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To better define the interrelationship of infection with human immunodeficiency virus (HIV) and tuberculosis (TB), we conducted three HIV serosurveys of inpatients and outpatients with confirmed or suspected TB in Kinshasa, Zaire. HIV seroprevalence in hospitalized sanatorium patients did not change significantly in serosurveys conducted in 1985 and 1987 (92/231 [40%] versus 85/234 [36%]). These proportions were significantly higher than the 17% HIV seroprevalence observed in a 1987 serosurvey of 509 consecutive patients with an initial diagnosis of pulmonary TB seen at an outpatient TB diagnostic center in Kinshasa (p less than 0.001). HIV seroprevalence was higher in sanatorium patients with extrapulmonary TB (22/46 [48%]) and suspected pulmonary TB (60/132 [45%]) than in patients with bacteriologically confirmed pulmonary TB (94/287 [33%]) (p less than 0.02). Mycobacterium sputum isolation rates were similar in HIV-seropositive (28/34 [82%]) and HIV-seronegative patients (135/159 [85%]). All isolates were Mycobacterium tuberculosis. Eighteen (21%) of 84 HIV-seropositive sanatorium patients in 1987, who were followed for two months after admission, had died, compared with 11 (9%) of 128 HIV-seronegative patients (p less than 0.01). However, clearance rates of acid-fast bacilli from sputum after standard therapy were equally good in HIV-seropositive and HIV-seronegative survivors. With the growing AIDS problem, the serious TB burden in sub-Saharan Africa may become even more onerous and may critically overload the stressed African health care systems.
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PMID:HIV infection in patients with tuberculosis in Kinshasa, Zaire. 249 32

Over a three-year period, 54 episodes of pneumonia were diagnosed in 45 adults infected with the human immunodeficiency virus (HIV). These episodes were reviewed in order to assess the distribution of pathogens and their clinical presentation. Thirty-six episodes were due to an opportunistic pathogen (Pneumocystis carinii in 31, Mycobacterium avium complex in 3, Mycobacterium tuberculosis in 2), and 18 were caused by non-opportunistic pathogens (11 Streptococcus pneumoniae, 2 Haemophilus influenzae, 5 unknown pathogens that responded to broad-spectrum antibiotics). Non-opportunistic pneumonias were characterized by an abrupt onset (18/18 had pulmonary symptoms of less than 7 days duration), high fever (13/18), and focal lung infiltrates (17/18). In contrast, opportunistic infections infrequently presented with pulmonary symptoms of less than 7 days duration (3/36) or high fever (7/36), and most of the chest radiograms (34/36) disclosed a diffuse lung infiltrate. In HIV-infected patients presenting with pneumonia, simple clinical and radiological data may point to bacterial pathogens. Such data could be used in selected cases to spare invasive procedures and to start empirical antibiotic therapy.
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PMID:Diagnosis of pulmonary infections in patients infected with the human immunodeficiency virus. 249 92

Mycobacterium tuberculosis bacteremia has recently been reported in patients infected with the human immunodeficiency virus (HIV). At our institution, tuberculosis occurs commonly among patients with and without HIV infection. We sought to determine the frequency of M. tuberculosis bacteremia among patients with newly diagnosed tuberculosis. During a 4-month period, mycobacterial blood cultures were obtained on all identifiable patients with newly diagnosed tuberculosis. Fifteen percent (9/59) of consecutive patients with tuberculosis had positive blood cultures for M. tuberculosis. Twenty-six percent (7/27) of patients known to be infected with HIV had positive mycobacterial blood cultures; two intravenous drug users who refused HIV-serologic testing also had positive mycobacterial blood cultures. M. tuberculosis bacteremia occurred at a higher rate among HIV-infected patients with an AIDS-defining opportunistic infection in addition to tuberculosis (3/3) than among HIV-infected patients without such an opportunistic infection (4/24; p less than 0.02). M. tuberculosis bacteremia occurred in 83% (5/6) of patients with disseminated tuberculosis and in 8% (4/53) of patients without disseminated tuberculosis (p less than 0.001). In all cases, tuberculosis was diagnosed in patients with M. tuberculosis bacteremia or else they died prior to the blood cultures demonstrating mycobacterial growth (mean time to detection of mycobacterial growth: 43 days). However, the frequent occurrence of M. tuberculosis bacteremia in HIV-infected patients with disseminated tuberculosis suggests that mycobacterial blood cultures may help confirm the diagnosis of tuberculosis in this group of patients.
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PMID:Frequency of Mycobacterium tuberculosis bacteremia in patients with tuberculosis in an area endemic for AIDS. 251 63

