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

In July 1993, the United States Public Health Service and the Infectious Disease Society of America gave a set of recommendations for early intervention and prevention of opportunistic infections in HIV-positive people. These guidelines follow CD4 counts. According to the guidelines, CD4 counts above 500 should be monitored every 4 to 6 months and screenings for tuberculosis, sexually transmitted diseases, and other diseases should also be done. At a CD4 count of 75, a prophylaxis of rifabutin against Mycobacterium avium complex (MAC) is advised. Oral ganciclovir has been effective in preventing or delaying cytomegalovirus in people with CD4 counts below 50. HIV-positive patients should be vaccinated for streptococcal pneumonia, hepatitis B, and influenza and avoid alcohol, drugs, and nicotine. AZT is still considered the first line therapy when symptoms appear or when CD4 counts fall. Combination antiretroviral therapies (AZT and ddI, AZT and ddC, and AZT and 3TC) are thought to be the best way to fight HIV. If symptoms include thrush, a prophylaxis against Pneumocystis carinii pneumonia should be started, such as TMP-SMX (Bactrim or Septra), dapsone, or aerosolized pentamidine.
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PMID:Early intervention and prevention options. 1136 17

The Third Conference on Retroviruses and Opportunistic Infections offered hope for new treatments for AIDS-related illnesses. News about antiretroviral therapies, especially protease inhibitors, was enthusiastically received. Anthony Fauci, MD, of the National Institutes of Health (NIH), proposed an expanded model of HIV progression. Carl Grunfeld, MD, discussed the issue of wasting and emphasized that secondary infections are the primary precipitants of wasting. The human growth hormone's role in treating wasting was addressed. The actions and effectiveness of the leading protease inhibitors, saquinavir, ritonavir, and indinavir, and the problems associated with resistance to them, were an area of concern. Preventing secondary infections, such as cytomegalovirus, parvovirus, cryptococcus, thrush, tuberculosis, mycobacterium avium complex, pneumocystis carinii pneumonia, and microsporidium, is a primary concern.
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PMID:Report from the 3rd Conference on Retroviruses and Opportunistic Infections. 1136 13

Although combination therapy with HAART (Highly Active AntiRetroviral Therapy) can increase CD4 (T-cell) counts, doctors have been cautious about stopping preventive treatments, or prophylaxis, for PCP (Pneumocystis carinii pneumonitis). Two studies, however, suggest that if HAART increases T-cell counts to over 200 for an extended time period, PCP prophylaxis may be safely stopped. Partly as a result of these study findings, the United States Public Health Service has rewritten guidelines on the prevention of opportunistic infections. The draft version continues to call for PCP prevention beginning when patients have T-cell counts below 200 or have a history of thrush. However, a new section states that providers may stop prophylactic treatment when T-cell counts remain over 200 for at least three to six months. Recommendations for preventing MAC (mycobacterium avium complex) and CMV (cytomegalovirus) have also changed with HAART and are briefly described.
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PMID:Stopping preventive treatments. 1136 80

We conducted a longitudinal study of 797 human immunodeficiency virus (HIV)-positive women (7732 visits) and 389 HIV-negative women (3651 visits) to characterize anemia. At enrollment, the prevalence of anemia was 28.1% among HIV-positive women and 15.1% among HIV-negative women (P<.0001), and during follow-up the cumulative incidence of anemia was 74% and 48%, respectively (P<.0001). Risk factors for anemia were African American race (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.73-2.69), age (per 5-year increase; OR, 1.12; 95% CI, 1.03-1.21), body mass index (OR, 0.96; 95% CI, 0.94-0.97), history of pneumonia (OR, 1.41; 95% CI, 1.20-1.65), oral candidiasis (OR, 1.42; 95% CI, 1.22-1.66), CD4+ lymphocyte count <200 cells/microL (OR, 1.68; 95% CI, 1.46-1.94), history of fever (OR, 1.42; 95% CI, 1.13-1.80), and zidovudine use (OR, 1.14; 95% CI, 1.01-1.30). Anemia was common and associated with an increased risk of death (hazards ratio, 1.64; 95% CI, 1.21-2.23) among HIV-positive women.
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PMID:Prevalence and cumulative incidence of and risk factors for anemia in a multicenter cohort study of human immunodeficiency virus-infected and -uninfected women. 1174 Jul 16

A study was done to investigate the occurrence of Cryptococcus neoformans infection in patients admitted to Tikur Anbessa Hospital. Cryptococcus neoformans is an important opportunistic fungal pathogen in immunocompromised patients. The study was done over a period of 18 months, from October 1998 to April 2000. During this period, a total of 1088 cerebrospinal fluid (CSF) specimens were sent to the bacteriology laboratory in Tikur Anbessa Hospital, out of which 275 were subjected for India ink examination. Out of these 19 (7%) were India ink positive. Additionally one lymph node aspirate was also India ink positive. All these specimens were culture positive for Cryptococcus neoformans. The medical records of these patients were retrospectively reviewed and all presenting clinical symptoms were recorded. In this group of patients with meningitis the most common presenting were fever and headache. In addition, at the time of admission, 75% of the patients had other opportunistic infections, such as oral candidiasis, herpes zoster and Pneumocystis carini pneumonia. The mortality rate was high even in patients with appropriate therapy. All the isolates were identified as C. neoformans var. neoformans. The variety gatti was not isolated in this study.
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PMID:Cryptococcosis in patients from Tikur Anbessa Hospital, Addis Ababa, Ethiopia. 1192 49

