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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cytomegalovirus (CMV) infections in patients with acquired immunodeficiency syndrome are common and may present as retinitis, encephalitis, esophagitis, gastritis, enterocolitis, adrenalitis, or pneumonitis. Three patients are presented with pharyngeal ulcerations secondary to CMV. Similar cases have not been previously described in the literature. Symptoms, physical findings, and the treatment of this clinical entity are discussed. Although pharyngeal CMV ulcers are not life-threatening, they may herald multisystemic CMV infection that may require prompt antiviral chemotherapy.
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PMID:Pharyngeal ulceration in AIDS patients secondary to cytomegalovirus infection. 164 46

To determine the significance of cytomegalovirus (CMV) pulmonary coinfection with Pneumocystis carinii pneumonia in AIDS, we examined the association of long- and short-term survival and morbidity (as defined by length of hospital stay) with recovery of CMV from bronchoscopy specimens and an indirect measure of virus titer in bronchoalveolar lavage fluid (the time to develop CMV cytopathology in culture) in 111 patients diagnosed with a first episode of P. carinii pneumonia. Compared with 57 individuals from whom CMV was not isolated, the 54 individuals from whom CMV were isolated did not differ in baseline characteristics, long-term survival (213 versus 275 days, p = 0.97), acute death rate (19% in both, p = 1.0), or length of hospital stay (19.7 versus 21.1 days, p = 0.68). Also, the time to develop CMV cytopathology in culture did not correlate with acute or long-term survival. Our observations thus do not support the use of CMV-specific antiviral therapy in AIDS patients with P. carinii pneumonia who also have evidence of pulmonary CMV infection.
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PMID:Morbidity and mortality of patients with AIDS and first-episode Pneumocystis carinii pneumonia unaffected by concomitant pulmonary cytomegalovirus infection. 164 16

A 59-year-old Japanese woman with Hodgkin's disease developed progressive dementia and died of pneumonia. The autopsy revealed necrotizing ventriculo-encephalitis caused by cytomegalovirus (CMV) infection, which was confirmed by immunohistochemical and electron microscopic examinations. It is suggested that CMV ventriculo-encephalitis could occur not only in patients with acquired immunodeficiency syndrome, but also in other immunocompromised hosts.
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PMID:An autopsy case of necrotizing ventriculo-encephalitis caused by cytomegalovirus in Hodgkin's disease. 165 May 18

The frequent reactivation of disease in immunosuppressed patients represents a serious health complication for acquired immunodeficiency syndrome (AIDS) patients with herpesviruses. Since the herpesviruses are often associated with the development of complication such as pneumonia and lymphoma, an emphasis is being placed on the rapid laboratory diagnosis of herpes simplex viruses 1 and 2, varicella- zoster, Epstein-Barr virus, and cytomegalovirus. Diagnostic methods that utilize monoclonal antibodies to detect viral antigens in clinical specimens are now within the scope of general laboratories and detection methods for viral DNA in clinical specimens are being advanced. Each of the viruses requires its own diagnostic procedures, however, and consideration should be given to practical and economic issues. The World Health Organization (WHO) has recommended that developing countries use rapid diagnostic techniques that do not require expensive, labor-intensive virus replication. Serological diagnosis can facilitate disease surveillance of the herpesviruses in different population groups in countries with little information on this infection's epidemiology. Who is recommending that regional or national reference laboratories establish confirmatory testing facilities to support the routing virological or microbiological services offered by local laboratories. Other WHO recommendations include the development of international standard preparations and reference reagents, compilation of a list of monoclonal antibodies available for collaborative diagnostic studies, and promotion of studies on the rapid diagnosis of herpesvirus-promoted encephalitides.
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PMID:Diagnosis of human herpesviruses: memorandum from a WHO meeting. 165 24

