Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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)

Although the pulmonary complications of advanced human immunodeficiency virus (HIV) infection have been well described, there is little information on respiratory manifestations of earlier disease. This report describes the respiratory disorders diagnosed over an 18-month period in a cohort of persons with or at risk for HIV infection with variable immunologic status. Cohort members were followed routinely and evaluated for respiratory disease by standard diagnostic algorithms. The 18-month incidence of each respiratory diagnosis was determined, and for frequent diagnoses, incidence by transmission category, location of residence, smoking status, CD4 count, and performance score at entry were compared. The most frequent respiratory diagnoses in HIV-seropositive cohort members were common to the general population: upper respiratory infection (33.4%), acute bronchitis (16.0%), acute sinusitis (5.3%), and bacterial pneumonia (4.8%). Pneumocystis carinii pneumonia occurred in 3.9%. Ambulatory respiratory illnesses were reported frequently regardless of immunologic status. The rates of P. carinii pneumonia and bacterial pneumonia were significantly greater in cohort members with entry CD4 counts < 250. Bacterial pneumonia occurred more frequently in injecting drug users and in cohort members with entry Karnofsky scores < 90. Disease stage and demographic and exposure factors are important variables affecting the respiratory manifestations of HIV infection.
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PMID:Respiratory illness in persons with human immunodeficiency virus infection. The Pulmonary Complications of HIV Infection Study Group. 825 94

Individuals infected with the human immunodeficiency virus (HIV) are more susceptible to bacterial infections because of defects in both cellular and humoral immunity. Streptococcus pneumoniae and Haemophilus influenzae are the most common causes of bacterial pneumonia in HIV-infected patients. However, more unusual bacteria can also cause pneumonia. Response to therapy is generally good for infections caused by pyogenic organisms, and complications are relatively few. Unfortunately, infections caused by Rhodococcus equi and Nocardia species are associated with significant morbidity and mortality. Moreover, the duration of therapy is long, and relapes are common. Prevention of bacterial pneumonia is an important part of the care of HIV-infected patients; the 23 valent pneumococcal vaccine is currently recommended for all HIV-infected patients. The role of other preventative measures remains unknown.
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PMID:Bacterial pneumonia in HIV-infected patients. 827 78

More than 50% of patients with acquired immunodeficiency syndrome (AIDS) develop pulmonary disease during the course of their illness. The authors reviewed 96 computed tomographic (CT) scans of patients with AIDS in an attempt to describe disease entities by the patterns seen on the scans. Such patterns included isolated ground-glass and interstitial infiltrates, which are suggestive of Pneumocystis carinii pneumonia (PCP). If pleural effusions or parenchymal nodules are also present, AIDS-related lymphoma (ARL) or Kaposi sarcoma (KS) is more likely. Although diffuse alveolar infiltrates are most commonly present in PCP, a segmental alveolar infiltrate is suggestive of a bacterial pneumonia, especially when associated with cavitation or ipsilateral pleural effusion. Well-defined nodules are typical for ARL, whereas ill-defined nodules are more commonly suggestive of KS. Accompanying adenopathy or effusion with nodules further suggests ARL. Different combinations of parenchymal, nodular, and pleural abnormalities may be suggestive for additional diagnoses, including Mycobacterium tuberculosis, M avium-intracellulare, and Cryptococcus neoformans infections and human immunodeficiency virus adenopathy. The authors believe that a specific pattern of involvement can help suggest a likely diagnosis in many instances.
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PMID:Pattern recognition of the pulmonary manifestations of AIDS on CT scans. 835 67

