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

Infection with the human immunodeficiency virus (HIV) is increasing in prevalence, and disease patterns are changing as patient survival lengthens. The purpose of this cross-sectional epidemiological study was to assess the prevalence and severity of self-reported symptoms of otolaryngologic disease in a group of patients attending a general HIV outpatient clinic (n = 203), and to compare the prevalence of self-reported symptoms with a sample of patients without HIV infection (n = 100). Of the HIV-infected patients, 65% of patients had AIDS, 35% were HIV-positive, and the median CD4 count was 135. Although only 11% of patients had seen an otolaryngologist in the prior 6 months, the majority of patients (66%) reported the presence of sinonasal disease during that time. Allergic rhinitis (80%) and sinusitis (54%) were the most commonly reported sinonasal symptoms, and 44% regularly used nasal or sinus medications. Sinonasal disease severity was significantly higher than the self-reported severity of mouth/throat disease (p = 0.01), ear disease (p = 0.03), and neck/salivary disease (p = 0.01). Although patients' self-reported overall health status was associated (p = 0.02) with CD4 count, the severity of sinonasal symptoms was not associated (p = 0.93) with CD4 count. Similarly, sinonasal symptom severity did not differ between HIV-positive and AIDS patients (p = 0.45). In other words, sinonasal disease severity did not improve as general health status improved.
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PMID:Prevalence of sinonasal symptoms in patients with HIV infection. 1039 39

Pneumococcal diseases are a major public health problem all over the world. The etiological agent, Streptococcus pneumoniae (the pneumococcus) is surrounded by a polysaccharide capsule. Differences in the composition of this capsule permit the serological differentiation between about 90 capsular types, some of which are frequently associated with pneumococcal disease, others rarely. Invasive pneumococcal infections include pneumonia, meningitis and febrile bacteremia; among the common noninvasive manifestations are otitis media, sinusitis and bronchitis. At least 1 million children die of pneumococcal disease every year, most of these being young children in developing countries. In the developed world, elderly persons carry the major disease burden. Conditions associated with increased risk of serious pneumococcal disease include HIV infection, sickle-cell anaemia and a variety of chronic organ failures. Vaccination is the only available tool to prevent pneumococcal disease. The recent development of widespread microbial resistance to essential antibiotics underlines the urgent need for more efficient pneumococcal vaccines. Immunity following pneumococcal disease is directed primarily against the capsular serotype involved. The currently licensed pneumococcal vaccine is based on the 23 most common serotypes, against which the vaccine has an overall protective efficacy of about 60%-70%. Children aged < 2 years, and persons suffering from various states of immunodeficiency, for example HIV infection, do not consistently develop immunity following vaccination, thus reducing the protective value of the vaccine in some major target groups for pneumococcal disease. However, in the healthy elderly population the polysaccharide vaccine provides relatively efficient protection against invasive pneumococcal disease. Extensive clinical trials are now under way with a new generation of pneumococcal vaccines. These protein-polysaccharide combinations, known as conjugate vaccines, contain 7-11 selected polysaccharides bound to a protein carrier, and induce a T-cell dependent immune response. These vaccines are likely to be protective even in children aged < 2 years, and may reduce pneumococcal transmission through a herd effect.
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PMID:Pneumococcal vaccines. WHO position paper. 1043 29