The clinical occurrence of Pneumocystis carinii and Mycobacterium tuberculosis was investigated in patients infected with human immunodeficiency virus (HIV) who had clinical pneumonia of unknown aetiology in Lusaka, Zambia. The results were compared with a similar group of patients in Stockholm, Sweden. Induced sputum samples were stained for Pneumocystis by indirect immunofluorescence using monoclonal antibody 3F6 and toluidine blue O. Mycobacterial culture and acid fast stain were performed on the specimens from Lusaka. P. carinii cysts were detected in none of 27 Lusaka patients, compared to 10 of 33 Stockholm patients. M. tuberculosis was identified in 11 of 22 Lusaka patients tested. In conclusion, P. carinii could not be incriminated as the aetiological agent of HIV-associated pneumonia in Zambia in contrast to the situation in Sweden, where Pneumocystis is the dominating aetiological agent.
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PMID:Pneumocystis carinii is not a major cause of pneumonia in HIV infected patients in Lusaka, Zambia. 251 30

Thirty-four rhesus monkeys were inoculated with Mycobacterium leprae inoculum isolated from sooty mangabey monkeys with leprosy. Later it was learned that one of the M. leprae-donor mangabeys was asymptomatically infected with simian immunodeficiency virus (SIV). Thus, five of the rhesus monkey were coinoculated with M. leprae and SIV. Three of the five became SIV-positive and developed signs of leprosy and an AIDS-like illness. Two animals remained healthy. The coinoculated leprosy-positive rhesus monkeys developed leprosy despite serologic response patterns to M. leprae antigens that usually indicate leprosy resistance. Three (60%) of the five SIV-positive rhesus monkeys developed leprosy compared with 21% of the animals who received SIV-free M. leprae inocula. Diminished lepromin skin test responses and decreasing T-helper cell percentages were observed in SIV-coinoculated rhesus monkeys with leprosy. These observations suggest that SIV increases the susceptibility of rhesus monkeys to leprosy, possibly related to loss of T-helper cell function.
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PMID:Interactions between simian immunodeficiency virus and Mycobacterium leprae in experimentally inoculated rhesus monkeys. 254 81

Pulmonary disease is the most important cause of morbidity and mortality in patients infected with human immunodeficiency virus (HIV). All parts of the hospital system are expected to be involved in the diagnosis and treatment of HIV infected patients in the coming years. Many different processes cause pulmonary disease alone or in combination. Bilateral interstitial infiltrates are the most frequent chest x-ray abnormality and are most frequently caused by infection with Pneumocystis carinii. Cytomegalovirus, Mycobacterium tuberculosis, nonspecific interstitial pneumonitis and pulmonary Kaposi's sarcoma are the most important parts of the differential diagnosis. An aggressive approach to the diagnosis of pulmonary disease in this patient population is indicated in order to provide optimal care and assess new therapies.
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PMID:Pulmonary disease in patients with human immunodeficiency virus infection. 255 41

Damage to the immune system induced by the human immunodeficiency virus (HIV) leads to a spectrum of opportunistic infections of which the lung is the most common site. In Europe and North America, pneumocystis carinii pneumonia is the presenting symptom in 64% of cases of acquired immunodeficiency syndrome (AIDS) and occurs at some point in 80% of AIDS victims. This infection is less common in Africa, where tuberculosis is the predominant opportunistic infection. Other AIDS-related lung infections that are gaining in prevalence include pneumonia due to pyogenic bacteria, pulmonary infection with Mycobacterium tuberculosis, and lymphoid interstitial pneumonitis. In addition, there is evidence that the lung may be extensively involved in Kaposi's sarcoma. Given the importance of the lung as a site for AIDS-related opportunistic infections, respiratory physicians will be required to become more involved in the diagnosis and management of AIDS cases.
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PMID:AIDS and the lung. Introduction. 259 18

