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

We report two cases of histoplasmosis occurring in human immunodeficiency virus-positive patients who immigrated to Italy, and focus our attention on the clinical features and therapeutic aspects, with particular emphasis on secondary prophylaxis. The patients had comparable human immunodeficiency virus baseline parameters, but had a completely different compliance over therapeutic regimens. The two patients were followed in two different city hospitals of our region, Padua and Verona, and the diagnosis was made on the basis of instrumental, histologic, and microbiologic findings. One of them was treated with corticosteroids because of nephrotic syndrome.
 ...
PMID:Histoplasmosis in two human immunodeficiency virus-positive immigrants to Italy: clinical features and management in the highly active antiretroviral therapy era. 1510 37

We performed a prospective observational study to assess the safety of stopping maintenance therapy for disseminated histoplasmosis among human immunodeficiency virus infected patients after response to antiretroviral therapy. All subjects received at least 12 months of antifungal therapy and 6 months of antiretroviral therapy before entry. Negative results of fungal blood cultures, urine and serum Histoplasma antigen level of <4.1 units, and CD4+ T cell count of >150 cells/mm3 were required for eligibility. Thirty-two subjects were enrolled; the median CD4+ T cell count at study entry was 289 cells/mm3. No relapses of histoplasmosis occurred after a median duration of follow-up of 24 months. This corresponded to an observed relapse rate of 0 cases per 65 person-years. The median CD4+ T cell count at final study visit was 338 cells/mm3. Discontinuation of antifungal maintenance therapy appears to be safe for patients with acquired immunodeficiency syndrome with previously treated disseminated histoplasmosis and sustained immunologic improvement in response to antiretroviral therapy.
 ...
PMID:Safety of discontinuation of maintenance therapy for disseminated histoplasmosis after immunologic response to antiretroviral therapy. 1548 65

Disseminated histoplasmosis is rare in Jamaica. However, with the increase in the number of immunocompromised patients in the population, the prevalence of this infection is likely to increase. We present a case of disseminated histoplasmosis in a 16-year-old girl with the acquired immune deficiency syndrome who presented to the Paediatric Infectious Diseases Service of the University Hospital of the West Indies, with cervical lymphadenitis progressing to ulcers and abscesses showing granulomatous inflammation likely to be of fungal aetiology. She later presented to the Emergency Room, with respiratory and gastrointestinal symptoms and was admitted to hospital, disoriented and with a persistent fever. She developed nuchal rigidity while in hospital and was anaemic, leukopaenic and thrombocytopaenic. She died of gastrointestinal bleed ten days post admission. She was the oldest known survivor of mother-to-child-transmission of human immunodeficiency virus in Jamaica. The slow growing fungus, Histoplasma capsulatum, was isolated from the patient's blood three weeks after the specimen was sent to the laboratory.
 ...
PMID:Disseminated histoplasmosis and AIDS at the University Hospital of the West Indies. A case report. 1519 26

We studied 52 patients with disseminated histoplasmosis, 30 with the acquired immunodeficiency syndrome (AIDS) (cohort 1) and 22 not co-infected with the human immunodeficiency virus (cohort 2). Demographic, clinical, laboratory, mycologic findings, as well as antifungal therapy and highly active antiretroviral (HAART), were analyzed. Skin lesions were significantly higher in cohort 1 than in cohort 2 (P = 0.001). Anemia, leukopenia, and an elevated erythrocyte sedimentation rate were also more pronounced in cohort 1 than in cohort 2 (P < 0.001). Histoplasma capsulatum was isolated more often in cohort 1 than in cohort 2 (P < 0.05) patients, but antibodies to H. capsulatum were detected more frequently in cohort 2 than in cohort 1 (P < 0.05). Itraconazole treatment was less effective in cohort 1 than in cohort 2 (P = 0.012). In cohort 1 patients, HAART improved response to antifungals when compared with individuals not given HAART (P = 0.003), who exhibited higher mortality rates (P = 0.025). Cohort 1 patients who were given dual antifungal and anti-retroviral therapies responded as well as the non-HIV patients in cohort 2, who were treated only with itraconazole. These results indicate the need to promote restoration of the immune system in patients with AIDS and histoplasmosis.
 ...
PMID:Disseminated histoplasmosis: a comparative study between patients with acquired immunodeficiency syndrome and non-human immunodeficiency virus-infected individuals. 1617 84

