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

To determine whether aspects of clinical history, physical examination, and laboratory studies improve the diagnostic accuracy of the chest roentgenogram in the diagnosis of Pneumocystis carinii pneumonia (PCP), we followed up 302 consecutive patients with respiratory symptoms and risk factors for human immunodeficiency virus. Of the 279 patients (92%) with follow-up information available, 31 (11%) were diagnosed with PCP. Only 68% of patients with PCP had typical chest roentgenograms. Regression analysis identified four independent predictors of PCP: diffuse or perihilar infiltrates, presence of mouth lesions, lactate dehydrogenase level more than 220 U/L, and erythrocyte sedimentation rate 50 mm/h or more. Using these four predictors, patients could be stratified into low-, intermediate-, and high-risk groups for PCP. We suggest that examination of the mouth, chest roentgenogram, lactate dehydrogenase level, and erythrocyte sedimentation rate be part of the evaluation of ambulatory patients with respiratory symptoms at risk for human immunodeficiency virus.
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PMID:Risk stratification of ambulatory patients suspected of Pneumocystis pneumonia. 198 85

We describe three patients with Pneumocystis carinii pneumonia as the initial presentation of severe combined immunodeficiency disease. The pneumonia in the first patient was treated successfully with trimethoprim/sulphamethoxazole (Tmp/Smz). The second patient died despite therapy with Tmp/Smz and pentamidine. The third patient failed to respond to therapy with Tmp/Smz and pentamidine. He was subsequently treated with trimetrexate and leucovorin. Treatment with the new folic acid antagonist trimetrexate resulted in complete recovery. The case histories of these children serve to illustrate the clinical symptoms and new therapeutic modalities of P. carinii pneumonia in patients with immunodeficiency disease.
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PMID:[Pneumocystis carinii pneumonia in patients with a severe combined immunodeficiency]. 199 Mar

Hospital discharge records of patients with Pneumocystis carinii pneumonia (PCP) in New York State were studied to determine whether cases of human immunodeficiency virus (HIV) infection were identified. We estimate that as many as 13 percent of hospitalizations of patients with PCP in 1987 and 10 percent of those in 1988 were not appropriately identified as HIV related. Identification of PCP as HIV related was a function of a hospital's volume of PCP admissions.
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PMID:An evaluation of the use of the Statewide Planning and Research Cooperative System of New York State as a resource planning tool for HIV infection. 199 Aug 64

Of 4,073 reported patients diagnosed with AIDS from 1978 through 1983, 821 (20%) were not reported to be dead by January 1987. Of these apparent long-term survivors, 780 (95%) were reported from 14 states or from local areas where collaborating health departments conducted special follow-up investigations: 119 (15%) were found to be alive, 475 (61%) were dead, and 186 (24%) were lost to follow-up. Health departments obtained consent to collect additional clinical and laboratory information on 48 of the living patients. Six (13%) had no laboratory evidence specific for human immunodeficiency virus (HIV) infection (antibody, antigen, viral isolation, or polymerase chain reaction assay); 41 (85%) had a positive result on at least one test; and one was not tested. Of the 41 infected patients, 25 (61%) had Kaposi's sarcoma (KS) and two (5%) had Pneumocystis carinii pneumonia as the only AIDS-indicative disease; the remainder had multiple diseases. CD4+ cell counts were low (less than 30% of total T lymphocytes) by the time of enrollment in 34 (87%) of 39 patients tested. When enrolled survivors with KS were compared with KS patients who had died within 2 years after AIDS diagnosis, survivors were less likely to have had other diseases in addition to KS than were nonsurvivors (31% versus 51%). While overall mortality by 1987 for patients diagnosed in 1978-83 was high (92-96%), a small number have survived and were doing relatively well clinically, despite evidence of continued CD4+ cell depression.
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PMID:Characterization of long-term survivors of acquired immunodeficiency syndrome. The Long-term Survivor Collaborative Study Group. 200 73

Six AIDS patients with Pneumocystis carinii pneumonia (PCP) underwent 67Ga scan as part of their evaluation. Only one patient of them showed the characteristic 67Ga distribution pattern for PCP, that is, diffuse, increased, bilateral lung activity greater than liver activity. Two patients who were receiving therapy for PCP and one patient with recurrent PCP showed focal or uneven 67Ga lung uptake. In the four patients, the scan showed more extensive lesion than the chest radiograph. The other two patients who died 2 months later of cellular immunodeficiency showed no or very slight lung uptake of 67Ga. In summary, 67Ga scanning is useful diagnostic procedure in evaluation of PCP in patients with AIDS.
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PMID:[67Ga citrate imaging in AIDS-related Pneumocystis carinii pneumonia in Japan]. 201 81

