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)

Progressive disseminated histoplasmosis (PDH) is a relatively common infectious illness in human immunodeficiency virus (HIV)-infected patients. In Houston, Texas, (which is moderately endemic for histoplasmosis) the frequency of PDH is 5% among patients with acquired immunodeficiency syndrome (AIDS), almost as high as that of those with cryptoccal disease. In highly endemic areas, the frequency of PDH in AIDS is even greater, up to 75% in some areas. It is likely that as the HIV epidemic continues to penetrate to more remote, highly endemic areas, more and more cases of PDH will occur. It is also clear that PDH may develop in HIV-infected patients who presently live in nonendemic areas, but who previously resided in endemic areas. It is important that all physicians who care for HIV-infected patients become thoroughly familiar with the clinical manifestation of this illness. Timely diagnosis depends on a high degree of diagnostic suspicion since the illness seldom presents with primary respiratory symptoms. It is prudent to consider PDH in the differential diagnosis of any systemic, wasting, febrile illness in HIV-infected individuals, especially if currently or in the past they have resided in areas endemic for the fungus. Similarly, whenever PDH is diagnosed in any patient who is in a high-risk group for HIV infection, prompt testing for HIV should be performed.
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PMID:Progressive disseminated histoplasmosis in the acquired immunodeficiency syndrome: a model for disseminated disease. 224 9

Although the clinical and epidemiologic features of progressive disseminated histoplasmosis (PDH) in the acquired immunodeficiency syndrome (AIDS) have been well described, the pathologic and pulmonary aspects remain to be fully defined. A retrospective review of three patients and a prospective study of four more with PDH and AIDS recently admitted to an inner city hospital in a non-endemic area were used to elucidate these features more fully. All patients were men aged 23 to 46 years, born in endemic areas, who had immigrated to the US seven to 15 years before the onset of their illnesses. Five had been exposed to human immunodeficiency virus (HIV) through intravenous drug use (one was also a homosexual), and two through heterosexual contacts. Respiratory symptoms were evident in five of the seven patients, fever in seven, weight loss in seven, hepatomegaly in four, splenomegaly in three, peripheral adenopathy in three, and gastrointestinal symptoms in three. PDH was the initial or only opportunistic infection in five patients. Bilateral nodular infiltrates (4/7), bilateral interstitial infiltrates (2/7), and mediastinal adenopathy associated with pleural effusion (1/7) were the chest roentgenographic findings. Histoplasma capsulatum was isolated from five of five bronchoalveolar lavages, four of four transbronchial biopsies, one of one endobronchial biopsy, one of one brushing, one of one pleural biopsy, three of three lymph node biopsies, two of two bone marrow biopsies, one of one liver biopsy, and three of four peripheral blood smears. Granuloma formation was seen in only three of 12 biopsies. There were ten or more fungi per monocyte in almost all tissues, some with extracellular forms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Disseminated histoplasmosis in AIDS. Clinicopathologic features in seven patients from a non-endemic area. 234 42

A non-comparative open trial with itraconazole in progressive forms of human histoplasmosis was carried out. Thirty two patients who completed 6 months of treatment were included; 29 suffered the chronic disseminated form; 2 exhibited a chronic pulmonary histoplasmosis and one patient presented a subacute disseminated form. Thirty patients were males and 2 females; their ages ranged from 37 to 78 years old (average 56.9). The following underlying diseases were registered: hepatopathies: 12 cases; endocrinopathies and steroid therapy: 13 cases; chronic obstructive pulmonary disease: 10 patients; malignancies: 3 cases; long treatment with psychotropic drugs; 2 cases and 1 immunodeficiency of unknown origin. The therapeutic schedule applied was: 100 mg/day, orally, during 2 months, followed by 50 mg/day for another four months. Twenty-nine patients achieved clinical cure, two showed a striking improvement (both had the chronic pulmonary form) and the treatment could not be evaluated in 1 case. A follow-up of longer than a year was registered in 23 cases, one died as a consequence of mesothelioma and another due to renal impairment, and no relapses were observed. A decreasing complement fixation titer (of more than 2-fold) was observed in 19 cases; 8 of 10 patients with negative skin tests turned positive and the erythrocyte sedimentation rate was reduced to more than a half in 24 cases. Concerning side-effects, a mild, transient and asymptomatic rise of the hepatic enzymes was registered in 9 patients. It seems that itraconazole will be the drug of choice in the treatment of human histoplasmosis in immunocompetent patients.
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PMID:Itraconazole in human histoplasmosis. 254 24

