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

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

Pulmonary infection with mycobacterium tuberculosis and clonal B-cell expansion is described in a 26-year-old woman with granulomatous disease of lung, liver, and bone marrow as well as a late onset common variable immunodeficiency syndrome (CVID).
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PMID:[Granulomatous inflammation with combined immunodeficiency]. 235 11

Pulmonary infection with Aspergillus can present a variety of clinical manifestations. Essentially, allergic bronchopulmonary aspergillosis, aspergilloma, and invasive aspergillosis are the three main forms. The coexistence of more than one of these entities is not unusual. Predisposing factors for such mycotic infections include previous lung-structure damage, immunodeficiency, and disturbances in the equilibrium of the resident flora of the respiratory tract. The radiological changes in pulmonary aspergillosis are described in association with clinical presentations and laboratory findings and are demonstrated by actual examples.
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PMID:[Clinical pictures of pulmonary aspergillosis]. 331 91

Advances in the therapy of tumors or for the maintenance of grafts have improved survival in a large number of patients, but at the price of repeated complications due to the induced immunodeficiency state. Pulmonary infections are a frequent occurrence, and while some are easily recognized and treated, others must be precisely diagnosed, as only early specific treatment can avoid the often fatal outcome. Various techniques have therefore been developed to obtain specimens for microorganism isolation before having ultimate recourse to a surgical lung biopsy. It is in this field that the most marked progress is currently being made. The different microorganisms responsible for these affections are reviewed, the majority being common to the immunodeficiency state, while others are encountered more frequently as a function of the underlying disorder and of the ecological conditions in each centre.
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PMID:[Infective pneumopathies of immunosuppression]. 704 73

Pulmonary infection with Rhodococcus equi is rare, and most cases are seen in immunocompromised patients, particularly those with acquired immunodeficiency syndrome. We describe the pathologic features in four cases of culture-positive R equi pneumonia occurring in patients infected with human immunodeficiency virus. All four patients had a solitary cavitary pulmonary mass that was resected (n = 3) or had undergone biopsy (n = 1). Pathologically, all specimens revealed sheets of histiocytes with abundant foamy to eosinophilic cytoplasm with numerous phagolysosomes that were positive for periodic acid-Schiff, Gomori methenamine silver, and Grocott stains. Occasional histiocytes contained Michaelis-Gutmann bodies, diagnostic of malakoplakia. The Michaelis-Gutmann bodies yielded positive results with periodic acid-Schiff, Gomori methenamine silver, Grocott, Giemsa, and von Kossa stains (three of three cases studied) and with alizarin red and Prussian blue stains (two of three cases studied). Many gram-positive coccobacilli within histiocytes and associated with neutrophils were found in one case. Ultrastructural study of one case showed histiocytes containing abundant phagolysosomes with degenerated bacterial components and Michaelis-Gutmann bodies. The latter had a targetoid appearance with variegated phagolysosome cores that were mineralized by deposition of electron-dense spicules surrounded by peripheral rings of granular and membranous material. Based on our observations and reports in the literature, there appears to be a more than coincidental association between pulmonary R equi infection, malakoplakia, and human immunodeficiency virus infection.
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PMID:Rhodococcus equi pneumonia and pulmonary malakoplakia in acquired immunodeficiency syndrome. Pathologic features. 751 60

We describe a North American human immunodeficiency virus (HIV)-positive patient with Strongyloides stercoralis infection of the gastrointestinal tract, who required repeated "standard" courses of thiabendazole. Pulmonary infection with numerous roundworms developed, as suspected by bronchoalveolar lavage, and while he was receiving therapy, dissemination occurred. On autopsy, S stercoralis was recovered in the gastrointestinal tract, liver, lung, and heart. After a literature review, we conclude that HIV-positive patients have a higher risk of dissemination and "standard" treatment failure. This may occur without elevation of IgE or eosinophilia. Those patients may require prolonged courses of thiabendazole or alternatively ivermectin therapy.
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PMID:Disseminated Strongyloides stercoralis in human immunodeficiency virus-infected patients. Treatment failure and a review of the literature. 832 52