The feasibility of on-site primary care services and their use by human immunodeficiency virus HIV-seropositive and seronegative injecting drug users within an outpatient methadone maintenance program are examined. A 16-month prospective study was conducted within an ongoing cohort study of HIV infection at a New York City methadone program with on-site primary care services. The study group consisted of 212 seropositive and 264 seronegative drug injectors. A computerized medical encounter data base, with frequencies of primary care visits and with diagnoses for each visit, was linked to the cohort study data base that contained information on patients' demographic characteristics, serologic status, and CD4+ T-lymphocyte counts. Eighty-one percent of the drug injectors in the study voluntarily used on-site primary care services in the methadone program. Those who were HIV-seropositive made more frequent visits than those who were seronegative (mean annual visits 8.6 versus 4.1, P < .001), which increased with declining CD4+ T-lymphocyte counts; 79 percent of those who were seropositive with CD4 counts of less than 200 cells per cubic millimeter received on-site zidovudine therapy or prophylaxis against Pneumocystis carinii pneumonia, or both. Common primary care diagnoses for patients seropositive for HIV included not only conditions specific to the human immunodeficiency virus but also bacterial pneumonia, tuberculosis, genitourinary infections, asthma, dermatologic disease, psychiatric illness, and complications of substance abuse; those who were seronegative were most frequently seen for upper respiratory infection, psychiatric illness, complications of substance abuse, musculoskeletal disease, hypertension, asthma, and diabetes mellitus. Vaginitis and cervicitis,other gynecologic diseases, and pregnancy were frequent primary care diagnoses among both seropositive and seronegative women.
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PMID:Utilization of on-site primary care services by HIV-seropositive and seronegative drug users in a methadone maintenance program. 839 79

Pooled human immunoglobulin labeled with indium-111 (111In-HIgG) was used to identify the presence and extent of infection in patients positive for human immunodeficiency virus (HIV), presenting with either symptoms and/or signs of acute chest infection or with pyrexia without localizing signs or symptoms. Fifty-five studies were performed in 51 patients with suspected chest infection or pyrexia without localizing signs. Of these, 111In-HIgG identified intrapulmonary accumulation in 17 patients with Pneumocystis carinii pneumonia, eight with bacterial pneumonia, five with cytomegalovirus pneumonia, three with pulmonary Mycobacterium avium intracellulare infection and one with a fungal pneumonia. There was no intrapulmonary accumulation of 111In-HIgG in five patients with bronchopulmonary Kaposi's sarcoma and in three patients with intrathoracic lymphoma. Quantification of lung/heart activity was significantly increased (p < 0.05) in patients with active chest infection compared with those with intrapulmonary tumor or no active lung pathology. Indium-111-HIgG scintigraphy also localized at 14 sites of extrapulmonary infection, including six patients with colitis. There were no false-negative studies but false-positive uptake was seen in four studies. These results confirm that 111In-HIgG correctly identifies the presence and extent of infection in patients positive for HIV antibody.
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PMID:Indium-111-labeled polyclonal human immunoglobulin: identifying focal infection in patients positive for human immunodeficiency virus. 841 Feb 71

Abnormalities have been previously noted in the lipid content of the lavage fluid of patients with bacterial pneumonia. In order to determine if these changes were also seen in surfactant apoproteins, we studied levels of surfactant protein A (SP-A) in patients with bacterial pneumonia. Patients without human immunodeficiency virus who were being evaluated for pulmonary infiltrates underwent bronchoscopy with bronchoalveolar lavage (BAL). Twenty-two patients with pneumonia, 12 caused by gram-positive organisms (Gm+ PNEU) and 10 caused by gram-negative organisms (Gm- PNEU), were compared with 10 patients with idiopathic pulmonary fibrosis (IPF) and 11 control subjects (CON). The percentage of neutrophils in the BAL was significantly higher in the patients with IPF and the pneumonia groups than in the control group (CON: mean, 1; range, 0 to 3. IPF: mean, 26; range, 13 to 42). Gm+ PNEU: mean, 33; range, 8 to 99. Gm- PNEU: mean, 64; range, 10 to 92; p < 0.0001). The amount of SP-A in the BAL fluid was similar for the CON and the IPF groups (CON: mean, 15; range, 5.75 to 26.5 micrograms/ml BAL. IPF: mean, 18.4; range, 6.49 to 45.64 micrograms/ml), whereas both pneumonia groups had significantly less SP-A (Gm- PNEU: mean, 5.54; range, 0.58 to 12.7. G+ PNEU: mean, 1.93; range, 0.47 to 6.74; p < 0.001). There was significantly less SP-A in the Gm+ PNEU group than in the Gm- PNEU group (p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Decreased surfactant protein A in patients with bacterial pneumonia. 844 1

