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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cytomegalovirus (CMV) colitis is thought to occur almost exclusively in immunosuppressed persons. Colonoscopy in patients with CMV colitis usually shows diffuse or localized ulceration, although mucosal friability, erosions, hemorrhage, and plaque-like pseudomembranes may be observed. We report on a patient with chronic renal failure undergoing hemodialysis therapy who had abdominal symptoms, including bloody diarrhea, along with colonoscopic findings suggestive of carcinoma of the colon. The patient was not infected with the human immunodeficiency virus and had normal lymphocyte subset numbers. He was subsequently found to have invasive CMV disease of the colon. CMV colitis can occur in persons who are not severely immunosuppressed, and its colonoscopic appearance may mimic that of colon cancer.
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PMID:Cytomegalovirus colitis mimicking colon carcinoma in an HIV-negative patient with chronic renal failure. 856 Nov 27

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

We describe three patients with advanced human immunodeficiency virus (HIV) infection, two with colitis and one with cholestatic hepatitis, for whom results of detailed endoscopic and histologic studies were suggestive of invasive spirochetosis. In the two patients with colitis, colonoscopic evaluation revealed either diffuse ulcerations or pustules; in both cases, there was histologic evidence of extensive superficial cell necrosis and infiltration of the mucosa and lamina propria with acute inflammatory cells. Spirochetes in the mucosa and crypts were visualized by Warthin-Starry silver staining. Morphologically similar spirochetes throughout the liver specimen from the patient with cholestatic hepatitis were demonstrated by Warthin-Starry silver staining. Analysis with electron microscopy revealed these organisms to be loosely coiled spirochetes. Despite extensive evaluation, no other pathogens were identified. Invasive spirochetal infection, as defined by the results of Warthin-Starry silver staining of involved tissues, should be considered in the differential diagnosis of patients with HIV infection who have otherwise unexplained colitis or cholestatic hepatitis.
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PMID:Invasive colitis and hepatitis due to previously uncharacterized spirochetes in patients with advanced human immunodeficiency virus infection. 858 36

Six patients suffering from an unusual form of colitis produced by Strongyloides stercoralis hyperinfection are described. In contrast to the usual Strongyloides hyperinfection syndrome, in which small intestinal and pulmonary manifestations are seen in patients with some forms of immunodeficiency, the patients described here presented with only a characteristic transmural eosinophilic granulomatous inflammation affecting mostly the colonic wall and clinically mimicking ulcerative colitis or Crohn's disease. This Strongyloides eosinophilic granulomatous enterocolitis apparently results from a florid inflammatory response by eosinophils, histiocytes, and giant cells with formation of granulomas that destroy the larvae entering the colon. This morphologic picture differs from that of the well-described hyperinfection syndrome, in which the bulk of the larvae pass through the colonic wall to complete the life cycle, with only a few larvae destroyed in the colon. The probable pathophysiologic mechanism of this unusual manifestation of hyperinfection is discussed based on the anatomic and clinical observations of patients who presented at different stages in the evolution of their condition and whose length of follow-up varied.
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PMID:Strongyloides stercoralis eosinophilic granulomatous enterocolitis. 861 25

Herpes simplex virus (HSV) is a well-recognized cause of gastrointestinal infection, most commonly in patients with underlying immunodeficiency. The esophagus, perianum, and rectum are the most common sites of involvement; however, extensive colitis is rare. We describe a woman with Crohn's disease who developed pathologically proven HSV colitis. We review the literature and present the possible implications of the diagnosis.
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PMID:Fulminant herpes colitis in a patient with Crohn's disease. 872 63

Administration of dextran sulfate to mice, given in the drinking water results in acute or subacute colonic inflammation, depending on the administration protocol. This colonic inflammation exhibits ulceration, healing and repair, and a therapeutic response that makes it valuable for the study of mechanisms that could act in the pathogenesis of human ulcerative colitis, a disease thought to have an immunologically dependent pathogenesis. To investigate if immunological mechanisms were involved in the induction of colonic inflammation in this model, mice with different degrees of immunodeficiency were used. It was shown that dextran sulfate induced colitis could be induced in Balb/c mice depleted of CD4(+) helper T cells by treatment with monoclonal antibodies preceded by adult thymectomy. The depletion of CD4(+) was verified by flow cytometric analysis. Furthermore, the colonic inflammation could equally be induced in athymic CD-1 nu/nu mice lacking thymus-derived T cells, in T and B-cell deficient SCID mice, and also in SCID mice depleted of NK cells by treatment with anti-asialo GM1 antibodies. The NK-cell depletion was verified by measuring spleen NK-cell activity. The resulting colonic inflammation in all these types of deficient mice was qualitatively comparable, as shown by clinical and histological appearance. These results indicate that the presence of functional T, B and NK cells is not crucial for the induction of dextran sulfate colitis in mice.
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PMID:Dextran sulfate sodium (DSS) induced experimental colitis in immunodeficient mice: effects in CD4(+) -cell depleted, athymic and NK-cell depleted SCID mice. 874 Oct 8