Pneumococcal diseases are a major public-health problem all over the world. The etiological agent, Streptococcus pneumoniae (the pneumococcus) in surrounded by a polysaccharide capsule. Differences in the composition of this capsule permit the serological differentiation between about 90 capsular types, some of which are frequently associated with pneumococcal disease, others rarely. Invasive pneumococcal infections include pneumonia, meningitis, and febrile bacteremia; among the common non-invasive manifestations are otitis media, sinusitis, and bronchitis. At least one million children die of pneumococcal disease every year, most of these being young children in developing countries. In the developed world, elderly persons carry the major disease burden. Conditions associated with increased risk of serious pneumococcal disease include HIV infection, sickle-cell anaemia, and a variety of chronic organ failures. Vaccination is the only available tool to prevent pneumococcal disease. The recent development of widespread microbial resistance to essential antibiotics underlines the urgent need for more efficient pneumococcal vaccines. Immunity following pneumococcal disease is directed primarily against the capsular serotype involved. The currently licensed pneumococcal vaccine is based on the 23 most common serotypes, against which the vaccine has an overall protective efficacy of about 60% to 70%. Children aged < 2 years, and persons suffering from various states of immunodeficiency, for example HIV infection, do not consistently develop immunity following vaccination, thus reducing the protective value of the vaccine in some major target groups for pneumococcal disease. However, in the healthy elderly population, the polysaccharide vaccine provides relatively efficient protection against invasive pneumococcal disease. Extensive clinical trials are now under way with a new generation of pneumococcal vaccines. These protein-polysaccharide combinations, known as conjugate vaccines, contain 7-11 selected polysaccharides bound to a protein carrier, and induce a T-cell dependent immune response. These vaccines are likely to be protective even in children < 2 years of age, and may reduce pneumococcal transmission through a herd effect.
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PMID:Pneumococcal vaccines: World Health Organization position paper. 1051 18

Bacterial infections are a major cause of morbidity and mortality in persons with human immunodeficiency virus (HIV) infection, particularly women. We performed a cross-sectional analysis of a history of bacterial infections among 1,310 women with or at risk for HIV infection. HIV-seropositive women were significantly more likely than seronegative women to report recent and lifetime histories of bacterial infection, even after history of injection drug use since 1977 was adjusted for; this included recent pneumonia (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.5-6.6), sinusitis (OR, 1.4; 95% CI, 1.0-2.0), and urinary tract infection (OR, 1.5; 95% CI, 1.1-2.1). Compared with HIV-negative women, women with CD4 cell counts of <200 were about eight times more likely to report recent pneumonia (OR, 7.8; 95% CI, 3.4-17.7); those with CD4 cell counts of 200-500 were almost three times more likely to do so (OR, 2.6; CI, 1.2-5.7). Logistic regression analysis revealed that only CD4 cell category and a recent history of smoking had a significant relationship to self-reported pneumonia.
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PMID:Self-reported bacterial infections among women with or at risk for human immunodeficiency virus infection. 1053 Apr 55

Although pulmonary diseases are important causes of illness and death in patients with human immunodeficiency virus (HIV) infection, advances in treatment and the demographics of HIV-infected populations are changing their incidence and manifestations. The rates of acquires immune deficiency syndrome (AIDS)- related mortality and opportunistic infections have fallen drastically since the introduction of highly active antiretroviral therapy (HAART) in 1996. The risk of developing specific disorders is related to the degree of immunosuppression, HIV risk group, area of residence, and use of antiretroviral treatments and prophylaxis against common infections. HIV-infected drug users are at increased risk for developing bacterial pneumonia and tuberculosis. Bronchitis and sinusitis occur commonly in the general population, but more frequently in HIV-infected persons. With progressive immunocompromise, the risk of developing bacterial pneumonia, Pneumocystis carinii pneumonia, and tuberculosis increases.
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PMID:Epidemiology and risk of pulmonary disease. 1063 9

We present the results paragraph signof MRI examinations in ten patients with documented Nijmegen paragraph signbreakage syndrome (NBS), aged 1.75-19 years. T1-, Proton-Density- and T2-weighted spin-echo sequences were performed in three planes. All patients showed microcephaly with decreased size of the frontal lobes and narrow frontal horns. In four patients agenesis of the posterior part of the corpus callosum was found, with colpocephaly and temporal horns dilatation. In one patient callosal hypoplasia was accompanied by abnormal cerebrospinal fluid spaces and wide cerebral cortex, suspicious of pachygyria. Sinusitis was present in all ten patients, as a result of primary immunodeficiency. As in ataxia teleangiectasia and other breakage syndromes, patients with NBS show an inherited susceptibility to malignancy and hypersensitivity to X- and gamma-radiation. CT is therefore contraindicated in these patients and MRI should be the method of choice for diagnostic imaging.
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PMID:Cranial MRI in the Nijmegen breakage syndrome. 1066 71

