Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Tracheobronchitis is an uncommon manifestation of infection due to Aspergillus species, occurring in < 7% of cases of pulmonary aspergillosis. At least 58 cases of invasive aspergillus tracheobronchitis have been described since 1962. We describe four patients with AIDS, all of whom were severely immunocompromised, who had ulcerative tracheobronchitis due to Aspergillus species demonstrated histologically. Three patients had received corticosteroids or were neutropenic at presentation. At bronchoscopy, three patients had some degree of diffuse tracheobronchitis, multiple ulcerative or "plaque-like" inflammatory lesions, and occasionally nodules involving the mainstem and segmental bronchi. The remaining patient had a single deep ulceration of the proximal trachea. Aspergillus was isolated from biopsy specimens from all four patients. There were varied degrees of invasion of the mucosa, submucosa, and cartilage on histological examination in three patients, one of whom had evidence of disseminated aspergillosis. Two patients subsequently developed pulmonary parenchymal disease due to Aspergillus. A review of aspergillus tracheobronchitis, including a discussion of airway disease in patients infected with human immunodeficiency virus, is presented.
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PMID:Ulcerative and plaque-like tracheobronchitis due to infection with Aspergillus in patients with AIDS. 788 70

Amphotericin is a powerful antifungal agent of high toxicity. Encapsulation in liposomes has led to new perspectives although clinical experience is still slight. Four patients, who were neither carriers of antibodies against the human immunodeficiency virus nor neutropenic, diagnosed of meningeal cryptococcosis, pleural aspergillosis, cerebral aspergillosis and ophthalmic candidiasis, respectively and treated with liposomal amphotericin are reported. The treatment was effective and well tolerated. Clinical improvement was observed in the patient with cerebral aspergillosis but magnetic resonance demonstrated persistence of the lesions. Only slight deterioration in renal function was observed in one case and in the other two renal failure improved upon substitution of conventional amphotericin by liposomal amphotericin. The slight systemic toxicity and the absence of local intolerance allowed the administration of high doses and shortening of the therapeutic schedule.
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PMID:[Liposome amphotericin in the treatment of deep mycoses in patients not severely immunosuppressed. An efficient alternative with low toxicity]. 823 58

Invasive aspergillosis recently has been encountered in adults and children with human immunodeficiency virus (HIV) infection even without known risk factors, such as neutropenia or corticosteroid therapy. Macrophages play a significant role in the host defenses against Aspergillus organisms by ingesting conidia and preventing their germination to hyphae. The antifungal activity of peripheral blood monocyte-derived macrophages (MDM) from 19 HIV-infected children was compared with that of 16 normal controls. The phagocytic activity of patients' MDM, measured as percentage of phagocytosis, was significantly decreased compared with normal donors (P = .014). In addition, the inhibitory activity of MDM on germination of intracellular A. fumigatus conidia was significantly impaired in patients compared with normal controls (P = .016). There was no significant difference in the defects between patients with lower or higher CD4 lymphocyte counts. Impairment of antifungal activity of macrophages may contribute to the susceptibility of HIV-infected patients to aspergillosis.
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PMID:Defective antifungal activity of monocyte-derived macrophages from human immunodeficiency virus-infected children against Aspergillus fumigatus. 824 47

Prevalence of aspergillosis in patients infected with the human immunodeficiency virus (HIV) is unknown. Mycologic findings in bronchopulmonary specimens from 614 HIV-positive patients sent to a parasitology laboratory between June 1, 1989 and May 31, 1991 were analyzed retrospectively; medical records of Aspergillus sp--positive patients were studied to evaluate the potential pathogenic role of this organism. Prevalence of Aspergillus sp. was 2.7% in bronchoalveolar lavage (BAL) specimens, (21/757), 15.1% in sputum specimens (3/53), 12.6% in bronchial aspirates (11/87), 7% in protected brush specimens (2/28), and 16.6% in lung biopsy specimens (4/24). A total of 20 patients (rate = 3.14%) had lung specimens positive for Aspergillus sp. (A. fumigatus 95% and A. niger 5%). Among them, 66% had a single positive specimen (14.3% with a positive smear) and 33% had several positive specimens (mean 4.9 +/- 3.3). Four patients (20%) with a more than 20-month history of AIDS and less than 36 CD4+ cells per microliter had documented pulmonary aspergillosis; three of these patients also had a current or past history of pulmonary mycobacterial infection. Rate of recovery of Aspergillus sp. in LAB specimens was low. The other specimens were harvested because of clinically suggestive manifestations. However, in 20% of patients with positive specimens. A. fumigatus was the cause of patent infection; these patients had severe AIDS-related immunodeficiency.
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PMID:[Frequency of bronchopulmonary isolation of Aspergillus species in patients infected with human immunodeficiency virus: pathogenic role?]. 833 93

Two cases of an unusual pathologic form of pulmonary aspergillosis in patients with the acquired immunodeficiency virus are reported. Each was characterized by chronic cavitary disease with involvement of small bronchioles and extension into subtending alveoli. It is suggested that this variant would best be described as chronic cavitary and invasive bronchopulmonary aspergillosis. A prominent feature in each case was the presence of numerous cytomegalovirus inclusions adjacent to the cavities and affected airways. The significance of this association is not known.
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PMID:An unusual form of pulmonary aspergillosis in two patients with the acquired immunodeficiency syndrome. 839 49

