with AIDS, but are usually due to M tuberculosis or M avium complex. Of the 35 patients with AIDS and M kansasii infection mentioned in the literature, only eight of these were described; and of the four patients (including our patient) who received therapy considered appropriate for this infection, only two survived.
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PMID:Mycobacterium kansasii infection in a patient with AIDS. 174 88

Physicians at a district general hospital in London, England admitted a 26 year old pregnant political refugee from Uganda complaining of shortness of breath, fever, and a productive cough for 1 week. She was at 10 weeks gestation and had not yet sought prenatal care. 6 years earlier she had a child and her pregnancy and delivery were normal. They diagnosed an interstitial pneumonia based on an X ray, arterial gases, and quick breathing and administered intravenous (IV) ampicillin and erythromycin for 3 days. Her condition deteriorated nevertheless, so they had her blood tested for HIV. She tested positive and suspected pneumocystosis (later confirmed) and began treatment with IV Septrin and hydrocortisone. She worsened, and by the 10th day of this treatment she was receiving 60% oxygen. They changed her treatment to IV pentamidine and oral rifampicin and isoniazid. By this time, her white blood cell count was 28.7x109/1 and hemoglobin concentration 8.2g/dl. Her condition would not allow her to undergo general anesthesia so an abortion requested by the patient was not performed. Additional treatment included continuous infusion of eflornithine, but she died despite it. This case poses 2 questions. Could she have lived if there had not been a delay in HIV diagnosis? Research shows that CD4 lymphocytes cell counts fall considerably during pregnancy in HIV positive women. So some advocate prophylaxis earlier in these women than other immunocompromised patients. Was it indeed her pregnancy that contributed to the severity of her illness and its inability to respond to treatment? Some researchers find pregnancy accelerates the progress of HIV infection, but researchers do not yet know if it also accelerates the progress of opportunistic infections. If so, terminating pregnancy may be considered.
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PMID:A maternal death caused by AIDS. Case report. 188 2

A 56-year-old man was admitted with hemiparesis and shortness of breath. He was positive to human immunodeficiency virus (HIV) antibody and was diagnosed as acquired immunodeficiency syndrome (AIDS) with Kaposi's sarcoma and pneumocystis carinii pneumonia. He developed chronic photosensitivity and vitiligo preceding the onset of the AIDS-related complex (ARC). Association of the two skin lesions with HIV infection is very rare. Although the role of HIV infection in these skin lesions is not significant, the immunological responses in the early course of HIV infection may have contributed to the development of both of these skin lesions.
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PMID:Vitiligo and chronic photosensitivity in human immunodeficiency virus infection. 192 Sep 68

The purpose of this study was to develop a strategy to reduce transfusion-related HIV transmission which went beyond the limits of routine HIV screening of blood donors. Current blood transfusion practices were assessed in 1044 patients for whom staff physicians had requested a transfusion between 5 September and 19 October, 1988. Children under 5 years of age with malaria, and pregnant women with acute anaemia requiring blood transfusion were the two highest risk groups. Many of the transfusions were given without an obvious medical indication; 22.7% (214 out of 955) of the recipients were transfused without prior laboratory tests [haemoglobin (Hb) or haematocrit (Hct)], 7.2% with Hb greater than 6g/100ml or Hct greater than 25% and 16.6% without clinical signs of severe anaemia (pulse less than 100/min without shortness of breath). The data of this study were used to organize a workshop for all the physicians responsible for blood transfusions in Kinshasa and two nearby health zones. A consensus statement on the indications for blood transfusion was developed. Subsequently, transfusion centres adopted this consensus statement instead of previous guidelines.
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PMID:Prevention of transfusion-associated HIV transmission in Kinshasa, Zaire: HIV screening is not enough. 238 19

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

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

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

In an ongoing prospective study of homosexual men conducted in Vancouver since November 1982, 87 cases of human immunodeficiency virus (HIV) seroconversion have been documented to date. Comparison of laboratory results obtained a mean of 4.9 months before and 5.4 months after the estimated date of seroconversion revealed that a significant increase in the serum IgG level (from 1149 to 1335 mg/dl on average) and in C1q binding (from 8.8% to 14.2% on average) was associated with early HIV infection (p less than 0.001). A marginally significant decrease in the ratio of helper to suppressor (CD4 to CD8) cells (from 1.55 to 1.29 on average) was also noted (p = 0.025). A marked decrease in absolute number of CD4 cells was not seen with seroconversion, which suggests that profound loss of these cells may be a long-term effect of HIV infection. The occurrence of symptoms (including fatigue, fever, night sweats, unintentional weight loss, diarrhea, joint pains, cough unrelated to smoking, shortness of breath, oral thrush, herpes zoster and rash) did not increase with seroconversion. This finding suggests that most cases of HIV seroconversion may be asymptomatic or associated with relatively minor symptoms. On the other hand, generalized lymphadenopathy was found to develop after HIV seroconversion in about 50% of cases.
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PMID:The Vancouver Lymphadenopathy-AIDS Study: 7. Clinical and laboratory features of 87 cases of primary HIV infection. 364 8

Postmortal examinations have shown cardiac involvement in more than 50 percent of patients with AIDS. Echocardiographic studies have shown exudative pericarditis in 18-38 percent of patients with AIDS. The pericardial effusion is usually without haemodynamic consequence, but may be associated with cardiac tamponade. Dilation and hypokinesia of the left ventricle have been found in 30 per cent of patients with AIDS. The impairement of the left ventricular function is primarily seen in febrile, severely diseased AIDS patients, while ambulatory HIV-positive patients have a low prevalence of myocardial involvement. AIDS-patients should be examined by echocardiography in case shortness of breath and hypoxemia are out of proportion to the pulmonary findings.
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PMID:[Heart involvement in HIV infection]. 797 Dec 37

Although pulmonary and central nervous symptoms prevail before death, autopsy often reveals marked myocardial alterations in AIDS patients. This discrepancy prompted us to systematically study cardiac alterations in 100 sequential autopsies of patients who died of AIDS. We appraised the results in relation to changes noted in other organ systems, and compared our data with the AIDS-associated cardiac alterations described in the literature. Cardiac lesions were present in more than 50% of our patients, predominantly in the myocardium (47%). 38 patients displayed signs of active myocarditis. The endocardium and epicardium were secondarily involved, although drug abuse (23 patients) was the most important risk factor for HIV infection, after homosexuality (44%). The prevailing opportunistic agents were identical to those generally seen in AIDS patients, i.e. toxoplasma, cytomegalovirus, mycobacteria and fungi, with the exception of Pneumocystis carinii. This microorganism spared the heart, although it was present in the lungs of 47 patients. Our results are in keeping with other published data. Toxoplasma, present in the myocardium of our patients more frequently than reported in other series, did not necessarily cause a concomitant myocarditis; Coxsackie viruses are deemed to be responsible for many cases of myocarditis in AIDS patients, perhaps even in cases in which we found toxoplasma pseudocysts to be present in the heart muscle. The study clearly shows that the heart is often the unrecognized target of AIDS-associated lesions, even in the initial phase of the AIDS outbreak (1981-1989). Thus, not every shortness of breath is necessarily of pulmonary origin.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Heart and AIDS]. 807 31


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