Note from Dr. Merle A. Sande--We have recently come to appreciate the fact that successful chemotherapy of opportunistic infections in patients with AIDS is akin to treatment of certain malignancies: In both instances, induction, followed by maintenance, therapy is required. Although control of initial infections is usually successful with current regimens, relapse is common if lifelong prophylactic or suppressive therapy is not used. This is true in human immunodeficiency virus (HIV)-infected individuals with Pneumocystis carinii pneumonia, cryptococcosis, histoplasmosis, toxoplasmosis, and cytomegaloviral infection. Because Drs. Joseph A. Kovacs and Henry Masur of the National Institutes of Health have been instrumental in developing strategies for the management of P. carinii pneumonia, they were asked to discuss their current approach to chemoprophylaxis of this infection in this AIDS Commentary.
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PMID:Prophylaxis of Pneumocystis carinii pneumonia: an update. 268 38

Two hundred seventy-two patients infected with human immunodeficiency virus (HIV) have received care from the members of the adult infectious disease section at the University of Oklahoma Health Sciences Center. The majority of these patients met the diagnostic criteria for acquired immunodeficiency syndrome. This group of patients was characterized by relatively few parenteral drug abusers, a high incidence of disseminated histoplasmosis, and an unexpectedly low frequency of toxoplasmosis. The prevalence of risk behaviors and endemic disease may be responsible for these particular case distributions.
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PMID:Clinical experience with HIV-infected patients at the University of Oklahoma Health Sciences Center. 274 84

Sixty four patients suffering a chronic disseminated histoplasmosis were studied with the aim of fingind if they had predisposing factors. Thirty cases (46.8%) presented the following predisposing conditions: long treatment with low doses of corticosteroids in 7, ethilic hepatopathy in 7, diabetes in 4, lymphoma in 3, epitheliomas in 3, epitheliomas and diabetes in 1, renal insufficiency in 1, toxic hepatitis in 1, radiations in 1, long treatment with psychotropics in 1 and primary combined immunodeficiency in 1. Only slight differences were detected between these two groups of patients; those who exhibited predisposing factors presented an increased number of clinical localizations, altered cell mediated immunological tests were more frequent as well as the number of patients with multiple relapses and deaths. Histoplasmosis was not the cause of death in any case. It is possible that if a more frequent aggressive exploration, as hepatic biopsy, would be done a higher number of patients with predisposing factors would have been demonstrated.
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PMID:[Chronic disseminated histoplasmosis as an opportunistic infection]. 332 4

Fourteen previously healthy young patients with unusual community-acquired opportunistic infections were seen over a period of three years. They differ from patients previously described in that 11 were heterosexual drug abusers (including two women) and only three were homosexual men. There were eight Puerto Ricans, five blacks, and one white. Infections included Pneumocystis carinii pneumonia (seven), disseminated Mycobacterium intracellulare infection, histoplasmosis, cryptococcosis, and cytomegalovirus infection (one each), oral thrush (13), and Candida esophagitis (two). All patients had impaired cellular immunity manifested by cutaneous anergy and lymphopenia, and all 11 tested had a markedly decreased ratio of T helper/inducer cells to T suppressor/cytotoxic cells. Twelve had evidence of associated viral infection (Epstein-Barr virus in nine, cytomegalovirus in five, Herpes simplex type 2 in two). Clinical presentation was with a severe opportunistic infection or with a prodrome consisting of oral thrush and nonspecific findings including malaise, fever, lymphadenopathy, or cough. The syndrome of immunodeficiency and opportunistic infection occurs in nonwhite heterosexual drug abusers, not exclusively in white homosexual men, and patients may present for medical care before the onset of a severe opportunistic infection.
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PMID:Community-acquired opportunistic infections and defective cellular immunity in heterosexual drug abusers and homosexual men. 621 79