Based on autopsy findings in 70 patients infected by human immunodeficiency virus (HIV) who died in the Pulmonology Department of the Treichville University Hospital Center in Abidjan, Ivory Coast. the authors assess the incidence of tuberculosis as the cause of death and analyze the clinical, bacteriologic, and histologic features of the disease. in this population. Pulmonary tuberculosis was the first cause of death in this series accounting for 31 cases (44.2%). In 12 cases (38.7%), microscopic identification failed during hospitalization and the disease had been misdiagnosed as common bacterial pneumonia. In 29 cases (93.5%) pulmonary tuberculosis was associated with abdominal involvement. In 17 cases (54.8%) involvement of more than two organs was observed. Of the 60 abdominal sites detected during the autopsy of the 31 patients with pulmonary tuberculosis, there were 19 (31.3%) in lymph nodes, 18 (30%) in the liver, 14 (23.3%) in the spleen, and 9 (14.9%) in the kidneys. Histologic features were remarkable by the absence of typical tuberculous granulomas. The findings of this study confirm the high incidence of disseminated tuberculosis in patient infected by HIV as noted in a number of previous studies.
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PMID:[Autopsy findings in 70 AIDS patients who died in a department of pneumology in Ivory Coast: impact of tuberculosis]. 855 23

The value of immunoscintigraphy with technetium-99m (99Tcm) labelled anti-granulocyte monoclonal antibody (BW250/183) was studied prospectively in human immunodeficiency virus (HIV-1) antibody-positive patients presenting with fever without localizing symptoms or signs. Twenty-three studies were performed in 23 patients and the results of 99Tcm-anti-granulocyte imaging were compared with the definitive microbiological or cytological diagnosis. Twenty-one patients had an infective cause of pyrexia, one patient had disseminated lymphoma and one Kaposi sarcoma. 99Tcm-anti-granulocyte antibody imaging correctly identified the sites of infection in only five (24%) patients, four of whom had infective colitis (one also had bacterial pneumonia) and one of whom had cellulitis. Sixteen foci of infection were not localized by 99Tcm-anti-granulocyte immunoscintigraphy (false-negative scans). Six of these patients had Pneumocystis carinii pneumonia; other diagnoses in this group included bacterial or fungal pneumonia and bacteraemia secondary to line infections. 99Tcm-anti-granulocyte antibody did not accumulate in the patients with disseminated lymphoma and Kaposi sarcoma (true-negative scans). 99Tcm-anti-granulocyte imaging, therefore, appears useful in identifying extrathoracic infection in HIV-1 positive patients. Its lack of sensitivity for the identification of pulmonary infection means that its role in the investigation of HIV-1 antibody-positive patients with fever without localizing symptoms or signs is limited.
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PMID:Immunoscintigraphy with a 99Tcm-labelled anti-granulocyte monoclonal antibody in patients with human immunodeficiency virus infection and AIDS. 857 Jan 14

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

Pulmonary infections are a very common complication in acquired immune deficiency syndrome (AIDS) patients. These infections may be severe enough to initiate the admission of these patients to intensive care units (ICU). Pneumocystis carinii pneumonia (PCP) is the most frequent cause of ICU admission because of acute respiratory failure. Mortality of ICU-admitted patients with this infection has changed with time. Initial reports confirmed a high mortality (80% to 90%). After 1985, the mortality rate decreased (50%). Factors such as the use of corticosteroids, better patient care, and a better knowledge of the disease probably explain this change. In recent years (1990 to 1995), mortality has worsened again, perhaps, because ICU facilities were offered more liberally to patients failing aggressive conventional treatment, including adjuvant therapy with corticosteroids. However, for those patients able to be discharged, the prognosis is not worse than expected according to the stage of their human immunodeficiency virus-1 (HIV-1) infection and immunologic status. Consequently, at least a limited period of ICU care and some respiratory support (either continuous positive airway pressure or mechanical ventilation) should be considered and offered to all HIV-1-infected patients with PCP and respiratory failure. Cytomegalovirus may be another cause of severe pulmonary infection in AIDS patients. This infection is difficult to diagnose; hence, it should be suspected when patients with PCP do not progress appropriately, or when no responsible pulmonary pathogen is found. When associated with PCP, mortality is very high. Disseminated tuberculosis is another potential cause of severe respiratory failure and respiratory secretions should be routinely examined for acid-fast bacilli in AIDS patients with pulmonary infiltrates. Finally, bacterial pneumonia (Streptococcus pneumoniae, Neisseria catarrhalis, Haemophilus influenzae, Staphylococcus aureus, and Pseudomonas aeruginosa) may also be the etiological agents of severe acute respiratory failure. Empiric antibacterial treatment to cover these microorganisms should be given when a bacterial agent is suspected.
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PMID:Severe pulmonary infections in AIDS patients. 877 81


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