Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the early 1990s, hospital survival among patients with human immunodeficiency virus (HIV)-related Pneumocystis carinii pneumonia (PCP) and respiratory failure was poor, approximately 20%. We examined ICU use and outcomes for patients with acute respiratory failure from PCP from 1995 to 1997. We conducted a retrospective medical record review using a random sample of 71 hospitals in seven regions of the United States. Among 1,660 patients with confirmed or presumed PCP, 155 (9%) received mechanical ventilation for respiratory failure. Factors that predicted use of mechanical ventilation, independent of severity of illness on hospital admission, included African-American ethnicity and geographic location (p </= 0.002). Hospital survival for patients receiving mechanical ventilation was 38% (95% CI 30, 46). Controlling for severity of illness, patients who were on PCP prophylaxis prior to developing PCP were less likely to survive to hospital discharge (p </= 0.02). There were no significant differences in hospital survival regardless of whether patients had received less than or more than 5 d of PCP treatment prior to respiratory failure (39 versus 29%; p = 0.5). In conclusion, from 1995 to 1997, hospital survival after PCP requiring mechanical ventilation was approximately 40%. Physicians caring for patients with severe HIV-related PCP should be aware of the improvements in outcomes for this disease before making recommendations about withholding or withdrawing ventilatory support for respiratory failure.
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PMID:Improvements in outcomes of acute respiratory failure for patients with human immunodeficiency virus-related Pneumocystis carinii pneumonia. 1093 59

We report on malakoplakia of the colon observed in a six month old girl in a setting of severe combined immunodeficiency (SCID) and a malformational syndrome termed CHARGE association. By the age of six months, hemorrhagic diarrhea had developed, and multiple ulcers were seen at colonoscopy. The biopsy specimen showed ulcerating malakoplakia. Immunodeficiency was primarily reflected by deprivation of CD4 cells in the peripheral blood, and CT scans failed to detect structures consistent with a normal thymus. There were also polylymphadenopathy and chronic erythroderma. The lymph node showed extreme hypoplasia of the follicular cortex and marked expansion of the paracortex. B cell counts progressively declined, and plasma cells were absent both in intact mucosa of the colon and in a lymph node. The patient died at eighteen months of respiratory failure following recurrent airway infections. Pediatric malakoplakia of the colon, though rare, may be regarded as an example of opportunistic bacterial infection in an immunocompromised host. Combined immunodeficiency (CID) has to be considered in such instances, in particular when malformational syndromes coexist affecting the development of the thymus.
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PMID:Malakoplakia of the colon in an infant with severe combined immunodeficiency (SCID) and charge association. 1098 22

The introduction of highly active antiretroviral therapy with protease inhibitors in 1996 has changed the morbidity and mortality of acquired immune deficiency syndrome patients. Therefore, the aetiologies and prognostic factors of human immunodeficiency virus (HIV)-infected patients with life-threatening respiratory failure requiring intensive care unit (ICU) admission need to be reassessed. From 1993 to 1998, we prospectively evaluated 57 HIV patients (mean+/-SEM age 36.5+/-1.3 yrs) admitted to the ICU showing pulmonary infiltrates and acute respiratory failure. A total of 21 and 30 patients were diagnosed as having Pneumocystis carinii and bacterial pneumonia, respectively, of whom 13 and eight died during their ICU stay (p=0.01). Both groups of patients had similar age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and severity in respiratory failure. The number of cases with bacterial pneumonia admitted to ICU decreased after 1996 (p=0.05). Logistic regression analysis showed that (APACHE) II score >17, serum albumin level <25 g.(-1), and diagnosis of P. carinii pneumonia were the only factors at entry associated with ICU mortality (p=0.02). Patients with bacterial pneumonia are less frequently admitted to the intensive care unit after the introduction of highly active antiretroviral therapy with protease inhibitors in 1996. Compared to the previous series, it was observed that the few Pneumocystis carinii pneumonia patients that need intensive care still have a bad prognosis.
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PMID:Reappraisal of the aetiology and prognostic factors of severe acute respiratory failure in HIV patients. 1130 62