The clinical records and autopsy data of 75 patients dying with AIDS were reviewed to determine the frequency of individual diseases diagnosed premortem and postmortem, the significance of pulmonary processes found in the lungs at autopsy, and the clinical and pathologic causes of death. Cytomegalovirus (CMV) infection was identified histologically either premortem or postmortem in 81% of patients. The lungs and adrenal glands were infected most commonly. Only one-half of CMV infections were recognized premortem. Pneumocystis pneumonia and Kaposi sarcoma occurred in 68% and 59% of patients, respectively, but were not unsuspected premortem in any patient. Visceral involvement with Kaposi sarcoma, however, was frequently recognized only at autopsy. While disseminated M. avium-intracellulare infection was common (31% of patients), histologically documented pulmonary disease was uncommon (3% of patients). Cryptococcal infection, diagnosed in 10 patients, was confined to the central nervous system in only 1 patient. Toxoplasma, in contrast, infected the brain of only 6 patients. All 75 patients had one or more disease processes identified in their lungs or pleurae at autopsy. These processes included opportunistic infections in 76% of patients, neoplasms in 37% (Kaposi sarcoma in 36% and lymphoma in 3%), and other processes in 60%. The most prevalent pathogen, CMV was found in pulmonary tissue from 44 patients and caused significant disease in 21 patients. Five patients died due to CMV pneumonia. Pneumocystis carinii was found at autopsy in 24 patients. In spite of treatment, pneumocystis pneumonia was fatal in 11 patients. One patient died with concomitant CMV and pneumocystis pneumonia. Kaposi sarcoma, identified in the lungs of 23 patients, led to death in 5 patients via upper airway obstruction, hemorrhage, or parenchymal destruction. Other fatal pulmonary processes included bacterial pneumonia in 9 patients, idiopathic diffuse alveolar damage in 5, cryptococcosis in 2, and pulmonary hemorrhage in 1. Specific clinical criteria were used to determine the cause of death due to organ system failure. Fifty-one percent of patients died due to respiratory failure; 16% from neurologic disease; 17% from hypotension that was not caused by respiratory, neurologic, or cardiac disease; and 3% from cardiac dysfunction. Thirteen percent of deaths did not meet the clinical criteria defining these 4 categories. This clinical assessment was combined with autopsy data to identify specific diseases as causes of death.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The causes of death in patients with human immunodeficiency virus infection: a clinical and pathologic study with emphasis on the role of pulmonary diseases. 165 64

To further improve the diagnostic value of bronchoscopy in the immunosuppressed population presenting with diffuse pulmonary infiltrates, we prospectively investigated the utility of bilateral bronchoalveolar lavage (BAL). We performed 62 bronchoscopies on 52 immunosuppressed patients. Of the 52 patients, 33 had pulmonary infections. The yield for Pneumocystis carinii pneumonia on bilateral BAL was 94 percent (31/33), compared to the 84 percent (51/61) previously obtained with unilateral BAL in our institution. The recovery of P carinii was unilateral in four of five patients without AIDS and in four of 26 patients with AIDS. Transbronchial biopsy gave a yield of 85 percent (11/13). In ten patients with definitive cytomegalovirus (CMV) pneumonia, recovery of CMV by combined culture and cytology was 100 percent. Of nine bronchoscopies with positive cytology for CMV, five showed cytopathologic changes in the BAL from both sides and four in the BAL from one side only. No complications were seen in the 14 patients with thrombocytopenia or the five patients receiving mechanical ventilation. Our findings indicate that bilateral BAL significantly increases the yield for recovery of P carinii (p less than 0.02) and CMV (p less than 0.001) in immunosuppressed patients.
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PMID:Bilateral bronchoalveolar lavage in the diagnosis of opportunistic pulmonary infections. 165 38

During a seven-year period, symptomatic cytomegalovirus (CMV)-infection was diagnosed in 21.5% (n = 10) of all AIDS patients at the National Hospital of Norway (retinitis n = 8, colitis n = 3, pneumonitis n = 2, gastritis n = 1). Symptomatic cytomegalovirus-infection was associated with a poor long-term prognosis (median survival 174 days, range 10-415). Median CD4+ lymphocyte counts at onset of symptomatic cytomegalovirus-infection was 24 x 10(6)/l (range 6-68). Regular ophthalmological examination of HIV-infected patients with severe immunodeficiency, and endoscopy with multiple mucosal biopsies in patients with suspected cytomegalovirus-infection of the gastrointestinal tract, were of major importance in diagnosing symptomatic cytomegalovirus-infection. Six patients received an induction course of ganciclovir, and foscarnet was administered in two patients due to leukopenia. Problems of toxicity to the available anti-CMV agents make the development of additional therapeutic approaches desirable.
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PMID:[Symptomatic cytomegalovirus infection in patients with acquired immunodeficiency syndrome]. 166 53

