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

In this open-label, randomized, parallel-groups study the Authors compare the parenteral administration of a beta-lactamase inhibitor associated with a semisynthetic penicillin (sulbactam-ampicillin) with the oral administration of a 3rd-generation quinolone (ofloxacin), in 20 HIV-infected subjects suffering from lower respiratory tract (LRT) infections. 12 patients were classified as AIDS, 6 as ARC (AIDS related complex) and 2 as asymptomatic seropositives. The risk of becoming HIV-infected and the work load for the health staff were also evaluated. The clinical and microbiological results indicate that oral ofloxacin is as effective as parenteral sulbactam-ampicillin for the treatment of LRT infections in HIV-positive individuals. In addition, the members of the health staff reported significantly less difficulty in administering ofloxacin in respect to sulbactam-ampicillin.
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PMID:AIDS patients with bacterial lower respiratory tract infections: treatment with ofloxacin versus sulbactam-ampicillin. 128 39

Rhodococcus equi, an unusual gram positive aerobic actinomycete, was first described as a respiratory pathogen of livestock in 1923. Reports of human clinical illness have emphasized R. equi as a cause of invasive pulmonary infection in severely immunocompromised patients and, recently, have implicated it as a cause of pneumonia, bacteremia and disseminated infection in HIV-infected patients. To determine the distribution of R. equi we evaluated 107 isolates referred to the Centers for Disease Control (CDC) during the period January 1973 through December 1990. The sites of these 107 isolates (101 patient and 6 animal isolates) were: blood (32 isolates), sputum (30), lung tissue (13) and other site (32). Before 1983, when the first R. equi isolate from an HIV-infected patient was received, CDC received a total of 52 patient isolates. In addition, during this 10 year period, R. equi isolates were received from more than one site from only one patient. However, during the two year period 1989-1990, we identified 8 patients with underlying HIV infection and R. equi pneumonia who accounted for 29 of 35 (83%) R. equi patient isolates; 6 of these patients also had bacteremia and three died with disseminated R. equi infection. No isolates were resistant to amoxicillin-clavulanate, ampicillin-sulbactam, gentamicin or imipenem, and few (less than 5%) isolates were resistant to erythromycin, rifampin, tetracycline, and trimethoprim-sulfamethoxazole. These results suggest that HIV-infected patients, in particular, are predisposed to develop invasive pulmonary, fatal disseminated R. equi infection (or both), and appropriate antimicrobial susceptibility testing of clinical isolates may improve the effectiveness of therapy of R. equi-infected patients.
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PMID:Distribution and antimicrobial susceptibility of Rhodococcus equi from clinical specimens. 139 8

We report a young male IVDA with CAH caused by HBV who was infected with HIV and who contracted listeriosis in the form of acute hepatitis and bacteremia, with epithelioid granulomas in the liver. Treatment with ampicillin and a aminoglycoside for 3 weeks was followed by rapid and maintained improvement. Involvement of the liver is unusual in listeriosis and, as far as we are aware, it has not been described previously in patients with HIV infection.
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PMID:Acute hepatitis by Listeria monocytogenes in an HIV patient with chronic HBV hepatitis. 147 74

Pneumonia caused by common pyogenic bacteria occurs frequently in HIV-infected patients. Its clinical presentation has been described as being similar to that seen in non-immunosuppressed hosts but clearly different to that of opportunistic pneumonias. An atypical presentation has rarely been seen. In a 10-month period, we saw 12 HIV-infected patients who presented with Haemophilus influenzae pneumonia which was clinically and radiologically indistinguishable from Pneumocystis carinii pneumonia. Ten of the patients were intravenous drug users and were in different stages of HIV disease. The clinical picture was characterized by a prolonged course (median 4 weeks), non-productive cough, dyspnoea, and absence of findings usually present in bacterial pneumonia. Laboratory data frequently showed absence of leukocytosis, increased lactate dehydrogenase levels, hypoxaemia, and decreased CD4+ cell counts. All presented with interstitial or mixed bilateral infiltrates. Resistance to ampicillin and trimethoprim-sulphamethoxazole were each found in seven cases. Eleven patients were cured with antibiotic therapy, although five relapsed. H. influenzae pneumonia should be considered in HIV-infected patients who present with pulmonary symptoms and bilateral infiltrates of subacute or chronic onset. Clinical resolution of pneumonia is the usual outcome, but recurrences of infection are frequent.
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PMID:Latent Haemophilus influenzae pneumonia in patients infected with HIV. 177 77