Histoplasmosis has rarely been reported in Taiwan, and its clinical manifestations may be similar to those of tuberculosis. With increasing international travel, physicians need to be aware of the possibility of this disease when caring for patients with advanced human immunodeficiency virus (HIV) infection who have traveled to endemic areas. A 55-year-old Chinese male from Burma presented with concurrent histoplasmosis and tuberculous meningitis as the initial opportunistic infection of acquired immunodeficiency syndrome. Fever, altered mentation, pancytopenia, splenomegaly and marked elevations of serum lactate dehydrogenase (3601 U/L) and ferritin (>10(6) ng/mL) were noted. Despite treatment with amphotericin B and antituberculous therapy, the patient died on the 25th day of hospitalization. This case illustrates the complexity and challenges of management of opportunistic infections in travelers returning from Southeast Asia who are in the advanced stage of HIV infection.
 ...
PMID:Meningitis due to Histoplasma capsulatum and Mycobacterium tuberculosis in a returned traveler with acquired immunodeficiency syndrome. 1687 29

We reviewed the clinical, microbiologic, and outcome characteristics of 72 patients with human immunodeficiency virus (HIV)-associated histoplasmosis (4 newly described) reported in Europe over 20 years (1984-2004). Seven cases (9.7%) were acquired in Europe (autochthonous), whereas the majority involved a history of travel or arrival from endemic areas. The diagnosis of progressive disseminated histoplasmosis (PDH) was made during life in 63 patients (87.5%) and was the acquired immunodeficiency syndrome (AIDS)-presenting illness in 44 (61.1%). Disease was widespread in 66 patients (91.7%) and localized in 6 (8.3%), with the skin being the most frequent site of localized infection. Overall skin involvement was reported in 47.2% of the patients regardless of whether histoplasmosis was acquired in Africa or South America. Reticulonodular or diffuse interstial infiltrates occurred in 52.8%. The diagnosis was made during life by histopathology plus culture in 44 patients (69.8%), histopathology alone in 18 (28.5%), and culture alone in 1 (1.5%). During the induction phase amphotericin B and itraconazole (74.6%) were the single most frequently used drugs. Both drugs were also used either in combination (10.2%) or in sequential therapy (11.8%). Cumulative mortality rate during the induction phase of treatment was 15.2%. Overall, 37 patients died (57.8%); death occurred early in the course in 18 (28.1%). Seven of 40 patients (17.5%) who responded to therapy subsequently relapsed. Autopsy data in 13 patients confirmed the widespread disseminated nature of histoplasmosis (85%) among AIDS patients with a median of 4.5 organs involved. The results of the present report highlight the need to consider the diagnosis of PDH among patients with AIDS in Europe presenting with a febrile illness who have traveled to or who originated from an endemic area.
 ...
PMID:Histoplasmosis among human immunodeficiency virus-infected people in Europe: report of 4 cases and review of the literature. 1652 50

We performed a retrospective study of 164 human immunodeficiency virus (HIV)-infected patients with disseminated histoplasmosis to identify the risk factors for death. Death occurred in 32% of the cases. Univariate analysis identified the following risk factors: diarrhea (odds ratio [OR] = 3.9, P = 0.001), neurologic manifestations (OR = 5.8, ; P = 0.001), hemoglobin level < 8.0g/dL (OR = 2.7, P = 0.004), urea level 2 times the normal upper limit (OR = 5.0, P < 0.001), creatinine level > 1.5 mg/dL (OR = 2.9, P = 0.005), aspartate aminotransferase (AST) level > 2.5 times the normal upper limit (OR = 3.1, P = 0.01), respiratory insufficiency (OR = 9.7, P < 0.001), sepsis (OR = 20.2, P < 0.001), and acute renal failure (OR = 2.5, P = 0.011). A hemoglobin level < 8.0 g/dL (OR = 3.8, P = 0.008), an AST level >or= 2.5 times the normal limit (OR = 1.0, P = 0.007), acute renal failure (OR = 2.96, P = 0.015), and respiratory insufficiency (OR = 12.2, P = 0.01) were independent risk factors for death.
 ...
PMID:Risk factors for death in acquired immunodeficiency syndrome-associated disseminated histoplasmosis. 1660 92