The epidemiology of brain abscess has changed with the increasing incidence of this infection in immunocompromised patients, particularly solid organ and bone marrow transplant recipients, and the decreasing incidence of brain abscess related to sinusitis and otitis. A number of new neuroimaging modalities, including single photon emission computed tomography, positron emission tomography, perfusion magnetic resonance imaging, and magnetic resonance spectroscopy, provide an initial noninvasive approach to diagnosis. The recommendations for the management of intracranial mass lesions in human immunodeficiency virus-infected individuals has changed as the incidence of toxoplasmic encephalitis has decreased with the use of trimethoprim-sulfamethoxazole prophylaxis. The epidemiology, pathogenesis, microbiology, clinical presentation, diagnosis, treatment and prognosis of brain abscess in the beginning of the 21 st century are provided in this review.
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PMID:Brain abscess. 1105 Dec 99

Over 12 million individuals worldwide are infected with the human immunodeficiency virus (HIV). Up to 60% of these persons may suffer from disease of the paranasal sinuses. Numerous differences exist between sinusitis in HIV and non-HIV infected patients. Some of the differences include HIV sinusitis pathogenesis, bacteriology, and management. This paper addresses these issues so that physicians may adequately prevent, diagnose, and treat persons suffering from HIV sinus infection.
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PMID:HIV sinusitis: rationale for a treatment algorithm. 1128 Aug 8

Common variable immunodeficiency is the most frequent of the primary hypogammaglobulinemias. It is manifested by a wide variety of clinical signs and symptoms. In this retrospective, nationwide survey data were collected on all patients with common variable immunodeficiency who were receiving immunoglobulin replacement therapy in Finland to study the prediagnostic clinical picture, diagnostic delay, and diagnostic findings. Ninety-five patients were identified. The median age of the patients was 33 years. Sixteen of the patients were children. Sinopulmonary infections were the most common prediagnostic signs and symptoms; 66% had suffered from recurrent pneumonia, 60% from recurrent maxillary sinusitis, and 45% from recurrent bronchitis. There was a considerable delay in diagnosis. The mean delay was 8 years. At the time of diagnosis chronic pulmonary complications had already developed in 17% of the patients. The diagnosis was based on low serum immunoglobulin concentrations. This study showed that the awareness of common variable immunodeficiency is low. To improve the recognition of hypogammaglobulinemia, it should be suspected in every patient with recurrent bacterial infections. In addition to a low serum IgG concentration, measurement of specific antibody production is recommended to establish the diagnosis before initiation of a life-long and costly replacement therapy.
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PMID:Diagnostic findings in 95 Finnish patients with common variable immunodeficiency. 1133 53

The epidemiology and natural history of bacterial infections among ambulatory patients with advanced human immunodeficiency virus (HIV) disease has not been well described. In this prospective study, 394 subjects were enrolled and followed at 8-week intervals for a median of 21 months. During follow-up, 164 (42%) of 394 patients developed at least 1 bacterial infection. The most common infections were sinusitis, bacterial pneumonia, skin and soft tissue infection, and bronchitis. Serious bacterial infections (defined as bacterial pneumonia, bacteremia, or deep visceral abscess) were reported by 56 subjects (14%). Female sex, age of <40 years, and Karnofsky score of < or =80 were independent risk factors for bacterial infections. Prophylaxis with clarithromycin, trimethoprim and sulfamethoxazole, or both had significant protective effect. The occurrence of any confirmed bacterial infection was associated with a significantly increased risk of mortality. This study documents that bacterial infections are common among patients with advanced HIV disease, especially among women.
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PMID:Impact of prophylaxis for Mycobacterium avium complex on bacterial infections in patients with advanced human immunodeficiency virus disease. 1134 May 34


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