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 association among bacterial pneumonia, human immunodeficiency virus (HIV) infection, and injection-drug use seems to have been well established, accurate estimates of the risk of community-acquired pneumonia among HIV-positive and HIV-negative injection-drug users (IDUs) are still needed. To estimate the incidence of pneumonia in a community of former IDUs, we followed 4,236 persons between 1991 and 1994; 1,114 (26.3%) were HIV-positive and 3,122 (73.7%) were HIV-negative. All patients were evaluated for pneumonia by standard criteria, a serum sample was obtained from each participant at least once a year, and laboratory values were monitored. Overall, 149 episodes of pneumonia occurred among HIV-positive patients and 61 among HIV-negative patients; incidence rates were 90.5 and 14.2 (per 1,000 person-years), respectively. The most common etiologic agents were Streptococcus pneumoniae, Chlamydia pneumoniae, and Haemophilus influenzae. Among the HIV-positive former IDUs, there was a 1.37-fold increase in the relative risk of pneumonia for every decrease of 100/mm3 in the CD4 cell count (95% confidence interval, 1.16-1.61). The incidence of community-acquired pneumonia was markedly higher among HIV-positive participants than among HIV-negative ones, a finding similar to that concerning the general population.
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PMID:Community-acquired pneumonia in a cohort of former injection drug users with and without human immunodeficiency virus infection: incidence, etiologies, and clinical aspects. 881 38

This study is based on a retrospective logistic regression analysis of all human immunodeficiency virus (HIV)-infected patients with Staphylococcus aureus pneumonia (SAP) admitted to the Department of Infectious Diseases, Catholic University, Rome, Italy between January 1986 and December 1994. Nineteen patients with 24 episodes of SAP were enrolled in the study. A control group of 38 HIV-infected patients without pneumonia was included. The attack rate of SAP was 8.31/1000 HIV-related hospital admissions and the frequency, out of the total number of bacterial pneumonia observed in the study period, was 16% (24 of 154 patients). The large majority of SAP was community acquired. On the univariate analysis, intravenous drug abuse (IVDA) (P = 0.02), history of previous Pneumocystis carinii pneumonia (PCP) (P = 0.03) and cirrhosis (P = 0.03) were significant risk factors for SAP. In addition, IVDA and previous PCP were independent risk factors on multivariate analysis. All patients presented with fever associated with cough (74%), chest pain (26%) or shortness of breath (37%). Chest X-ray documented lobar pneumonia (78%), predominantly in the lower lobes, consolidation with cavitation (11%), and interstitial-nodular infiltrates (11%). Pleural effusion was present in 31% of patients. The response to therapy was favourable in 79% of patients. Recurrence occurred in 26% and death occurred in 21% of patients. Death was significantly associated with the low level (< 50 mm-3) of circulating T CD4+ cells (P = 0.03) and the recurrence of pneumonia (P = 0.03). In conclusion, the present study indicates that S. aureus is an important aetiologic agent of bacterial pneumonia in HIV-infected patients, especially if they are drug abusers with previous PCP.
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PMID:Predictors of Staphylococcus aureus pneumonia associated with human immunodeficiency virus infection. 898 27

The purpose of this study was to assess the accuracy of chest x-ray (CXR) interpretation in the diagnosis of pneumocystis carinii pneumonia (PCP), bacterial pneumonia (BP), and pulmonary tuberculosis (TB) in human immunodeficiency virus (HIV)-positive patients and to identify the frequency with which these infections mimic one another radiographically. The admitting CXRs of 153 HIV-positive patients with laboratory proven BP (n = 71), PCP (n = 73), and TB (n = 9) and those of 10 HIV-positive patients with no active disease were reviewed retrospectively and independently by three radiologists who were blinded to clinical and laboratory data. Median percent accuracies were as follows: TB, 84%; PCP, 75%; BP, 64%; and no active disease, 100%. Fifteen of 153 cases (9.8%) were shown to mimic other infections radiographically. A confident and accurate diagnosis can be made radiographically in the majority of cases of PCP, BP, and TB in HIV-positive patients at the time of hospitalization. In approximately 10% of cases, these infections may mimic one another radiographically.
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PMID:Chest radiograph interpretation of Pneumocystis carinii pneumonia, bacterial pneumonia, and pulmonary tuberculosis in HIV-positive patients: accuracy, distinguishing features, and mimics. 898 59

