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

The causative agent of acquired immunodeficiency syndrome is a retrovirus, human T lymphotropic virus type III/lymphadenopathy-associated virus, now known as human immunodeficiency virus (HIV). Infection of children with HIV results in a wide spectrum of clinical manifestations, ranging from asymptomatic to symptomatic, with the severest disease forms including neurologic deterioration, opportunistic infections and malignancy. This virus infects preferentially T cells bearing the CD4 receptors and also seems to exhibit preference for the central nervous system. The predominant route of infection in children is transplacental, and most affected children are infected at the time of birth. For women who give birth to infants with congenital infection with HIV, the main risk factor is intravenous drug abuse; a smaller percentage of these women acquire the infection via sexual contact and a few are infected via blood transfusions. Estimates for the incidence of transmission of the virus from an infected mother to her offspring vary from about 20 to 70%. Infection in most children and adults is documented by serologic testing, inasmuch as almost all infected people are HIV antibody-positive. Mothers of congenitally affected children are always HIV antibody-positive and also frequently have immune abnormalities. Women who give birth to infected children may, however, be asymptomatic in 50% of instances or more. Because antibodies to HIV are predominantly of the IgG class, they cross the placenta. All infants born to infected women therefore acquire passively transferred antibodies to HIV irrespective of whether or not the infants are infected with the virus itself. These passively transferred antibodies may sometimes persist for as long as 15 months. Thus in infants and children under 15 months of age in the absence of symptoms, the only definitive way to establish diagnosis is by viral isolation or viral antigen detection. Clinically the HIV-infected children can be divided into two groups, symptomatic and asymptomatic. Among the symptomatic group the main diagnostic specific features are: (1) opportunistic infection, e.g. with Pneumocystis carinii pneumonia; (2) interstitial pneumonitis with respiratory distress resulting from lymphocytic interstitial pneumonitis; (3) microcephaly and other neurologic abnormalities; (4) recurrent bacterial infections.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Human immunodeficiency virus infection in children: nature of immunodeficiency, clinical spectrum and management. 304 60

Pulmonary diseases contribute significantly to the morbidity and mortality in children infected with the human immunodeficiency virus. The wide array of lung diseases spans from early acute bacterial infections, to the lymphoid interstitial pneumonitis/pulmonary lymphoid hyperplasia complex, to opportunistic infections. The unique clinical and histopathologic features of these diseases are reviewed.
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PMID:Pulmonary disease in infants and children. 304 86

The following groups were compared: (1) children less than 18 years old who have hemophilia-associated acquired immunodeficiency syndrome (AIDS) with other children with AIDS and with adults who have hemophilia-associated AIDS and (2) asymptomatic HIV-infected hemophilic children with asymptomatic HIV-infected hemophilic adults. Children with hemophilia-associated AIDS were older than other children with AIDS (medians 13 and 1 years, respectively) and less frequently had lymphocytic interstitial pneumonitis (5% v 48%) but had similar incidences of Pneumocystis carinii pneumonia (51% v 53%) and similar case to fatality ratios (59% v 61%). Children with hemophilia-associated AIDS had P carinii pneumonia significantly less often than did adults with hemophilia-associated AIDS, but both had similar case to fatality ratios (adults 72% with P carinii pneumonia, 68% dead). Significantly more hemophilic children than adults with AIDS were nonwhite (30% v 14%) and resided in the tristate area of New York/New Jersey/Pennsylvania (43% v 25%). The immune effects of human immunodeficiency virus (HIV) to date on asymptomatic pediatric and adult hemophiliacs are similar but may be more severe in adults. It is concluded that, although some of the clinical manifestations of AIDS (eg, lymphocytic interstitial pneumonitis) occurring or not occurring in older children infected through blood factor products differ from those of other children with AIDS, disease outcome to date is equally poor. The reasons for the differences between hemophilic children and hemophilic adults with and without AIDS warrant further investigation.
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PMID:Human immunodeficiency virus infection in hemophilic children. 326 56

Aspergillus infection was studied in patients admitted to the Bone Marrow Transplant (BMT) Service at the Johns Hopkins Oncology Center during a 9-year period. The overall incidence was 4% in 549 patients reviewed. The incidence at autopsy was 12% (21 of 174 patients autopsied). There was no difference in frequency of occurrence in allogeneic compared to autologous BMT recipients. However, all infections in autologous BMT patients (5 of 5) occurred during neutropenia before engraftment. In contrast, 16 of 17 infections in allogeneic BMT patients occurred after engraftment (p = 0.0002). This difference presumably related to differences in duration of neutropenia and immunodeficiency. Age, underlying disease, date of BMT, preparative regimen, remission status, prior treatment, interstitial pneumonitis and concomitant cytomegalovirus infection did not predispose patients to aspergillus infection. Different post-BMT immunosuppressive regimens did not affect the risk for aspergillus infection except that patients who were given cyclophosphamide plus methylprednisolone had a higher incidence of aspergillus infection than those given methotrexate (12% versus 1%, p = 0.03). Acute graft-versus-host disease imposed a slight risk for infection (p = 0.06).
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PMID:Aspergillus infections in bone marrow transplant recipients. 333 65