Pulmonary infections are a very common complication in acquired immune deficiency syndrome (AIDS) patients. These infections may be severe enough to initiate the admission of these patients to intensive care units (ICU). Pneumocystis carinii pneumonia (PCP) is the most frequent cause of ICU admission because of acute respiratory failure. Mortality of ICU-admitted patients with this infection has changed with time. Initial reports confirmed a high mortality (80% to 90%). After 1985, the mortality rate decreased (50%). Factors such as the use of corticosteroids, better patient care, and a better knowledge of the disease probably explain this change. In recent years (1990 to 1995), mortality has worsened again, perhaps, because ICU facilities were offered more liberally to patients failing aggressive conventional treatment, including adjuvant therapy with corticosteroids. However, for those patients able to be discharged, the prognosis is not worse than expected according to the stage of their human immunodeficiency virus-1 (HIV-1) infection and immunologic status. Consequently, at least a limited period of ICU care and some respiratory support (either continuous positive airway pressure or mechanical ventilation) should be considered and offered to all HIV-1-infected patients with PCP and respiratory failure. Cytomegalovirus may be another cause of severe pulmonary infection in AIDS patients. This infection is difficult to diagnose; hence, it should be suspected when patients with PCP do not progress appropriately, or when no responsible pulmonary pathogen is found. When associated with PCP, mortality is very high. Disseminated tuberculosis is another potential cause of severe respiratory failure and respiratory secretions should be routinely examined for acid-fast bacilli in AIDS patients with pulmonary infiltrates. Finally, bacterial pneumonia (Streptococcus pneumoniae, Neisseria catarrhalis, Haemophilus influenzae, Staphylococcus aureus, and Pseudomonas aeruginosa) may also be the etiological agents of severe acute respiratory failure. Empiric antibacterial treatment to cover these microorganisms should be given when a bacterial agent is suspected.
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PMID:Severe pulmonary infections in AIDS patients. 877 81

Increasing numbers of children with human immunodeficiency virus (HIV) infection continue to be seen in the United States. Pulmonary infections constitute a major cause of morbidity and mortality in these children Pneumoncystis carinii pneumonia, pulmonary lymphoid hyperplasia/lymphoid interstitial pneumonitis, and bacterial pneumonias, all described in high frequency in the earliest cases of pediatric acquired immunodeficiency syndrome, remain the pulmonary diseases confronted most often. Other pathogens, such as Mycobacterium tuberculosis and respiratory virus infections are now being identified in increasing numbers in HIV-infected children. Advances in our understanding of these disease processes and their clinical manifestations have allowed development of a systematic approaches to the common problem of the HIV-infected child with fever, tachypnea, and hypoxemia and an abnormal chest radiograph. These approaches, coupled with improvements in available treatment options, have led to earlier diagnosis and improved survival. Prophylaxis strategies have been developed for the most serious pulmonary infections, especially P carinii pneumonia. However, lack of identification of infants and children at risk of HIV infection has limited their effectiveness. Pulmonary infections in HIV-infected children continue to take a high toll with regard to morbidity and mortality. Only with continued advances in primary therapy to slow progression of the underlying immunodeficiency and widespread use of available prophylactic guidelines will these be reduced.
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PMID:Human immunodeficiency-virus-related pulmonary infections in children. 888 75

Pulmonary infections, including mixed infections, are common in patients with human immunodeficiency virus (HIV), and a specific diagnosis is desirable to direct therapy. In a retrospective study of patients suspected of having Pneumocystis carinii pneumonia, we examined the usefulness of fiberoptic bronchoscopy in the immediate diagnosis of tuberculosis. In 267 patients, pneumocystis pneumonia was diagnosed in 115 (43%), of whom 5 (4%) also had concomitant tuberculosis. Bronchoalveolar lavage gave an immediate diagnosis of tuberculosis by positive acid-fast bacilli stain in 3 patients, while the transbronchial biopsy was suggestive in a fourth. Four of these patients developed respiratory failure, and 2 died. In patients with pneumocystis pneumonia, respiratory failure was significantly more common in those with tuberculosis (P = .0077). In 156 (58%) of the 267 cases, bronchoalveolar lavage was negative for pneumocystis pneumonia, while tuberculosis was diagnosed in 14 (9%), and an immediate diagnosis was made in 10 (71%). In a series of HIV-infected patients suspected mainly of having pneumocystis pneumonia, tuberculosis was found instead in 19 (7%), and both diseases were present in 5 (2%). Bronchoscopy provided an early diagnosis of tuberculosis in 63%. Patients with concomitant pneumocystis pneumonia and tuberculosis had a high rate of respiratory failure.
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PMID:Early bronchoscopic diagnosis of concomitant tuberculosis and Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. 893 36


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