We examined trends in the incidence of specific respiratory disorders in a multicenter cohort with progressive human immunodeficiency virus (HIV) disease during a 5-yr period. Individuals with a wide range of HIV disease severity belonging to three transmission categories were evaluated at regular intervals and for episodic respiratory symptoms using standard diagnostic algorithms. Yearly incidence rates of respiratory diagnoses were assessed in the cohort as a whole and according to CD4 count or HIV transmission category. The most frequent respiratory disorders were upper respiratory tract infections, but the incidence of lower respiratory tract infections increased as CD4 counts declined. Specific lower respiratory infections followed distinctive patterns according to study-entry CD4 count and transmission category. Acute bronchitis was the predominant lower respiratory infection of cohort members with entry CD4 counts > or = 200 cells/mm3. In cohort members with entry CD4 counts of 200 to 499 cells/mm3, the incidence of bacterial and Pneumocystis carinii pneumonia each increased an average of 40% per year. In members with entry CD4 counts < 200 cells/mm3, acute bronchitis, bacterial pneumonia, and P. carinii pneumonia occurred at high rates without discernible time trends, despite chemoprophylaxis in more than 80% after Year 1, and the rate of other pulmonary opportunistic infections increased over time. Each year, injecting drug users had a higher incidence of bacterial pneumonia than did homosexual men. The yearly rate of tuberculosis was < 3 episodes/100 person-yr in each entry CD4 and HIV-transmission group. We conclude that the time trends of HIV-associated respiratory disorders are determined by HIV disease stage and influenced by transmission category. Whereas acute bronchitis is prevalent during all stages of HIV infection, incidence rates of bacterial pneumonia and P. carinii pneumonia rise continuously during progression to advanced disease. In advanced disease, the incidence of acute bronchitis, bacterial pneumonia and P. carinii pneumonia is high despite widespread chemoprophylaxis.
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PMID:Respiratory disease trends in the Pulmonary Complications of HIV Infection Study cohort. Pulmonary Complications of HIV Infection Study Group. 900 Dec 92

We describe the first case, to our knowledge, of apparently isolated pulmonary vasculitis mimicking bacterial pneumonia in a patient infected with human immunodeficiency virus (HIV). Patients presenting with fever, cough, and pulmonary infiltrates present a diagnostic challenge. As a result of severe T cell mediated immunosuppression and humoral dysregulation, the differential diagnosis is diverse. One must consider both noninfectious and infectious etiologies. Noninfectious etiologies such as pulmonary lymphoma, endobronchial Kaposi's sarcoma, and adverse drug reactions are common. Recent recognition of the paradoxical association between HIV and systemic vasculitis requires additional acknowledgment of this problem in diagnosis.
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PMID:Isolated pulmonary microangiitis mimicking pneumonia in a patient infected with human immunodeficiency virus. 910 14

Human immunodeficiency virus (HIV)-infected patients are at increased risk of contracting bacterial infections, mainly pneumonia. Despite this, little is known about immunopathogenic mechanisms in HIV-related bacterial pneumonia. This paper investigates the presence of the neutrophil chemotactic mediators, interleukin-8 (IL_8) and leukotriene B4 (LTB4), in bronchoalveolar lavage (BAL) fluid from 27 HIV-infected patients with bacterial pneumonia. Significantly elevated levels of IL-8 were found in BAL fluid of patients with bacterial pneumonia [529 pg ml-1 (296-1161 pg ml-1)] compared to matched patients with Pneumocystis carinii pneumonia (PCP) [59 pg ml-1 (42-254 pg ml-1)] and healthy controls [58 pg ml-1 (37-82 pg ml-1)]. Levels of LTB4 were not elevated during bacterial pneumonia when compared to PCP patients and healthy controls. Furthermore, a positive correlation was found between IL-8 levels in BAL fluid and relative BAL neutrophilia (r = 0.60, P = 0.001) in bacterial pneumonia. In conclusion, elevated IL-8 levels in BAL fluid were found in patients suffering from bacterial pneumonia, which may account for the influx of neutrophils to the lung, whereas LTB4 appears not to be an important chemotactic factor in this setting.
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PMID:Interleukin-8 and leukotriene B4 in bronchoalveolar lavage fluid from HIV-infected patients with bacterial pneumonia. 917 51