Two women with Stage II breast carcinoma treated with lumpectomy followed by breast irradiation and adjuvant chemotherapy developed Pneumocystis carinii pneumonia while receiving cytotoxic chemotherapy. Neither woman had evidence of immunosuppression before therapy. They both had profound lymphopenia, reversed CD4/CD8 ratios, and normal peripheral blood total leukocyte counts at the time of their infections. Both women were seronegative for human immunodeficiency virus type 1 and had no risk factors for such an infection. The patients' CD4 lymphocyte counts increased after chemotherapy for breast carcinoma was discontinued. Thus, it appears that the therapy they received may have caused severe T-lymphocyte mediated immunosuppression.
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PMID:Pneumocystis carinii pneumonia associated with profound lymphopenia and abnormal T-lymphocyte subset ratios during treatment for early-stage breast carcinoma. 201 44

In a prospective study of 72 human immunodeficiency virus (HIV) positive patients presenting with fever and breathlessness, a non-invasive management protocol, incorporating a scanning technique using radioactively labelled diethylenetriamine penta acetate (DTPA) and sputum induction, was found to be highly sensitive and specific in the early detection of Pneumocystis carinii pneumonia (PCP). At presentation, the DTPA scan was abnormal in 34 of 36 cases of PCP, irrespective of smoking history, whilst the chest radiograph was diffusely abnormal in 21 cases. Sputum induction identified 7 of 14 patients with PCP in the first six months of its use and 7 of 10 patients over the last six months. The DTPA lung scan and induced sputum examination are non-invasive techniques which can be used to investigate out-patients. In combination they detected all cases of PCP at presentation, reduced the need for bronchoscopy, resulted in a low case fatality (5.4%) and reduced the need for admission.
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PMID:Non-invasive management of fever and breathlessness in HIV positive patients. 202 34

To assess the effect of the human immunodeficiency virus (HIV) epidemic on mortality in US children younger than 15 years of age and to identify associated causes of death, the authors examined final national mortality statistics for 1988, the most recent year for which such data are available. In 1988, there were 249 deaths attributed to HIV/acquired immunodeficiency syndrome (AIDS) in children younger than 15 years of age. Associated causes of death listed most frequently on 270 death certificates with any mention of HIV/AIDS included conditions within the AIDS surveillance case definition (30%), pneumonia (excluding Pneumocystis carinii pneumonia) (17%), septicemia (10%), and noninfectious respiratory diseases (8%). The impact of HIV/AIDS as a cause of death was most striking in the 1-through 4-year-old age group and in black and Hispanic children, particularly in the Northeast. By 1988 in New York State, HIV/AIDS was the first and second leading cause of death in Hispanic and black children 1 through 4 years of age, accounting for 15% and 16%, respectively, of all deaths in these age-race groups. With an estimated 1500 to 2000 HIV-infected children born in 1989, the impact of HIV on mortality in children will become more severe.
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PMID:Impact of the human immunodeficiency virus epidemic on mortality in children, United States. 203 83

To assess the clinical and laboratory workload arising from human immunodeficiency virus (HIV)-related inpatient admissions in a London teaching hospital, a 10-month retrospective audit was performed of the casenotes of all HIV-infected inpatients admitted under the care of one consultant physician. During this period, 84 inpatients were identified who generated 371 admissions, of whom 71 (84.5%) had acquired immunodeficiency syndrome (AIDS). Over two-thirds of admissions were essentially day cases, attributed to blood transfusions, antimicrobial and tumour, chemotherapy, and minor surgery; with blood transfusions alone accounting for 43% of all admissions. Pulmonary infections (pyogenic and cell-mediated opportunist) accounted for 46 (12%) of admissions, with Pneumocystis carinii pneumonia second only to blood transfusions in caseload prevalence score (see below). Neurological complications of AIDS were associated with the longest admissions. Laboratory-based investigations were heavily utilized by AIDS inpatients, particularly bacteriological services. Choice of radiological investigation correlated with the anatomical site of disease presentation: plain radiology for chest symptoms, ultrasound for abdominal symptoms and computerized tomography (CT scanning) for neurological presentations. Drug-induced anaemia accounted for a substantial number of HIV-related admissions for red cell transfusions, which together with the disproportionate workload from daycase-type admissions, might be better handled in lower dependency day wards.
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PMID:Analysing the workload from HIV inpatients: a 10-month retrospective study. 204 15

Pulmonary infection by Pneumocystis carinii in patients with acquired immunodeficiency syndrome (AIDS) can result in different radiological patterns with an ever expanding spectrum. A 40-year-old male, infected with the human immunodeficiency virus (HIV), presented with toxic symptoms and multiple pulmonary cystic lesions in the context of a Pneumocystis carinii pneumonia. The rarity of this radiological presentation is discussed and literature is reviewed. In addition, the possible pathogenetic mechanisms are discussed, and emphasis is made on the need for higher suspicion index in similar presentations in patients at risk of HIV infection.
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PMID:[Pneumatocele as a form of presentation of Pneumocystis carinii pneumonia]. 205 33


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