During the 11 month period up to 30 September 1987, 37 patients (26 male, 11 female, mean age 27 years) with respiratory symptoms who were human immunodeficiency virus (HIV) positive, were studied prospectively on 40 occasions to determine the cause of any pulmonary complications. HIV was heterosexually transmitted. Predominant symptoms were cough (89%), fever (89%), weight loss (83%), and dyspnoea (60%). Transnasal fibre-optic bronchoscopy (with bronchoalveolar lavage, bronchial brushings and transbronchial lung biopsies) was performed on 35 patients, twice on 3 patients. 'Tru-cut' lung biopsies were obtained from 2 patients who died before bronchoscopy. Pulmonary tuberculosis was the commonest disease, being found in one-third of the patients (12 of 37). Mycobacterium tuberculosis was cultured from 4; the remainder of the plates were contaminated. Pneumocystis carinii was present in 8 patients: as the sole pathogen in 3, with Streptococcus pneumoniae in 4, Staphylococcus aureus in 2, and one also had tuberculous lymphadenitis. Endobronchial Kaposi's sarcoma was seen in 6 of 7 patients with skin nodules. Bacterial pathogens isolated included Staph. aureus (5), S. pneumoniae (5), Klebsiella pneumoniae (2), Haemophilus influenzae (2), H. parainfluenzae (1) and Pseudomonas aeruginosa (1). Invading Aspergillus fumigatus was diagnosed by lung biopsy in one. No diagnosis was reached for 8 patients. It is concluded that in Central Africa pulmonary complications in AIDS patients are similar to those in Europe and North America but the incidence of different pathogens depends on the prevalence of pathogens in the community. M. tuberculosis is probably the commonest pathogen. This study has confirmed that P. carinii pneumonia does occur, but occurs less frequently.
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PMID:Pulmonary diseases in patients infected with the human immunodeficiency virus in Zimbabwe, Central Africa. 261 33

The problem of tuberculosis (TB) in population, infected by human immunodeficiency virus I (HIV I) in Slovenia is presented in the period from 1986 when the first patient was registered, till 1989. In Slovenia it has been established that TB plays an important role in patients with HIV infection. Out of 14 patients with symptomatic HIV infection, 6 suffered from pulmonary TB and 1 patient from extrapulmonary TB (50%), mostly being expressed already in the early stage of HIV infection. In 3 patients with acquired immunodeficiency syndrome (AIDS) the pulmonary TB had been proven before the HIV infection was established. In one case the mycobacterial infection was confirmed pathohistologically after death; one patient suffered from disseminated TB. Out of three patients with AIDS related complex (ARC) two of them showed the apical pulmonary TB with cavitations. The data available show a prevalence of infection with Mycobacterium tuberculosis (MT) in population of Slovenia, so the occurrence of TB in a HIV positive person must by all means be taken into account regardless of the stage of disease. In the opposite, the possibility of HIV infection in newly detected TB patient must always be considered, especially concerning younger persons, predominantly men, whose history reveals risk behaviour. The paper presents also the clinical features as well as diagnosis, therapy and prevention of TB in HIV positive persons.
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PMID:[Mycobacterium tuberculosis infection in persons infected with HIV and its characteristics in the HIV-infected population in Slovenia]. 263 92

Fungal and mycobacterial infections are among the most common opportunistic infections in patients infected with human immunodeficiency virus (HIV). Candida infections are the bell-wether of progression to symptomatic HIV infection and candida oesophagitis often marks the onset of the acquired immunodeficiency syndrome (AIDS). More than 80% of AIDS patients have candida disease. Candida infections remain local and respond to treatment but tend to recur. Cryptococcal infections initially affect few HIV positive patients but involve 10-30% with AIDS. Meningitis is the usual presentation and dissemination is common. Amphotericin usually produces improvement but cure is infrequent, and maintenance therapy is advisable. Mycobacteria cause intracellular infections increasing in parallel with immunodeficiency. Mycobacterium avium-intracellulare is predominant, occurring with other opportunistic pathogens causing systemic and local symptoms with high bacterial density in infected cells. Multidrug treatment is best, but the results are disappointing. Tuberculosis is prevalent in certain groups of patients. It often presents with atypical clinical and pathological features. Anti-tuberculous treatment is effective and prophylaxis should be considered. Endemic fungi with mycobacteria cause sporadic infections. Opportunistic infections are the lethal arm of HIV infection. Diligent diagnosis and persistent treatment offer benefit to HIV-infected patients.
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PMID:Fungal and mycobacterial infections in patients infected with the human immunodeficiency virus. 265 13


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