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 25 year old, human immunodeficiency virus (HIV) seropositive, severe haemophilic patient was treated for suspected Pneumocystis carinii infection with high dose intravenous cotrimoxazole and subsequently with prednisolone. When he improved he was discharged on oral treatment only to return two days later, extremely unwell, with headaches, fever, sweats, tachycardia and hypotension. A lumbar puncture showed modest neutrophil pleocytosis but despite empirical antibiotic treatment with intravenous benzylpenicillin and cefuroxime he continued to deteriorate. Culture of cerebrospinal fluid subsequently grew Enterococcus faecalis that was resistant to trimethoprim and sensitive to ampicillin, rifampicin, and vancomycin. After a change in treatment to intravenous ampicillin and rifampicin he dramatically improved. Enterococcal meningitis is rare in adults but important to recognise and treat appropriately in view of its high mortality and relative resistance to antibiotics. In our case the combination of HIV infection and previous treatment with antibiotics or steroids, or both, were probable predisposing factors.
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PMID:Enterococcal meningitis in an HIV positive haemophilic patient. 190 98

Although resistance to Listeria monocytogenes infection requires intact T cell-mediated immunity, only 20 patients with human immunodeficiency virus (HIV) infection and listeriosis (including one patient described herein) have been reported to date. Listeriosis developed before AIDS in five cases. Syndromes included meningitis in nine cases, bacteremia in nine, brain abscess in one, and endocarditis in one. Eighteen patients were treated with ampicillin, penicillin, or amoxicillin with or without aminoglycosides. Clinical and microbiologic responses were obtained in one patient with bacteremia treated with vancomycin and in one patient with meningitis treated with trimethoprim-sulfamethoxazole. Three of the nine patients with meningitis died, as did the patient with brain abscess. All nine patients with bacteremia and the patient with endocarditis survived. No case of relapse was documented. L. monocytogenes, although uncommon, should be considered in the differential diagnosis of febrile illness, meningitis, and brain abscess in patients with HIV infection.
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PMID:Listeriosis in patients infected with human immunodeficiency virus. 201 9

Although listeriosis is an uncommon infection in patients with human immunodeficiency virus (HIV) infection, the frequency of listeriosis in New York City has increased because of the increase in the number of HIV-infected patients. The medical records of 30 patients admitted to three medical centers in New York City from 1981 to 1988 with infections due to Listeria monocytogenes were reviewed. Six patients had AIDS, one was seropositive and asymptomatic, and four had risk factors for HIV infection. While the annual number of cases of listeriosis in patients without risk factors for HIV infection was constant, 9 of the 11 patients with AIDS or with risk factors for HIV infection presented with listeriosis between 1985 and 1988, the last half of the survey period. These patients were male homosexuals or intravenous drug abusers, and all but one were black or Hispanic. Manifestations of listeriosis in patients with AIDS or with risk factors for HIV infection included bacteremia without apparent source in seven, meningitis in three, and endocarditis in one, syndromes that were similar to those in patients without risk factors for HIV infection. Ten of 11 patients were treated with penicillin or ampicillin, and 7 were also given an aminoglycoside. All patients responded well to therapy and no relapses were observed. Physicians should include antibiotics effective against L. monocytogenes when treating AIDS patients with meningitis of unknown origin and consider the diagnosis of listeriosis in patients with sepsis of unknown origin.
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PMID:Listeriosis in patients with HIV infection: clinical manifestations and response to therapy. 210 31

Persistent shigellosis, due to Shigella flexneri resistant to multiple antibiotics, developed in a 40-yr-old homosexual man with human immunodeficiency virus infection. The Shigella strain demonstrated resistance to ampicillin, tetracycline, and trimethoprim-sulfamethoxazole. Although Shigella flexneri isolates resistant to trimethoprim-sulfamethoxazole are uncommon in the United States, laboratories should monitor resistance patterns through routine in vitro susceptibility testing.
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PMID:Multiple drug-resistance in Shigella flexneri isolated from a patient with human immunodeficiency virus. 332 11

Cutaneous reactions to penicillin-type antibiotics are usually caused by IgE-mediated reactions directed toward the beta-lactam ring (in penicillin, ampicillin-amoxicillin, and cephalosporins). These allergic reactions may be reliably diagnosed (96% to 99% of the time) with a battery of skin tests derived from penicillin. A few individuals have been identified in Spain, and now Canada, who react to side chains of the beta-lactam antibiotics (and not the beta-lactam ring). Nonallergic cutaneous or systemic reactions to trimethoprim sulfamethoxazole (TMP-SMX) are now an emerging problem among HIV-infected patients. Life-threatening reactions have been described in HIV-infected infants who were rechallenged with TMP-SMX. New 10-day and 48-hour desensitization procedures have been used successfully in some TMP-SMX-reactive patients. Stevens-Johnson syndrome and Lyell's syndrome (toxic epidermal necrolysis) are the most serious of the antibiotic-associated cutaneous reactions. These reactions may be caused by an immune reaction similar to graft-versus-host syndrome. Corticosteroids have been shown to be helpful in the management of Stevens-Johnson syndrome. Although the mortality of toxic epidermal necrolysis is usually high, several children with this disorder have been successfully treated in a burn unit.
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PMID:Antibiotic drug allergy in children. 784 10


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