A retrospective chart review (January 1987-December 1994) of cases of histologically proven Pneumocystis carinii pneumonia (PCP) in 9 infants (ages 1.1-7 months) who had perinatally acquired human immunodeficiency-1 virus (HIV) infection was performed. None of the children was suspected of having HIV or had received PCP prophylaxis. Respiratory failure requiring mechanical ventilation developed in all 9 children. Comparison of survivors (5) with nonsurvivors (4) showed no significant differences in the age of onset, weight for length, hemoglobin level, total protein/albumin, lactic dehydrogenase (LDH), liver function tests, lymphocyte numbers and functions, time on mechanical ventilation, treatment received (including the use of steroids), and other complications occurring during the acute phase of pneumonia. The survivors had significantly higher platelet counts than nonsurvivors (mean 516 K versus 237 K, p = 0.02), a trend toward lower arterial-alveolar (A-a) gradient (mean 415 versus 218, p = 0.07), and earlier use of steroids after the onset of illness (2.5 versus 1 day, p = 0.06). Four of 5 children treated after December 1989 survived compared to 1 of 4 prior to that. Four survivors followed for a median length of 29 months (range 28-32 months) had stable physical and neurocognitive development, improvement in CD4+ T cell counts [mean 27% (range 23-36%), absolute count-mean 1631 (range 1427-1631)] and immunologic functions, and decrease in p24 Ag in 3 of 4. The cellular proviral load measured by DNA quantitative polymerase chain reaction (QC-PCR) decreased (40 K to 17.3 K copies) in one of two patients studied at two time points. PCP continues to be a serious complication of HIV infection in infancy and aggressive preventive approaches seem warranted. In our institution no single factor was responsible for improved survival following PCP after 1989. Four of 5 survivors continued to do well 28-32 months after the acute episode.
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PMID:Outcome and survival in HIV-infected infants with Pneumocystis carinii pneumonia and respiratory failure. 1136 82

Protease inhibitors, used as treatment in human immunodeficiency virus (HIV) infection, are associated with a syndrome of peripheral lipodystrophy, central adiposity, hyperlipidemia and insulin resistance. An HIV-positive patient with chronic obstructive pulmonary disease is presented who developed the lipodystrophy syndrome that is associated with the use of protease inhibitors. It is postulated that the lipodystrophy syndrome further compromised his lung function, leading to respiratory failure. Patients who have pulmonary disease and are taking protease inhibitors require monitoring of clinical status and pulmonary function tests.
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PMID:Respiratory failure associated with the lipodystrophy syndrome in an HIV-positive patient with compromised lung function. 1152 Nov 44

We report four human immunodeficiency virus (HIV)-infected patients (3 men and one woman, average age, 34.3 years) with pulmonary infection (two with pneumonia and two with lung abscess) caused by Rhodococcus equi. These patients, who presented with fever and productive cough, were admitted to Nakornping Hospital in northern Thailand. Chest roentgenograms showed pulmonary infiltration and/or cavitary lesions. Their conditions were poor because of severe anemia, and transfusion was necessary in three of the four patients. Before culture results were available, the etiologic microorganisms identified in sputum smears were gram-positive and acid-fast coccobacilli. One of the four patients had a mixed infection with R. equi and Salmonella enteritidis. The mean CD4 lymphocyte count in the three tested patients was 10/mm3 (CD4/CD8 ratio = 0.057). Four isolates of R. equi were sensitive to imipenem, minocycline, erythromycin, vancomycin, and ciprofloxacin (minimum inhibitory concentrations; MICs, <or=1.56 microg/ml), but resistant to most beta-lactam antibiotics. Two isolates were sensitive (MICs, 0.20 and 0.78 microg/ml) and two resistant (MICs 50 and >100 microg/ml) to rifampicin. Two patients were treated with erythromycin plus rifampicin, while the other two were treated with anti-tuberculous drugs. However, treatment was ineffective; three patients subsequently died because of respiratory failure, and one patient did not improve and was transferred to another hospital in her hometown.
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PMID:Pulmonary infection caused by Rhodococcus equi in HIV-infected patients: report of four patients from northern Thailand. 1181 May 71