The paper reports on a theme of important pediatric interest, pneumonia with Pneumocystis carinii (PC), a more widespread affection lately, due to the progress in pediatric reanimation, on the one hand (that allowed the survival for a long time of several biologically handicapped infants) and as a consequence of the more and more common use of immunosuppressing therapy, on the other hand (malignant diseases, transplant of organs, etc.); another important role in the increase of the PC pneumonia is played, recently, both in the adult and the child, by the infection with HIV (acquired immunodeficiency syndrome). The authors discuss largely on the pathogenic agent, PC, proved to be a fungus by molecular genetic studies, and on the biological field (small age, dystrophy, prematurity, "debilitating" chronic diseases, long diarrheic diseases, congenital malformations, hospitalization, some infections with long evolution: tuberculosis, Cryptococcus, infection with cytomegalic virus). The paper also deals with epidemiology, pathogeny and pathologic anatomy of the disease (characteristic macroscopic aspect: nonaired lung of high consistency, with whitish infiltrations alternating with congestive zones and the microscopic aspect of alveolo-interstitial pneumonia). The clinical picture includes the common form, met in the biologically handicapped infant and hypoergic hypoimmune form, appearing in all ages in immunodeficient subjects. Radiological examination, pulmonary scintigraphy and a series of laboratory data (with evidence of parasitic cysts) complete the clinical examination, making easier the diagnosis. The techniques of seroimmunological diagnosis offers great hope for the future. The positive diagnosis shows the clinical elements that suggest the presence of the disease, the contribution of the radiologic examination and mainly the presence of the parasite in the bronchitic secretions; the therapeutic response is a retroactive element in the positive diagnosis. The differential diagnosis is presented in detail. The paper concludes with a series of treatment schemes used, prophylaxis, evolution, complications and prognosis of the disease.
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PMID:[Pneumocystis carinii pneumonia]. 166 1

The expression "immunocompromised host" refers to an individual who has one or more defects in the body's natural defense, which leads to severe, often life-threatening, infections. Alcoholism, diabetes mellitus, advanced age, the use of antacids, and viral infections have immune-modulating effects. The human immunodeficiency virus, cytomegalovirus, Epstein-Barr virus, and Non A, Non B hepatitis virus also contribute to immunosuppression. The lung has a special vulnerability to infection, and pneumonia accounts for more than 40% of deaths in the immunosuppressed population. Diagnostic methods include detection of microbial antigens by monoclonal antibodies, DNA sequences by the polymerase chain-reactions or DNA probes, and unique metabolites of pathogens by gas chromatography. Transtracheal aspiration was used to obtain uncontaminated respiratory secretions, but fiberoptic bronchoscopy with shielded brush and bronchoalveolar lavage (BAL) is a better means of diagnosis because of a 90% sensitivity in diagnosing pneumocystis infection. Percutaneous aspiration and open lung biopsy are reserved for more complicated cases. Empiric treatment is justified in far advanced AIDS or relapsed myelogenous leukemia with limited life expectancy, or when there is uncontrollable bleeding diathesis or impaired pulmonary function as invasion diagnostic procedures will not be tolerated. The most important antiinfective measure is careful hand washing, while prophylactic antibiotics, selective decontamination, and antifungal, antiviral, and antiparasitic agents can be used. Active and passive immunization against specific pathogens, immunological reconstitution with granulocyte-macrophage colony-stimulating factor (GM-CSF) and reducing the dosage of immunosuppression are the other strategies for prevention. In the last several decades there has been substantial progress in the management of chronic diseases which used to be fatal.
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PMID:Pulmonary infections in the immunocompromised host. 166 54

Main etiologic agents of AIDS-related infections pneumonia and diagnostic tools useful to identify microorganism are discussed. Bronchoalveolar lavage (BAL) remains the most important performed technique to collect pulmonary secretions, but it needs to be completed by colorimetric, immunological (monoclonal antibodies), serological (ELISA vs. mycobacterial antigens), molecular (DNA probes) techniques. These tools are very useful to identify pathogen agents.
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PMID:[The microbiological aspects of AIDS-related respiratory infections]. 166 82


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