This case report describes a 3-year-old American Quarter Horse with acquired immunodeficiency. Clinical signs included chronic diarrhea due to Salmonella typhimurium and bacterial pneumonia. Characterization of the immunodeficiency involved in vivo phytohemagglutinin (PHA) intradermal testing, in vitro lymphocyte proliferation in response to concanavalin A, immunofluorescence flow cytometry data on blood lymphocytes, serum protein electrophoresis and immunoglobulin (Ig) quantification. A diagnosis of B lymphocyte deficiency with resulting deficiencies in serum IgG, IgA and IgM and a concurrent decrease in T cell function was made based on these tests. Postmortem examination revealed no evidence of lymphosarcoma. This case represents a variation of young adult-onset B cell deficiency not previously described in the literature.
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PMID:Acquired B lymphocyte deficiency and chronic enterocolitis in a 3-year-old quarter horse. 923 37

We prospectively studied features of pyogenic bacterial pneumonia in 263 consecutive human immunodeficiency virus-infected inpatients over a 6-month study period. Risk factors for bacterial pneumonia were examined by a case-control study that included 33 cases who presented with at least one episode of bacterial pneumonia and 80 controls without bacterial pneumonia. The estimated cumulative incidence of bacterial pneumonia per year was 12.5 cases per 100 inpatients (95% confidence interval [CI], 8.8-17.2). The 38 episodes of bacterial pneumonia that occurred in the 33 inpatients were mainly unilateral, but 32 episodes were patchy lobar or diffuse infiltrates. Microbiological etiologies were obtained in 33 of the 38 episodes of bacterial pneumonia. Thirty-seven pathogens were identified, including Streptococcus pneumoniae (16, of which 12 had a decreased susceptibility to penicillin), Haemophilus influenzae (6), and Pseudomonas aeruginosa (6). The risk factors for bacterial pneumonia that were identified after logistic regression included prior sinusitis within 1 month before admission (odds ratio [OR], 3.2; 95% CI, 1.1-9.1) and prior bacterial infection of the lower respiratory tract within 6 months before admission (OR, 3.1; 95% CI, 1.1-8.3).
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PMID:Pyogenic bacterial pneumonia in human immunodeficiency virus-infected inpatients: a clinical, radiological, microbiological, and epidemiological study. 1006 68

There is growing public recognition of the importance of oral health, as symbolized by the theme. "Oral Health for a Healthy Life" proposed for the 1994 World Health Day. In this report, the efficacy of antimicrobial mouth rinses, mainly Listerine, was reviewed by three investigators who are working as a microbiologist, a microbiologist, a dentist, and a dental hygienist participating in oral health care. Listerine, an antimicrobial mouth rinse, completely killed microorganisms in 10 to 30 seconds; the microbes includes methicillin-resistant Staphylococcus aureus, Streptococcus pyogenes, Helicobacter pylori, Candida albicans, Streptococcus mutans, Actinomyces viscosus, Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans. Listerine was also weakly effective in inactivating human immunodeficiency viruses. Bacteria in samples collected from human dental plaque and saliva were completely killed within 30 seconds when exposed to Listerine. When saliva samples were collected from subjects who had rinsed their mouths with 20 ml of Listerine or 1:50 diluted povidone-iodine, levels of viable anaerobic bacteria in the samples were reduced to 1%. When Listerine was used for oral surgery such as tooth extraction and periodontal surgery, the agent was effective in relieving toothache. This was probably due to a decrease in oral bacteria by the antimicrobial action of Listerine, leading to lowering the inflammatory response of the host. The use of antimicrobial mouth rinse during dental treatments such as endodontic treatment proved effective for more reliable infection control. In Japan, there are an increasing number of elderly and medically compromised hosts who are potentially at risk for developing pneumonia due to silent aspiration of microbes in the oral cavity and throat. For the aged with such potential risk, using of antimicrobial mouth rinse may be effective in preventing dental plaque accumulation when used in addition to the mechanical control of plaque, since they tend to have difficulty in brushing teeth by themselves. Indeed, the use of antimicrobial mouth rinse in these elderly people proved useful not only in preventing bacterial pneumonia, but also in improving their quality of life by preserving their oral health.
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PMID:The efficacy of antimicrobial mouth rinses in oral health care. 966 26

The lower respiratory tract has always been a major site of complications in patients with human immunodeficiency virus (HIV) infection. In the era before Pneumocystis carinii prophylaxis (PCP) this organism accounted for more than 70% of initial AIDS-defining diagnoses and was by far the most common identifiable cause of mortality. Even in the era of prophylaxis, PCP continues to be the most common AIDS-defining diagnosis and the most common identifiable cause of death. Despite the historic emphasis on PCP, bacterial pneumonia seems to be at least as common or more common. A substantial spectrum of other opportunistic pathogens are also commonly encountered in these patients. This article reviews pneumonia in patients with HIV infection.
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PMID:Pneumonia in the patient with HIV infection. 977 91


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