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

Sixteen patients with severe primary humoral immunodeficiency diseases were treated intravenously for 12 months with a beta-propiolactone stabilized preparation of IgG (Intraglobin) as part of a phase II study of safety and efficacy. In order to evaluate the metabolism of IgG in these patients and to determine whether increased doses of IgG would lead to a decrease in the rate of infections, the study was divided into two periods. All patients were infused with a standard dose of 100 mg/kg/month for 6 months and the peak and trough serum IgG concentrations were determined. The half-life of the IgG was determined in each patient after the fourth month and this value was used to calculate the dose necessary to raise the trough serum IgG concentration to a minimum of 200 mg/dl. The patients received this individualized dose in the final 6 months and the half-life determination was repeated at the conclusion of the study. Only 3 of 10 patients who received a higher dose in the second period had a substantial increase in trough serum IgG concentrations, but the failure to achieve higher concentrations was not due to a shortening of the half-life. The Intraglobin was well tolerated with no patient unable to complete the study due to side-effects. Ten percent of the infusions were associated with minor, self-limited reactions, with 16 of the 19 reactions occurring in the first 6 months. There were no life-threatening infections during the 12-month period. A total of 105 episodes of infections were recorded, but only a cumulative total of 51 days of normal school or work activity were lost by the 16 patients during the 12 months of the trial period. Most infectious episodes were due to chronic bronchitis, sinusitis, and otitis. There was no reduction in the number of infections in the second, higher dose period of the study; however, as there was little increase in serum IgG concentration, more data are required before it will be possible to determine if the incidence of chronic infections can be reduced by a further increase in the serum IgG concentration.
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PMID:Use of a new chemically modified intravenous IgG preparation in severe primary humoral immunodeficiency: clinical efficacy and attempts to individualize dosage. 642 23

Infections of the upper respiratory tract are common to both the immunodeficient and the normal child during their development. The most common head and neck manifestations of immunodeficiency disease are recurrent suppurative otitis media, tonsillitis, sinusitis, rhinitis, and nasopharyngitis. Often the head and neck specialist is confronted with a child with one or more of these problems and must institute the appropriate therapy or decide on an avenue for further investigation. This paper outlines the major immunodeficiency state, discusses the immune defects thought to be responsible for the spectrum of clinical findings, and suggests a systematic approach to the evaluation of these difficult diseases. The recognition of immunodeficient individuals is an important step in their treatment so that adjunctive immunological therapy can be provided.
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PMID:Immunodeficiency diseases: head and neck manifestations. 698 47

An increasing number of patients with human immunodeficiency virus (HIV) suffer from acute infectious sinusitis, and many suffer recurrent episodes at a higher rate than their non-HIV counterparts. This study investigates a mechanism underlying the increased incidence of sinusitis, that of prolonged mucociliary transport time (MTT). Nasal mucociliary clearance was examined in 30 HIV-infected patients and 30 matched, non-HIV controls using a nasal saccharin transport test. MTTs for the study group and the controls were 11.9 +/- 5.9 minutes and 7.4 +/- 3.7 minutes, respectively. This difference attained statistical significance (P < .05). Study group patients with a history of sinusitis had a mean MTT of 13.7 +/- 6.8 minutes. Those with complaints of "new onset" nasal obstruction since HIV conversion had a mean MTT of 13.5 +/- 6.8 minutes. Statistical significance (P < .05) was found comparing these times to controls, as well as to study patients without these symptoms. These data support an inherent delay of mucociliary clearance in HIV-infected patients which is chronic, possibly irreversible, and, in association with nasal obstruction, represents a major mechanism of both the high acute and recurrent sinusitis rate in this population. The cause of the mucociliary delay is still unclear and needs to be further investigated.
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PMID:Mucociliary clearance abnormalities in the HIV-infected patient: a precursor to acute sinusitis. 882 29