Review of the medical records of 43 patients with common variable immunodeficiency (CVID) and 23 patients with X-linked agammaglobulinemia (XLAG) revealed a high incidence of chronic gastrointestinal complaints, most commonly diarrhea. Thirty-eight biopsies, four small-bowel resection specimens, and one autopsy from 10 patients with CVID and one patient with XLAG showed a wide range of abnormalities. A pattern resembling acute graft-versus-host disease, with apoptotic bodies and lymphocytes in crypts, was seen in the stomach (four patients), small bowel (three patients), and colon (three patients). Small-bowel specimens from three CVID patients with malabsorption showed mild to severe villous atrophy. Three CVID patients had Giardia in biopsies. Two cases of small bowel lymphoma associated with nodular lymphoid hyperplasia were identified in CVID patients. One patient's small bowel contained foamy histiocytes in the lamina propria, resembling Whipple's disease or chronic granulomatous disease, with numerous apoptotic bodies in crypts. Ultrastructurally, the histiocytes contained cellular debris. The patient with XLAG had recurrent fissuring necrosis of small bowel resembling Crohn's disease; a patient with CVID had colitis with features similar to ulcerative colitis. Poorly formed granulomas were seen in the stomach (one CVID patient) and the colon (two CVID patients). Lymphocyte populations were dominated by T cells; B cells were scarce except in lymphoid follicles in CVID patients with nodular lymphoid hyperplasia. Patients with CVID and XLAG manifest a spectrum of abnormalities in the gastrointestinal tract, with patterns superficially resembling graft-versus-host disease, inflammatory bowel disease, and Whipple's disease, but often lacking some of the diagnostic features of the diseases. Many of the CVID patients with chronic gastrointestinal complaints (62%) also had evidence of autoimmune phenomena, suggesting that in some patients the inflammatory process in the gastrointestinal tract has an autoimmune component.
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PMID:Gastrointestinal pathology in patients with common variable immunodeficiency and X-linked agammaglobulinemia. 882 31

The objective of this study was to determine the effect of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) on inflammatory bowel disease (IBD). A retrospective survey of the medical records of St. Paul's Hospital and its AIDS-care physicians/gastroenterologists searching for patients with both HIV/AIDS and IBD was conducted. Of 1,839 hospitalized patients (4,459 hospital admissions) from 1989 to 1993, two patients with AIDS/HIV and IBD were found. The physician survey revealed four patients for a total of six patients. Four patients developed de novo IBD--two ulcerative colitis (UC), one Crohn's disease (CrD), and one indeterminate colitis (IC)--after HIV infection. Two patients had UC predating HIV seroconversion. The absolute CD4 count of patients with de novo IBD was 210-700 cells/ml at the time of IBD. The patient with IC maintained quiescent IBD from a CD4 count of 190-30 cells/ml. The other had many relapses before HIV seropositivity. With CD4 count depletion, disease activity improved. IBD medications were discontinued at a CD4 count of 130 cells/ml. Diarrhea returned at a CD4 count of 20 cells/ml; however, sigmoidoscopy was unremarkable, and mucosal biopsy revealed cryptosporidiosis without active UC. No patient had an AIDS-related illness during active IBD. Two patients followed to CD4 counts of < 30 cells/ml suffered AIDS-related infections with quiescent IBD. With a progressive decline in CD4 count, IBD disease activity may improve and remit. The CD4 count at which remission occurs may reflect severe immunodeficiency such that risk for AIDS-related infection is high. Active IBD may occur with lesser degrees of immunodeficiency.
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PMID:Human immunodeficiency virus infection, the acquired immunodeficiency syndrome, and inflammatory bowel disease. 883 95

The definition and routine diagnosis of cytomegalovirus (CMV) colitis in patients infected by human immunodeficiency virus (HIV) are controversial. In 100 consecutive HIV-infected patients who underwent colonoscopy for the investigation of diarrhea, we compared the yields of routine diagnostic tools for CMV infection and assessed the risk of further CMV organ disease in subgroups of patients with the following features: full evidence of CMV colitis (group 1), colonic CMV infection but no endoscopic lesions (group 2), and no evidence of colonic CMV infection (group 3). All biopsies taken during colonoscopy were examined immediately by routine hematoxylin and eosin (H&E) staining and viral culture and then pooled for second-line H&E staining and immunohistology. Among the 15 diagnoses of CMV colitis (group 1), two were missed during initial H&E examination, and both patients developed further CMV organ disease during follow-up. Of the 12 group 2 patients 11 were not receiving anti-CMV drugs at the time of initial colonoscopy. CMV organ disease was not significantly more common in these patients than in group 3 during follow-up. We conclude that routine H&E staining of colonic biopsy specimens for CMV inclusions is not 100% sensitive for CMV colitis. The favorable outcome of colonic CMV infection without endoscopic lesions suggests that only patients with full evidence of CMV colitis warrant specific antiviral therapy.
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PMID:Definition and diagnosis of cytomegalovirus colitis in patients infected by human immunodeficiency virus. 917 Apr 16

Homosexual persons or human immunodeficiency virus (HIV)-infected patients frequently excrete cysts of nonpathogenic strains of Entamoeba histolytica ("Entamoeba dispar"). However, invasive amoebiasis is rare. We report two patients with AIDS and cytomegalovirus colitis in whom invasive amoebiasis was histologically diagnosed. It is concluded that E. histolytica has to be considered in HIV-infected patients with colitis.
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PMID:Invasive amoebiasis in two patients with AIDS and cytomegalovirus colitis. 923 Apr 8


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