Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
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Infectious complications in cirrhotic patients can cause severe morbidity and mortality. Bacterial infections are estimated to cause up to 25% of deaths in cirrhotic patients. The most frequent are urinary tract infection, spontaneous bacterial peritonitis, respiratory tract infection, and bacteremia. It has been said that cirrhosis is the most common form of acquired immunodeficiency, exceeding even AIDS. The specific risk factors for infection in cirrhotic patients are low serum albumin, gastrointestinal bleeding, intensive care unit admission for any cause, and therapeutic endoscopy. Certain infectious agents are more virulent and more common in patients with liver disease. These include Vibrio, Campylobacter, Yersinia, Plesiomonas, Enterococcus, Aeromonas, Capnocytophaga, and Listeria species, as well as organisms from other species. Spontaneous bacterial peritonitis is a frequent, severe, life-threatening complication of patients with ascites. Current observations and recommendations regarding treatment and prophylaxis are reviewed. A brief synopsis of miscellaneous infections encountered in cirrhotic patients is also included.
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PMID:Infectious complications of cirrhosis. 1146 97

Urinary tract infections (UTIs) are considered to be the most common bacterial infection. According to the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, UTI accounted for nearly 7 million office visits and 1 million emergency department visits, resulting in 100,000 hospitalizations. Nevertheless, it is difficult to accurately assess the incidence of UTIs, because they are not reportable diseases in the United States. This situation is further complicated by the fact that accurate diagnosis depends on both the presence of symptoms and a positive urine culture, although in most outpatient settings this diagnosis is made without the benefit of culture. Women are significantly more likely to experience UTI than men. Nearly 1 in 3 women will have had at least 1 episode of UTI requiring antimicrobial therapy by the age of 24 years. Almost half of all women will experience 1 UTI during their lifetime. Specific subpopulations at increased risk of UTI include infants, pregnant women, the elderly, patients with spinal cord injuries and/or catheters, patients with diabetes or multiple sclerosis, patients with acquired immunodeficiency disease syndrome/human immunodeficiency virus, and patients with underlying urologic abnormalities. Catheter-associated UTI is the most common nosocomial infection, accounting for >1 million cases in hospitals and nursing homes. The risk of UTI increases with increasing duration of catheterization. In noninstitutionalized elderly populations, UTIs are the second most common form of infection, accounting for nearly 25% of all infections. There are important medical and financial implications associated with UTIs. In the nonobstructed, nonpregnant female adult, acute uncomplicated UTI is believed to be a benign illness with no long-term medical consequences. However, UTI elevates the risk of pyelonephritis, premature delivery, and fetal mortality among pregnant women, and is associated with impaired renal function and end-stage renal disease among pediatric patients. Financially, the estimated annual cost of community-acquired UTI is significant, at approximately $1.6 billion.
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PMID:Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. 1211 66

According to reports from the Program for Appropriate Technology in Health (PATH) and the World Bank, women in less developed countries (LDCs) suffer the greatest risk due to reproductive health problems. At any given time, a woman in a LDC is more likely than not to have at least 1 reproductive health problem that could be treated by a primary care provider or counseling and referral ("Women's Reproductive Health: The Role of Family Planning Programs," a PATH report). Among diseases for which cost-effective interventions exist (treatments or preventive measures), reproductive health problems account for the majority of the disease burden (a measure of healthy years lost due to disability or premature death) among women aged 15-44. A study of 650 women in India found that more than 50% reported specific gynecological problems; clinical examination found more than 90% had 1 or more such problems. In a study of 509 nonpregnant women in rural Egypt, it was discovered that more than 52% had a reproductive tract infection, 56% had some form of uterine prolapse, 14% had a urinary tract infection, and 11% had an abnormal Pap smear. Major reproductive health problems continue into menopause; cervical cancer, which is linked to reproductive tract infections and early and frequent childbearing, strikes 400,000 women in LDCs each year. Sexually transmitted disease (STD) and human immunodeficiency virus (HIV) infections are also problems; women are twice as likely as men to contact gonorrhea from an infected sex partner, and 14 million women will have been infected with HIV by the year 2000 (WHO estimate). Treatment is often unsought by women because they do not understand the risk, are unaware of the symptoms, or fear the stigma of attending a clinic. If all the women who wanted to control their fertility had access to family planning services, maternal mortality would decrease by nearly 50%. Reproductive health services (routine gynecological care, perinatal care, family planning services, cancer screening, STD/HIV services, nutritional supplementation, and other services appropriate to age) are needed.
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PMID:Reproductive health problems loom in LDCs. 1231 59