We report the beneficial effect of steroids in a 27-year-old woman with lymphocytic interstitial pneumonitis (LIP) and common variable immunodeficiency (CVID). Exertional dyspnea, x-ray infiltrates, and pulmonary physiologic abnormalities decreased or increased during 3 1/2 years of follow-up in parallel with the administered dose of prednisone. This observation rules out concomitant spontaneous remission as the explanation of steroid-induced improvement of LIP in CVID. Steroid treatment was apparently safe: the frequency and severity of recurrent bronchial infections did not change, although IgG replacement therapy was not provided.
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PMID:Lymphocytic interstitial pneumonia of common variable immunodeficiency. 334 96

We cultured bronchoalveolar lavage fluid for the human immunodeficiency virus (HIV) from 23 consecutive patients with acquired immunodeficiency syndrome (AIDS) and pulmonary symptoms. We also included a nonconsecutive AIDS patient with recent worsening of respiratory symptoms who had had lymphocytic interstitial pneumonitis (LIP) diagnosed six months earlier. Infectious HIV was present in the cellular fraction from two of the 23 consecutive patients and in the patient with LIP. No virus was isolated from the cell-free portion of the centrifuged fluids. The patients from whom HIV was cultured were not distinguishable from other patients by clinical, radiographic, or laboratory data, and their subsequent course did not appear to differ. One patient with a positive HIV culture had organizing pneumonia without evidence of LIP at autopsy three weeks after lavage. This study demonstrates that HIV can be cultured from cells obtained by bronchoalveolar lavage and suggests that its presence is not associated with a single specific pulmonary histologic pattern.
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PMID:Human immunodeficiency virus recovery from bronchoalveolar lavage fluid in patients with AIDS. 337 Oct 96

The clinical expression of infection with the human immunodeficiency virus (HIV) appears increasingly complex. It includes manifestations due to opportunistic diseases, as well as illness directly caused by HIV itself. Neurologic disease may include involvement of the brain, spinal cord and peripheral nerves and is probably directly caused by HIV, as is lymphocytic interstitial pneumonia. The etiology of the chronic diarrhea and a papular pruritic skin eruption associated with HIV infection is unclear. Between 2% and 8% of HIV-infected persons progress to the acquired immunodeficiency syndrome (AIDS) per year, with no apparent decrease in the rate of disease progression over time. A chronically activated state secondary to chronic microbial antigenic exposure may increase both the susceptibility to HIV infection and development of disease. Increased HIV gene expression, followed by persistent antigenemia, appear to be triggering factors in clinical deterioration. The role, if any, of environmental and/or genetic cofactors remains unclear.
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PMID:Clinical manifestations and the natural history of HIV infection in adults. 343 53

As of December 1986, we have identified 23 symptomatic children with human immunodeficiency virus (HIV) infection in New Haven. Twelve developed AIDS as manifested by lymphocytic interstitial pneumonitis, Pneumocystis carinii pneumonia (PCP), and/or disseminated mycobacterial infections; seven of them have died. The remainder have milder clinical syndromes, which include failure to thrive, diffuse lymphadenopathy, and parotid swelling. When compared to adults with AIDS, children often have hypergammaglobulinemia and normal numbers of T4 lymphocytes. Intravenous drug abuse by the mother or mother's consort is the risk factor in 87 percent of these children. Two families have now been identified with more than one symptomatic child, but in no family is there evidence of spread from symptomatic children to uninfected siblings. A prospective study was begun to attempt to assess the risk of developing symptomatic HIV infection when a child is born to a mother with antibodies to HIV.
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PMID:AIDS and antibodies to human immunodeficiency virus (HIV) in children and their families: clinical experience at Yale-New Haven Hospital. 348 Nov 46

Three patients with the acquired immune deficiency syndrome (AIDS) or AIDS-related complex and lymphocytic interstitial pneumonia are reported. All patients presented with progressive dyspnea, nonproductive cough, fever, anorexia, weight loss, and arterial hypoxemia. Chest roentgenograms exhibited bilateral diffuse reticular-nodular densities. The diagnosis of lymphocytic interstitial pneumonia was made by fiberoptic bronchoscopy or open lung biopsy. Two patients were treated with corticosteroids, with significant improvement. The third patient died of pneumonia due to Pneumocystis carinii six months after the diagnosis of lymphocytic interstitial pneumonia was established. Serum antibodies to human immunodeficiency virus (HIV) were demonstrable in the two patients in whom the test was performed. Lymphocytic interstitial pneumonia is probably another pulmonary manifestation of AIDS or AIDS-related complex. Although the clinical presentation may be identical to the more common opportunistic infections, the treatment differs, and the prognosis may be better.
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PMID:Lymphocytic interstitial pneumonia in patients at risk for the acquired immune deficiency syndrome. 349 42

A fourteen-week-old boy is described who was admitted with failure to thrive and an interstitial pneumonia caused by Pneumocystis carinii infection. A late onset congenital rubella infection was diagnosed in combination with an immunodeficiency. The congenital rubella infection induced a chronic meningoencephalitis. Further investigations revealed intracerebral calcifications on computerized tomography of the skull. The clinical symptoms of early and late onset congenital rubella syndrome are described. The differential diagnosis of intracerebral calcifications are shortly reviewed.
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PMID:[Intracerebral calcification in a patient with late-onset congenital rubella]. 349 69


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