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

The differential diagnosis of cavitary pulmonary lesions in individuals infected with human immunodeficiency virus (HIV) is broad, especially in patients with advanced disease. In patients with Pneumocystis carinii pneumonia, cavitation is an uncommon manifestation of a common disease. It is unusual in patients with pulmonary cryptococcosis, coccidioidomycosis, and histoplasmosis but occurs frequently in patients with invasive pulmonary aspergillosis. In patients with pulmonary tuberculosis, cavities are more common during earlier stages of HIV disease, when cellular immunity is relatively preserved. Mycobacterium avium complex is an uncommon cause of lung disease and infrequently produces cavities. However, Mycobacterium kansasii, is often associated with cavitation. Cavities can complicate any bacterial pneumonia and are especially common with pneumonia due to Pseudomonas aeruginosa, Nocardia asteroides, and Rhodococcus equi. Noninfectious causes of cavitary lesions are rare, but cavitary lesions caused by pulmonary Kaposi's sarcoma and non-Hodgkin's lymphoma have been reported. Because of the broad differential diagnosis and because most cavities are caused by treatable opportunistic infections, a definitive diagnosis is essential.
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PMID:Cavitary pulmonary lesions in patients infected with human immunodeficiency virus. 872 7

Twenty-five central venous lines (two external 23 subcutaneous ports) were placed in 19 boys with haemophilia A (n = 17) or B (n = 2). The mean age of the boys was 4.9 years (range 0.2-15.3 years). The haemophilia was severe (factor level < 1%) in 18 boys and moderate (factor level 3%) in one. Three boys had circulating inhibitors and three were positive for human immunodeficiency virus (HIV)-1 antibody. Central venous lines were placed to facilitate intermittent factor replacement therapy (n = 6), long-term factor prophylaxis (n = 9), induction of an immune tolerance protocol (n = 2) or therapy for acquired immunodeficiency syndrome (AIDS)-related complications (n = 2). The ports remained in place for 15795 days (mean 687 days, range 11-2059 days). The frequency of port-related sepsis was 48% (11/23 ports in eight boys) or 0.7 port infections per 1000 patient days. Ports were removed from five boys with an unresolved infection (four with Staphylococcus aureus sepsis and one with Pseudomonas sp. sepsis). Other complications requiring port removal included a catheter tip placed too high in the venous system (n = 1), severe persistent pain associated with needle access of the port (n = 1) and a subclavian vein thrombosis (n = 1). Both the benefits and risks of a subcutaneous port should be considered when deciding whether to place this device in a very young child with haemophilia.
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PMID:Central venous access catheters in children with haemophilia. 873 96

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

We identified 31 patients with human immunodeficiency virus (HIV) infection and lung abscess. All patients had advanced HIV disease, and the mean CD4 cell count was 17/mm3 (range, 2-50/mm3). Twenty-two patients (71%) had previous opportunistic infections, and 24 (77%) had previous pulmonary infections. Symptoms at the time of presentation included fever (90% of patients), cough (87%), dyspnea (35%), pleuritic chest pain (26%), and hemoptysis (10%). The microbiological etiology was established for 28 patients, and the pathogens recovered were bacteria (65%), Pneumocystis carinii (6%), fungi (3%), and mixed microorganisms (16%). The pathogens included Pseudomonas aeruginosa (11), Streptococcus pneumoniae (6), P. carinii (5), Klebsiella pneumoniae (5), Staphylococcus aureus (4), Aspergillus species (3), viridans streptococcus (2), Haemophilus influenzae (1), Streptococcus milleri (1), Proteus mirabilis (1), and Cryptococcus neoformans (1). Mycobacterium tuberculosis was not isolated; two patients for whom a microbiological etiology was not established responded to antituberculous therapy. Patients were treated for 2-12 weeks; 25% of the patients received > 4 weeks of therapy. The outcome was poor: 36% of the patients had recurrences, and 19% died. In patients with AIDS, lung abscess is associated with advanced HIV infection, is due to a broad spectrum of pathogens, responds poorly to antibiotics, and has a poor prognosis.
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PMID:Lung abscess in patients with AIDS. 882 70

Malignant otitis externa is a necrotising infection of the external ear canal which may spread to include the mastoid and petrous parts of the temporal bone, leading to skull base osteomyelitis. It is almost exclusively caused by infection with Pseudomonas aeruginosa, and usually occurs in elderly non-insulin-dependent diabetic patients. However isolated cases have been reported in a small number of non-diabetic patients, particularly in children who are immunocompromised due to malignancy, malnutrition and severe anaemia. In 1984 a case of malignant otitis externa was reported in a child with an acquired immunodeficiency syndrome (AIDS)-like illness, prior to identification of the human immunodeficiency virus (HIV). Since that time further sporadic cases of this invasive infection have been reported in HIV and AIDS. We present two further cases and also a review of the current literature.
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PMID:Malignant otitis externa in HIV and AIDS. 886 14