Urinary tract infections (UTIs) are considered to be the most common bacterial infection. According to the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, UTI accounted for nearly 7 million office visits and 1 million emergency department visits, resulting in 100,000 hospitalizations. Nevertheless, it is difficult to accurately assess the incidence of UTIs, because they are not reportable diseases in the United States. This situation is further complicated by the fact that accurate diagnosis depends on both the presence of symptoms and a positive urine culture, although in most outpatient settings this diagnosis is made without the benefit of culture. Women are significantly more likely to experience UTI than men. Nearly 1 in 3 women will have had at least 1 episode of UTI requiring antimicrobial therapy by the age of 24 years. Almost half of all women will experience 1 UTI during their lifetime. Specific subpopulations at increased risk of UTI include infants, pregnant women, the elderly, patients with spinal cord injuries and/or catheters, patients with diabetes or multiple sclerosis, patients with acquired immunodeficiency disease syndrome/human immunodeficiency virus, and patients with underlying urologic abnormalities. Catheter-associated UTI is the most common nosocomial infection, accounting for >1 million cases in hospitals and nursing homes. The risk of UTI increases with increasing duration of catheterization. In noninstitutionalized elderly populations, UTIs are the second most common form of infection, accounting for nearly 25% of all infections. There are important medical and financial implications associated with UTIs. In the nonobstructed, nonpregnant female adult, acute uncomplicated UTI is believed to be a benign illness with no long-term medical consequences. However, UTI elevates the risk of pyelonephritis, premature delivery, and fetal mortality among pregnant women, and is associated with impaired renal function and end-stage renal disease among pediatric patients. Financially, the estimated annual cost of community-acquired UTI is significant, at approximately $1.6 billion.
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PMID:Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. 1260 37

We report a retrospective study of 106 patients with bacterial infections from 322 patients infected with the human immunodeficiency virus (HIV) resulting in 33 percent. Epidemiological profile of bacterial infection in HIV patient is the same that observed in tunisian patient with HIV: a young male infected mainly by sexual route. Bacterial infection is located in the lungs in 38.3 percent, in the skin in 16.5 percent, in upper respiratory tract and oral in 12.7 percent, sexually transmitted disease and bacteremia are respectively found in 12 percent, bacterial genito-urinary tract infection in 5.3 percent, bacterial gastro-intestinal tact infection in 2.3 percent and meningitis in 0.8 percent. Bacterial infections occur at all stages in patients with HIV, but mainly in 77.7 percent at AIDS stage. Regardless the infectious site, granulocytes number is normal in 66 percent of cases. Bacterial investigation find a bacterial specie in 14.3 percent and a bacterial positive serology in 11.2 percent. Mortality caused by bacterial infection is found in 11.3 percent.
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PMID:[Bacterial infections in AIDS (mycobacterial infections excluded): study of 100 cases]. 1270 77

Sixty-four episodes of Xanthomonas spp. infection were observed in 2.400 patients hospitalised for HIV disease (~2.7%) over an 8-year period: sepsi-bacteremia in 52 cases, lower respiratory tract infection in 6 cases, urinary tract infection in three patients, pharyngitis in two cases, and lymph node resented the fourth most common non-mycobacterial bacterial pathogens responsible for bacteremia in our HIV-infected patients: 52 cases out of 878 diagnosed (5.9%). The progression of HIV-related immunodeficiency, the occurrence of leukopenia-neutropenia, hospitalisation, previous antibiotic and/or corticosteroid treatment, and instrumentation, seemed to act as risk factors for the occurrence of Xanthomonas spp. infection. In three patients suffering from severe immunodeficiency and concurrent AIDS-related disorders, Xanthomonas spp. complication contributed to death, while a relapsing disease occurred in two cases only. Because of the poor antimicrobial susceptibility of these pathogens (also confirmed in our series), Xanthomonas spp. infection associated with advanced HIV disease and concurrent risk factors, may represent a potentially severe complication.
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PMID:HIV disease and bacterial superinfections due to Xanthomonas spp.: a frequent association. 1272 5

Infections are common in systemic lupus erythematosus (SLE), and remain a source of mortality. The types of infections (such as pneumonia, urinary tract infection, cellulitis, and sepsis) in SLE patients are similar to the general population and include the same pathogens (Gram-positive and Gram-negative). SLE patients may also develop opportunistic infections, especially when treated with immunosuppressive agents. As a high-risk population, identification and treatment of chronic infections such as tuberculosis, hepatitis B, or human immunodeficiency virus (HIV), are important prior to the institution of immunosuppression to prevent reactivation or exacerbation of the infection. A common caveat is to distinguish between a lupus flare and an acute infection; judicious use of corticosteroids and cytotoxic drugs is critical in limiting infectious complications. The risk factors associated with susceptibility to disease include severe flares, active renal disease, treatment with moderate or high doses of corticosteroids and/or immunosuppressive agents, and others. Genetic factors (complement deficiencies, mannose-binding lectin, Fcgamma III, granulocyte macrophage colony-stimulating factor [GM-CSF], osteopontin) may predispose certain SLE patients to develop infections. Parameters including C-reactive protein (CRP) and adhesion molecules may help to differentiate an infectious disease from an exacerbation of the disease. Finally, the mechanism of molecular mimicry by specific microbial agents may play a role in the induction of SLE.
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PMID:SLE and infections. 1279 59