The bacteriology of sinusitis in human immunodeficiency virus (HIV)-infected patients has been only sporadically reported. In this study, we report the results of cultures taken from 12 HIV patients with refractory chronic sinusitis who underwent surgery. Nine of the 12 patients had positive cultures with 16 isolates and 5 patients having multiple isolates. Five of the 12 patients grew out atypical or opportunistic infections not responsive to standard medical therapy, including 3 patients with cytomegalovirus, 1 with Aspergillus fumigatus, and 1 with Mycobacterium kansasii. These results suggest the need for aggressive medical care for HIV-infected patients with sinusitis and early intervention for tissue cultures in patients who do not respond to standard antibiotic regimens.
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PMID:Bacteriology of sinusitis in human immunodeficiency virus-positive patients: implications for management. 756 35

Non-Hodgkin's lymphoma (NHL) is a frequent complication of human immunodeficiency virus (HIV) infection, but involvement of the sinonasal region has only rarely been reported. We report three cases of AIDS-associated sinonasal NHL that occurred at our institution and review eight cases that were reported in the literature. The epidemiological and clinicopathologic features of these cases are described and compared with those of three other groups of patients: non-HIV-infected patients with sinonasal NHL, HIV-infected patients with NHL of any anatomic site, and HIV-infected patients with infectious sinusitis. Patients with AIDS-associated sinonasal NHL more frequently developed bony erosion and presented with signs and symptoms referable to adjacent structures, such as the orbit, than did HIV-infected patients with sinusitis, and patients with AIDS and NHL less frequently had typical sinus symptoms and diffuse sinus involvement than did patients with sinusitis. However, the clinical manifestations of these conditions overlap; thus a high index of suspicion for NHL is imperative for prompt diagnosis. These lymphomas typically are high-grade and disseminate early, and the prognosis is generally poor.
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PMID:Sinonasal non-Hodgkin's lymphoma in patients infected with human immunodeficiency virus: report of three cases and review. 757 23

Fourteen patients with common variable immunodeficiency (CVID) were studied. The common clinical manifestations were recurrent sore throat, sinusitis, respiratory infections, diarrhea, and malnutrition. All had low IgG, with normal cell-mediated immunity. Treatment with immunoglobulin and/or plasma was effective in most of them. There were no severe adverse events with the therapy.
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PMID:Common variable immunodeficiency (CVID) in northern India. 761 12

Diagnostic criteria for allergic fungal sinusitis have not been established, and clinical information consists primarily of isolated case reports. We proposed five diagnostic criteria for allergic fungal sinusitis including: (1) the demonstration of the characteristic eosinophil-rich allergic mucin visually or histopathologically, (2) a positive fungal stain or culture from the sinus at surgery, and (3) the absence of immunodeficiency or diabetes. With these criteria, seven patients in our metropolitan area with allergic fungal sinusitis were identified in a short period. Initial symptoms in our seven patients reflected those in 99 case reports in that two children were first seen with proptosis, one child and three adults with nasal congestion, and one adult with symptoms of chronic sinusitis. All had pansinusitis as shown on x-ray films. Six patients were atopic, five had nasal polyposis, and five had Curvularia species cultured from the sinuses. Infections with Bipolaris species, asthma, and chronic sinusitis were less common in our patients than in those previously reported. Recurrent symptoms and additional surgery sometimes resulted when the diagnosis was delayed by failure to obtain silver stains for fungus on surgical material sent for histopathologic review. Sinus tomography showed that the fungal material in the sinuses was of high density, which distinguished it from polyps or bacterial exudate. Bony compression, erosion, and rupture of the sinus walls were common. Results of IgE levels, precipitin determinations, and eosinophil counts were variable in both our patients and those in the literature. On the basis of our review, we believe that the simple diagnostic criteria proposed are appropriate for both research and clinical purposes.
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PMID:Diagnostic criteria for allergic fungal sinusitis. 762 60