A case of the cerebellar form of progressive multifocal leukoencephalopathy (PML) without remarkable immune depression or immune deficiency is reported here. The patient was a 74-year-old-woman who had complications of chronic renal failure and renal anemia for several years. Seven months before her death she had symptoms of general fatigue, gait disturbance and articulation disorder. During her hospitalization period her neurological disorder gradually progressed irreversibly with failure of consciousness and she died of respiratory failure. She did not have remarkable clinical signs of immunodeficiency nor did she receive immunosuppressive therapy. Clinically she had not been diagnosed with PML. At the post-mortem examination different degrees of demyelination were observed in the brain white matter: diffuse and severe in the cerebellum, moderate and coalescent in the brainstem, and light and patchy in the cerebrum. JC virus antigen-positive cells were frequently observed in the demyelinated lesions in the cerebrum and sometimes observed in the brainstem, but were rarely found in the cerebellum. These findings suggest that PML lesions may be present with different degrees of demyelination that are inversely correlated with the number of JC virus-infected cells. This fact should be considered when evaluating the brain biopsies of PML patients.
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PMID:Autopsy case of the cerebellar form of progressive multifocal leukoencephalopathy without immunodeficiency. 1203 Apr 15

We describe a case of a 61-year-old woman with amyopathic dermatomyositis (ADM), who developed rapidly progressive interstitial pneumonia and died of respiratory failure. An autopsy revealed interstitial pneumonia with diffuse alveolar damage, associated with infiltration of T cells, mostly positive for CD 8. The alveolar lining epithelial cells manifested the remarkable expression of immediate early/early antigen of human cytomegalovirus (HCMV). Moreover, the extract of the lung was transmittable of HCMV infection to cultured human embryo-fibroblasts in vitro. On the other hand, in the semi-quantitative analysis of HCMV genome, using laser-assisted microdissection, followed by PCR method, the genomic DNA in the alveolar lining epithelial cells was little detected in this case, although it was remarkable in the case of immunodeficiency with cytomegalovirus pneumonia. This case may be important to know the role of the immune response of host to HCMV infection on the development of rapidly progressive interstitial pneumonia.
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PMID:[Analysis of human cytomegalovirus infection of an autopsy case of dermatomyositis with rapidly progressive interstitial pneumonia: the possible correlation between the viral genome and its related protein on the pathogenesis]. 1216 14

There are few data on Pneumocystis carinii pneumonia (PCP) in critically ill human immunodeficiency virus (HIV)-negative patients. Improved knowledge of the presenting symptoms of and prognostic factors for PCP may help to reduce the high mortality rate associated with PCP in such patients. We retrospectively studied 39 consecutive patients with acute PCP-related respiratory failure and malignancy who were treated at 2 intensive care units (ICUs) during a 10-year period. Univariate logistic regression identified the following 8 predictors of mortality at 30 days after patient admission to the ICU (30-day mortality rate, 33%): complete remission of the malignancy (odds ratio [OR], 0.18), receipt of >1 course of antimalignancy chemotherapy (OR, 17.2), involvement of 4 lobes noted on a chest radiograph (OR, 5), >15% neutrophils in bronchoalveolar lavage [BAL] fluid specimens (OR, 6), Organ System Failure score (OR, 7.33), Simplified Acute Physiology Score II (OR, 1.12), and the need for either mechanical ventilation (OR, 63) or vasopressors (OR, 25.9). Studies are needed to determine whether aggressive monitoring and treatment of patients with >15% neutrophils in BAL fluid specimens can improve the outcome of critically ill patients with malignancy and PCP.
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PMID:Pneumocystis carinii pneumonia in critically ill patients with malignancy: a descriptive study. 1235 79

Optimal therapy against Legionella infection is based on agents with a high intrinsic activity, an appropriate pharmacokinetic and pharmacodynamic profile (including the ability to penetrate phagocytic cells), a low incidence of adverse reactions and an advantageous cost-efficacy relationship. Newer macroazalides and fluoroquinolones are among the first-line therapies and in severe infections, particularly those occurring in immunocompromised patients, azithromycin and later fluoroquinolones are the agents of choice. Delay in the onset of adequate therapy is a key factor associated with a poor outcome. Thus, all patients with pneumonia associated with respiratory failure, shock or underlying disease causing severe immunodeficiency should initially receive an agent active against Legionella spp., at least while the aetiology remains unknown. Adjunctive measures improve outcome in critically ill patients. In intubated patients with delayed resolution, superinfection by Pseudomonas aeruginosa or co-infection caused by other pathogens should be excluded.
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PMID:Legionnaires' disease: a rational approach to therapy. 1266 78


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