A 7-month-old infant presented at a tertiary centre with a 6-day history of a skin rash, fever and diarrhoea. Clinical features included pyrexia, kwashiorkor, extensive ulcerating skin lesions suggestive of ecthyma gangrenosum, hepatomegaly, meningismus, neutropenia and iron deficiency anaemia. Blood and skin aspirate cultures yielded a positive growth of Pseudomonas aeruginosa. Apart from severe protein energy malnutrition, no other causes of immunodeficiency were found. He responded well to parenteral antibiotic therapy with gentamicin and piperacillin.
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PMID:Community-acquired Pseudomonas aeruginosa infection in an infant. 889 49

Pulmonary disease was studied in four patients with ataxia-telangiectasia. Immunodeficiency was characterized by lymphopaenia, hypo-gammaglobulinaemia and decreased T-cell response to phytohaemagglutinin stimulation in mixed lymphocyte cultures. All four patients died from respiratory failure. Autopsy revealed that all four patients suffered from bronchiolitis obliterans in all lobes. Immunohistochemical examination demonstrated expression of MHC class II antigens on bronchiolar epithelium. Pulmonary infections in ataxia-telangiectasia patients included a case of mycoplasma pneumonia, one of cytomegalovirus pneumonia and one of Pseudomonas aeruginosa infection. The aetiology and immunological background of bronchiolitis obliterans are discussed. Bronchiolitis obliterans is a characteristic finding in ataxia-telangiectasia and may be due to the underlying immune deficit.
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PMID:Bronchiolitis obliterans in ataxia-telangiectasia. 908 16

Pseudomonas aeruginosa is increasingly reported as a respiratory pathogen in patients with advanced human immunodeficiency virus (HIV) disease. We retrospectively reviewed the chest radiographic appearances of 29 HIV-infected adults with bronchopulmonary infection in whom Pseudomonas aeruginosa was the sole respiratory pathogen isolated. The commonest radiographic abnormality was a diffuse reticular (11 patients) or reticulonodular (9 patients) infiltrate in the pulmonary interstitium. Alveolar opacification was seen in seven patients. Cavitation was rare (2 patients), as was ground-glass opacification (2 patients). Five patients had pleural effusions. No patient had mediastinal or hilar lymphadenopathy. Normal chest radiographs were seen in eight patients. Although the radiographic appearances of Pseudomonas bronchopulmonary infection in HIV-infected patients are non-specific, an interstitial infiltrate is a common finding. Pseudomonas aeruginosa should be considered along with the commoner pathogen Pneumocystis carinii in the differential diagnosis of an interstitial infiltrate in this group of patients.
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PMID:Pseudomonas aeruginosa bronchopulmonary infection in patients with advanced human immunodeficiency virus disease. 913 63

Pseudomonas aeruginosa is emerging as an increasingly common opportunistic infective agent in the immunocompromised human immunodeficiency virus (HIV) positive patient (Kielhofner et al., 1992). Improvements in the prevention and treatment of opportunistic infections in HIV and acquired immunodeficiency syndrome (AIDS) has led to longer life expectancy (Graham et al., 1992), and this has changed the incidence of Pseudomonas aeruginosa infection in this population (Baron and Hollander, 1993). We present a case of a patient with AIDS who developed a fulminant Pseudomonas aeruginosa stenosing subglottic infection. We are unaware of any previous reports of this particular manifestation of Pseudomonas aeruginosa infection.
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PMID:Infectious pseudomonas subglottic stenosis occurring in a patient with acquired immunodeficiency syndrome. 929 38

In a prospective study, we investigated the incidence, characteristics, and risk factors of nosocomial infections (NIs) in patients with human immunodeficiency virus disease. There was a total of 528 admissions of 405 eligible patients; 46 NIs (8.7% per discharge) were identified in 39 patients. The proportional frequencies of NIs were as follows: 16 skin and/or soft-tissue infections (including localized catheter-associated infections), 3.0%; 14 respiratory tract infections, 2.7%; 11 bloodstream infections, 2.1%; and 5 urinary tract infections, 0.9%. The most common etiologic agents were Staphylococcus aureus (27.6%), Pseudomonas aeruginosa (13.8%), and Enterobacter cloacae (13.8%). The duration of hospitalization was not significantly prolonged by NI in the cohort.
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PMID:Incidence and epidemiology of nosocomial infections in patients infected with human immunodeficiency virus. 963 94


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