Fifty-eight patients with human immunodeficiency virus infection were analyzed for clinical manifestations and potential risk factors for Pseudomonas aeruginosa infection by use of case-control methodology. Most had AIDS. Of 73 episodes of P. aeruginosa infection, 45 (62%) were bacteremias primarily associated with central venous catheters (16), pneumonia (12), soft tissue (4), or urinary tract infections (4). Twenty-eight episodes (38%) were nonbacteremic, with pneumonia (13), soft tissue infections (6), and sinusitis (4) accounting for the majority of infections. Fifty episodes (68%) were community-acquired. The recurrence rate was 23%. The overall mortality attributable to P. aeruginosa infection was 22%. Central venous and urinary catheter use and steroid therapy were significantly more frequent in cases than controls (P < .05). Thus, P. aeruginosa infection in patients with advanced human immunodeficiency virus disease is often community-acquired and associated with substantial mortality and, in some cases, specific risk factors.
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PMID:Clinical manifestations and risk factors of Pseudomonas aeruginosa infection in patients with AIDS. 770 21

Twenty patients with chronic refractory sinusitis or rhinitis were identified to have immune defects on the basis of total immunoglobulin level, immunoglobulin G subclass, and vaccine response. Eight patients were immunoglobulin A deficient, five had low immunoglobulin levels with vaccine hyporesponse, and four had low immunoglobulin levels with normal vaccine responses. Three subjects showed isolated immunoglobulin G1 deficiency. Demographic variables such as age, sex, infection pattern, and any other related disorders were studied retrospectively, which may have contributed to the diagnosis. An immunologic screen was essential for the diagnosis of immunodeficiency in these patients. Treatment options included prophylactic antibiotics, management of associated allergies, functional endoscopic sinus surgery, and replacement therapy with immunoglobulin in selected patients.
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PMID:Immunologic defects in patients with chronic recurrent sinusitis: diagnosis and management. 783 46

The full range and occurrence of medical conditions in persons infected with human immunodeficiency virus (HIV) before they develop illnesses that define acquired immunodeficiency syndrome (AIDS) have not been systematically or completely described. In a retrospective and prospective cohort study, 1,073 homosexual and bisexual men in three US cities were interviewed and examined twice per year from January 1988 to September 1992. Study participants were from San Francisco, California (273 HIV-seropositive and 432 HIV-seronegative men), Denver, Colorado (107 positive and 129 negative men), and Chicago, Illinois (54 positive and 78 negative men). A total of 305 HIV-positive men had specifiable dates of HIV seroconversion (mean of 15.3 months between the last negative and the first positive HIV antibody test). Besides much increased incidences of thrush (incidence relative risk (IRR) = 23.3) and hairy leukoplakia (IRR = 551), the following conditions also occurred significantly more frequently in HIV-positive men than in HIV-negative men: anal herpes (incidence density (ID) = 10.7/100 person-years; IRR = 7.7); sinusitis requiring antibiotics (ID = 6.2/100 person-years; IRR = 2.1); anal warts (ID = 5.8/100 person-years; IRR = 2.7); seborrhea (ID = 3.8/100 person-years; IRR = 6.6); community-acquired pneumonia (ID = 1.4/100 person-years; IRR = 2.7); skin cancers (ID = 1.0/100 person-years; IRR = 2.2); and seizures, often apparently "breaking through" prior anticonvulsant therapy (ID = 0.8/100 person-years; IRR = 5.6). First episodes of hairy leukoplakia, thrush, and skin cancer occurred at low mean CD4 counts (mean counts were less than 350 cells/microliters) and late in HIV infection (mean times were more than 8 years after HIV seroconversion). Many medical problems, some not widely appreciated, occur in HIV-infected men before they develop AIDS-defining illnesses, signifying considerable morbidity from pre-AIDS HIV infection.
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PMID:The spectrum of medical conditions and symptoms before acquired immunodeficiency syndrome in homosexual and bisexual men infected with the human immunodeficiency virus. 853 42


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