Pulmonary aspergillosis is a relatively common fungal infection in individuals who are immunocompromised or have intrinsic lung disease. Clinical, radiological, and pathologic manifestations are quite varied and depend to a large extent on the type and severity of local or systemic host defense abnormalities. In individuals with only structural lung damage, saprophytic growth alone is the rule. Patients with atopy or other hypersensitivity state typically develop allergic disease, most often allergic bronchopulmonary aspergillosis. Individuals with other immunologic abnormalities, particularly immunodeficiency, and with granulocytopenia characteristically develop invasive disease, which may take several morphological forms. Identification of Aspergillus as the cause of all these disease variants is usually not a problem. However, recognition of the different patterns of disease is useful in understanding the pathogenesis of disease and in interpreting premortem clinical and radiographic abnormalities.
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PMID:Pulmonary aspergillosis: pathologic and pathogenetic features. 841 39

Human immunodeficiency virus (HIV)-infected patients may acquire invasive aspergillosis without previously recognized risk factors, such as neutropenia or corticosteroid therapy. Because neutrophils (PMNL) are an important component of host defense in aspergillosis, the antifungal activity of PMNL against hyphae of Aspergillus fumigatus in 31 HIV-infected children was assessed. Hyphal damage was unaffected in 15 HIV-infected children with age-adjusted CD4 cell counts > or = 25% of the normal median value; it was decreased in 16 with CD4 cell counts < 25% (both vs. 20 healthy controls, P = .001. Incubation with sera from 12 of 14 HIV-infected children but not with the recombinant HIV proteins gp120, gp41, and p24 suppressed antifungal activity of normal PMNL compared with normal serum (P = .002). Pretreatment of defective PMNL from 5 patients with granulocyte colony-stimulating factor (G-CSF) partially corrected the defect (P = .002). These findings suggest that impaired serum-mediated antifungal activity against Aspergillus hyphae exists in PMNL of HIV-infected patients with low CD4 cell counts; G-CSF may improve this activity.
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PMID:Impairment of neutrophil antifungal activity against hyphae of Aspergillus fumigatus in children infected with human immunodeficiency virus. 845 Feb 55

Fourteen patients with poor-prognosis intermediate- to high-grade non-Hodgkin's lymphoma (NHL) associated with human immunodeficiency virus (HIV) infection (12 patients) or human T-cell leukemia virus type I (HTLV-I) infection (two patients) received cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and etoposide 240 mg/m2 administered as a continuous intravenous (IV) infusion over 4 days (infusional CDE); treatment was repeated every 28 or more days for up to six cycles. All HIV-positive patients had at least one poor prognostic feature, which included either extranodal disease (10 patients), Karnofsky performance status less than 70% (six patients), a CD4 count less than 100/microL (six patients), or a prior history of acquired immunodeficiency syndrome (AIDS; one patient). Both HTLV-I-positive patients had an elevated serum lactate dehydrogenase (LDH) level, a poor prognostic feature in that setting. Complete response (CR) occurred in 10 patients (71%; 95% confidence interval, 48% to 95%) and partial response (PR) occurred in three patients (21%), yielding an overall objective response rate of approximately 93%. The estimated Kaplan-Meier median survival was 17.4 months; seven of 12 HIV-positive patients are alive and disease-free with a median follow-up of 15 months (range, 7 to 24 months). Hospitalization was required after 19% of treatment cycles due to fever associated with granulocytopenia. Documented or suspected opportunistic infection occurred in five patients (36%), bacteremia occurred in three patients (21%), and candidemia occurred in one patient (7%). There was one treatment-related death attributable to disseminated aspergillosis. This pilot study suggests that infusional CDE may be a highly active regimen capable of producing durable remissions in a high proportion of patients with HIV-related NHL. Further study is required to confirm this observation.
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PMID:Infusional cyclophosphamide, doxorubicin, and etoposide in human immunodeficiency virus- and human T-cell leukemia virus type I-related non-Hodgkin's lymphoma: a highly active regimen. 849 Jan 87

Invasive aspergillosis is an uncommon but increasingly reported complication of AIDS. Sinusitis, usually bacterial in etiology, is frequently seen among human immunodeficiency virus (HIV)-infected patients. We discuss the cases of three patients with AIDS and invasive aspergillus sinusitis seen at our institutions and those of 15 patients who are described in the literature. Seven of the 18 had brain involvement, 3 had orbital involvement, and 7 had mastoid or other bony disease. Three had evidence of concomitant invasive pulmonary aspergillosis. Of 15 patients with evaluable histories, 11 had recognized risks for invasive aspergillosis; 6 had previous sinusitis, otitis, or polyposis; and 11 had prior conditions indicative of advanced HIV-related disease. Despite aggressive surgical intervention and systemic antifungal therapy, nearly all patients died as a result of aspergillosis.
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PMID:Aspergillus sinusitis in patients with AIDS: report of three cases and review. 852 38

The differential diagnosis of cavitary pulmonary lesions in individuals infected with human immunodeficiency virus (HIV) is broad, especially in patients with advanced disease. In patients with Pneumocystis carinii pneumonia, cavitation is an uncommon manifestation of a common disease. It is unusual in patients with pulmonary cryptococcosis, coccidioidomycosis, and histoplasmosis but occurs frequently in patients with invasive pulmonary aspergillosis. In patients with pulmonary tuberculosis, cavities are more common during earlier stages of HIV disease, when cellular immunity is relatively preserved. Mycobacterium avium complex is an uncommon cause of lung disease and infrequently produces cavities. However, Mycobacterium kansasii, is often associated with cavitation. Cavities can complicate any bacterial pneumonia and are especially common with pneumonia due to Pseudomonas aeruginosa, Nocardia asteroides, and Rhodococcus equi. Noninfectious causes of cavitary lesions are rare, but cavitary lesions caused by pulmonary Kaposi's sarcoma and non-Hodgkin's lymphoma have been reported. Because of the broad differential diagnosis and because most cavities are caused by treatable opportunistic infections, a definitive diagnosis is essential.
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PMID:Cavitary pulmonary lesions in patients infected with human immunodeficiency virus. 872 7


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