Urinary tract infections are the most frequent hospital acquired infections and represent one of the major problem in general practice. The predominant causative agents are enteric gram-negative bacteria. Nevertheless, the importance of gram-positive bacteria, particularly Staphylococcus aureus and Enterococcus, has progressively increased especially in nosocomial urinary tract infections. Such an increase is probably related to the indiscriminate use of beta-lactam antibiotics or to the growing number of susceptible patients (surgical procedures, immunodeficiency, ecc.) The therapeutic approach of community and hospital infections is different: while in the first case treatment is usually not difficult, the therapy for nosocomial urinary tract infections should be based on the results of antibiotic susceptibility tests since a multiantibiotic resistant microorganism is often involved.
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PMID:[Gram positive microorganisms in urinary tract infections: epidemiology and therapy]. 1496 67

In people infected with the human immunodeficiency virus (HIV) both the CD4 T-cell count and the viral load are used to monitor disease progression to acquired immunodeficiency syndrome (AIDS). CD4 counts of <500/mm(3) are associated with opportunistic infections and certain malignancies, so-called 'AIDS-defining' conditions. Highly active antiretroviral therapy, using combinations of reverse transcriptase inhibitors and/or protease inhibitors, can improve considerably the prognosis of people who are HIV-positive, but such therapy is not yet widely available in many developing countries. People with AIDS are predisposed to urinary tract infection (UTI) by uncommon bacteria and pathogens, e.g. fungi, parasites and viruses, which may affect any urogenital organ; treatment should be culture-specific and long-term, because there is a tendency to recurrence, infection with multiple organisms and resistant isolates. Voiding dysfunction in patients with AIDS is usually a result of neurological complications caused by opportunistic infections, and has a poor prognosis. Of patients with AIDS, 30-50% develop a cancer, especially Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL). KS may involve any urogenital organ, but is usually part of systemic disease. Small lesions on the external genitalia can be treated with laser, cryotherapy or surgical excision, larger lesions with radiotherapy, and disseminated or visceral KS with multidrug chemotherapy. NHL may involve the kidneys, testes and retroperitoneal lymph nodes, thus obstructing the ureters, which may require ureteric stenting or percutaneous nephrostomy. NHL can be treated with radiotherapy and combination chemotherapy. Urolithiasis in patients with AIDS may be caused by indinavir, a protease inhibitor, but the more common types of stones may also occur. Fluid-electrolyte and acid-base disturbances are common in patients with advanced AIDS, secondary to vomiting, diarrhoea, malnutrition or septicaemia. HIV-associated nephropathy occurs in 10-30% of patients, and often leads to renal failure. Testicular atrophy is common, leading to infertility, erectile dysfunction (ED) and decreased libido. Treatment for ED must include counselling about strategies to reduce the transmission of HIV. The risk of HIV transmission after parenteral exposure to blood from an HIV-positive patient is relatively low (0.2-0.4%); the urologist can reduce the risk of transmission during surgery by adopting certain precautions. After occupational exposure to HIV, chemoprophylaxis with antiretroviral medication can significantly reduce the probability of HIV transmission.
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PMID:The urological management of the patient with acquired immunodeficiency syndrome. 1692 74

Viral and bacterial infections may serve as an environmental trigger for the development or exacerbation of systemic lupus erythematosus (SLE) in the genetically predetermined individual. In addition, SLE patients are more prone to develop common (pneumonia, urinary tract infection, cellulitis, sepsis), chronic (tuberculosis), and opportunistic infections possibly due to inherit genetic and immunologic defects (complement deficiencies, mannose-binding lectin [MBL] polymorphisms, elevated Fcgamma III and GM-CSF levels, osteopontion polymorphism), but also due to the broad spectrum immunosuppressive agents that are part of therapy for severe manifestations of the disease. Hence, SLE patients are considered a high-risk population, where identification and treatment of chronic infections such as tuberculosis, hepatitis B or human immunodeficiency virus, are important prior to the institution of immunosuppression so as to prevent reactivation or exacerbation of the infection. Infections in SLE patients remain a source of morbidity and mortality. A caveat often encountered is to distinguish between a lupus flare and an acute infection; in such cases parameters including elevated CRP (and adhesion molecules) may aid in the diagnosis of infection. Recent research has provided convincing evidence that EBV infection may play a major role not only in molecular mimicry but also in aberrations of B cells and apoptosis leading to a state of perpetual heightened immune response in SLE.
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PMID:Infections and SLE. 1637 52


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