CD40 ligand (CD40L) deficiency is an X-linked combined immunodeficiency characterized by impaired class switch recombination. We analyzed clinical and molecular findings in 11 Argentinian patients from seven unrelated families. The mean age at onset of symptoms was 1.1 years (0.5-3.0 years) and the 10 alive patients have a median age of 17 years. We identified two nonsense mutations, including R11X reported as a "hypomorphic" defect, four missense mutations, and one point deletion. Although R11X was associated herein with parvovirus B19-anemia and higher Igs levels as previously described, histoplasmosis and Pneumocystis jiroveci pneumonia were also present. Other so-called "milder" mutation, T254M, was present in three related patients clinically and immunologically undistinguishable from the rest of the cohort. Furthermore, 10 of the 11 patients, having heterogeneous mutations, never had persistent neutropenia, none presented Cryptosporidium sp. infection nor developed liver-biliary tract disease, highlighting the debatable concept of "milder" mutations.
 ...
PMID:Clinical follow-up of 11 Argentinian CD40L-deficient patients with 7 unique mutations including the so-called "milder" mutants. 1735 59

Dimorphism and pathogenesis of Hisdistoplasma capsulatum is a dimorphic fungal pathogen with worldwide significance, which causes a broad spectrum of disease. In the saprophytic stage, it lives as a mycelial form consisting of hyphae bearing both macro and microconidia. Infection with H. capsulatum occurs by inhalation of microconidia (1-4 x 2-6 microm) or small mycelia fragments (5-8 microm) in the terminal bronchioles and alveoli of the lung. Inhaled conidia then convert into the yeast form that is responsible for the pathogenesis of histoplasmosis. As a soil fungus with no known requirements for interacting with a mammalian host as a necessary stage of its life cycle, the number of its strategies for successful pathogenesis is particularly remarkable. They include dimorphic mould-yeast transition, entry into host macrophages, subcellular localization, intracellular survival and proliferation during clinically unapparent infection with capacity for reactivation. H. capsulatum became the subject of increasing studies concurrently with the rising prevalence of human immunodeficiency. This paper presents an overall view of advances in the investigation of H. capsulatum dimorphic transition and pathogenesis.
 ...
PMID:[Dimorphism and pathogenesis of Histoplasma capsulatum]. 1737 May 80

Sixty symptomatic confirmed human immunodeficiency virus (HIV)-positive adult patients, of both sexes, suspected of having a fungal infection were taken as a study population, and the clinicomycological profile was correlated with the immunological status of the patients with particular reference to CD4 counts. Relevant samples were collected and subjected to direct microscopy, fungal culture and serology. CD4 counts were determined by flow cytometry. Patients belonged to the age group of 17-65 years, with a male : female ratio of 4.8 : 1. Heterosexuality was the commonest mode of transmission. Candidiasis was the most common diagnosis (41.7 %), followed by cryptococcosis (10.0 %), and pneumocystinosis and aspergillosis (8.3 % each). Two cases of histoplasmosis were also diagnosed. A low mean CD4 count of <200 cells microl(-1) was seen with most fungal infections. A total of 73 % of patients belonged to World Health Organization (WHO) stage 4, while 23.33 % belonged to stage 3. Thirty one patients (51.67 %) belonged to Centers for Disease Control and Prevention (CDC) stage C3. Various fungal infections correlated well with the mean CD4 counts. It was difficult to correlate statistically WHO and CDC staging because of the small sample size. However, it was possible to assess to a limited extent the possibility of using clinical diagnosis to predict the status of progression of HIV infection in a resource-poor outpatient setting.
 ...
PMID:AIDS-related opportunistic mycoses seen in a tertiary care hospital in North India. 1764 19


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>