Immunodeficiency with hyperimmunoglobulinemia M is a rare disease characterized by very low levels of IgG and IgA and normal or high levels of serum IgM and IgD. Recurrent and severe systemic infections with pathogenic bacteria are frequent if immunoglobulin replacement therapy is not given. Histoplasmosis is a systemic granulomatous mycosis due to Histoplasma capsulatum and characterized by a particular affinity for the reticuloendothelial system. Glabrous skin involvement in histoplasmosis is highly unusual except in patients with advanced human immunodeficiency viral disease. Cutaneous histoplasmosis and granulomatous reaction were diagnosed in a 5-year-old boy with hyper-IgM disease. The lesion improved after oral ketoconazole therapy. To our knowledge, this is the first case of cutaneous histoplasmosis associated with hyper-IgM to be reported.
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PMID:Cutaneous histoplasmosis in a child with hyper-IgM. 750 54

In the human immunodeficiency virus (HIV) infected patient, skin infections caused by S aureus are extremely common. Impetigo, ecthyma, and folliculitis are all seen. Recurrences are common due to a nasal carriage rate of 50%. Dermatophytosis usually manifests as tinea pedis or unguium and is caused by Trichophyton rubrum. Oral candidiasis may be the initial evidence of HIV infection, and is predictive of more rapid progression to acquired immune deficiency syndrome (AIDS). Topical agents are usually effective for oral lesions, but involvement of the esophagus requires oral imidazole therapy. Systemic fungal infections are most commonly caused by cryptococcosis or histoplasmosis. The finding of either of these infectious agents in the skin is pathognomonic of disseminated infection. Cryptococcus presents as umbilicated papules resembling molluscum or as large ulcerations. Histoplasmosis has no specific cutaneous morphology. Scabies is very common in HIV-infected persons, and once the helper T-cell count is less than 200, it may present atypically. Permethrin is the recommended treatment in this setting.
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PMID:Treatment of bacterial, fungal, and parasitic infections in the HIV-infected host. 750 36

Bacillary angiomatosis (BA) presents most commonly as a cutaneous disease and is caused by two organisms. Bartonella (Rochalimaea) henselae and Bartonella (Rochalimaea) quintana. Biopsy confirmation of cutaneous BA is essential because lesions can mimic nodular Kaposi's sarcoma in appearance. Although the vast majority of human immunodeficiency virus (HIV)-infected patients with BA have CD4 lymphocyte counts of less than 100 cells per mm3, the disease responds well to antimicrobial therapy. Staphylococcus aureus is the most common bacterial skin pathogen affecting HIV-infected patients. The prevalence of skin disease due to S. aureus may be explained by high nasal carriage rates for the organism ( > or = 50%) and altered immune function in conjunction with an impaired cutaneous barrier. Herpes simplex virus causes mucocutaneous disease early in the course HIV infection and ulcerative lesions at any site in advanced HIV infection. Herpes zoster is common early in the course of HIV infection; recurrent and disseminated herpes zoster infections are characteristic of patients with advanced HIV disease. Acyclovir resistance is usually seen in patients with large, untreated, ulcerative lesions of herpes simplex virus and in patients with chronic, verrucous lesions of varicella-zoster virus. Cutaneous cryptococcosis, histoplasmosis, and coccidiomycosis are markers of disseminated disease and require biopsy confirmation. Scabies is easily diagnosed but may be atypical in presentation and difficult to eradicate in advanced HIV disease.
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PMID:Cutaneous manifestations of opportunistic infections in patients infected with human immunodeficiency virus. 755 76


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