The increasing prevalence of HIV infection in urban India together with limited financial resources necessitates judicious HIV testing. This prospective study was undertaken to determine the utility of selective screening for HIV infection based on five clinical risk factors reported in African children. The study was conducted at the Departments of Paediatrics and Microbiology, LTMG Hospital, Bombay, India between September 1998 and 2000. The children were enrolled after taking informed consent from their parents. The HIV seroprevalence rate was determined in children (aged 1 month to 12 years) consecutively admitted with severe malnutrition, serious pyogenic infections (pneumonia, pyogenic meningitis, septicaemia), disseminated tuberculosis, chronic diarrhoea and oral candidiasis, present either singly or in combination. Children above 18 months of age were diagnosed as being infected with HIV if they tested positive by two different HIV enzyme-linked immunosorbent assay (ELISA) tests. In children less than 18 months of age the diagnosis of HIV infection was made if they were ELISA positive and also fulfilled the WHO criteria for symptomatic HIV infection. Of a total 204 children (110 male, 94 female) screened, 24 (11.8 per cent) were diagnosed as HIV-infected. The HIV seropositive rate was highest in children having oral candidiasis (40.6 per cent), followed by chronic diarrhoea (18.2 per cent), disseminated tuberculosis (16.2 per cent), severe malnutrition (14.4 per cent), and serious pyogenic infections (11.2 per cent). Only the presence of oral candidiasis was a significant independent risk factor for predicting HIV infection (p < 0.0001). However, as the number of risk factors concomitantly present increased, the chances of the child being infected with HIV also increased significantly (p < 0.001). Our study shows that clinically-directed selective screening does have a practical role in diagnosing HIV infection in a resource-poor setting.
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PMID:Utility of clinically-directed selective screening to diagnose HIV infection in hospitalized children in Bombay, India. 1216 98

A case of post-transplantation pneumonia due to Candida krusei is reported. A 42-year-old man was admitted 28 days after heart transplantation with cough, pleuritic pain and fever. A chest computed tomograph showed multiple alveolar infiltrates bilaterally. He received broad-spectrum antibiotics, fluconazole for oral candidiasis, and cotrimoxazole for possible Pneumocystis carinii. A short-lived period of improvement was followed by respiratory failure. Cultures of bronchial washings grew C. krusei and C. albicans. The infection was documented by histology and culture obtained by transthoracic aspiration. Treatment with amphotericin B was initiated, but the patient died. Histology and culture of a pulmonary specimen, obtained immediately post mortem, further documented the infection with C. krusei.
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PMID:Pneumonia due to Candida krusei. 1251 55

Case records of HIV infected patients were analyzed for identifying neurological manifestations. Eight patients (7 males) were identified to have probable HIV encephalopathy (in a period of 24 months) as per the CDC revised classification system. Their ages ranged from one year to ten years. The neurological manifestations noted included-developmental delay (2 cases), seizures (6 cases), acute onset alteration of sensorium (4 cases), aphasia (2 cases), loss of vision (2 cases), focal neurological deficits (6 cases), brisk deep tendon reflexes (7 cases), extensor plantar responses (5 cases) and signs of cerebellar dysfunction (2 cases). Other clinical features included growth failure, microcephaly, fever, lymphadenopathy, hepatomegaly, splenomegaly, pneumonia, otorrhea and oral candidiasis. Cerebrospinal fluid studies were normal. The neuroimaging features included cerebral atrophy and ventricular dilatation, cerebral infarction, basal ganglia calcification and cerebellar atrophy. Childhood HIV infection may have a variety of neurological abnormalities. HIV infection should be suspected in children presenting with unexplained neurological manifestations and growth failure.
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PMID:Neurological manifestations of HIV infection. 1265 56

The purposes of this study were to measure incidence and determine risk factors associated with opportunistic infections (OIs) and mortality among an HIV-infected cohort in Nairobi, Kenya. Three hundred and eighty-one seropositive ambulatory adults in Nairobi, Kenya were followed from 1997 to 2000 with participants visiting the clinic every two months and when acutely ill. Acute bronchitis was the most frequent diagnosis, followed by sexually transmitted infections, candida vaginitis (among women), fever, diarrhoea, pneumonia, HIV-associated skin rash, oral candidiasis and urinary tract infection. Associations between the frequency of these diagnoses including survival and sociodemographic factors and initial CD4 count were assessed. A CD4 count <200 cells/mL at recruitment was strongly associated with decreased survival (adjusted odds ratio=3.0, 95% confidence interval 1.7-5.1). These findings may help to target high-risk populations and guide OI prevention and treatment strategies including decisions regarding initiation of antiretroviral therapy in sub-Saharan Africa.
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PMID:Mortality and burden of disease in a cohort of HIV-seropositive adults in Nairobi, Kenya. 1500 75

Antibiotics generally considered for antibacterial prophylaxis for immunosuppressed patients are trimethoprim-sulfamethoxazole and the quinolones. Trimethoprim-sulfamethoxazole can significantly reduce infections and is highly effective in preventing pneumonia due to Pneumocystis carinii. However, it can cause sulfonamide-related reactions, myelosuppression, oral candidiasis, and development of bacterial resistance, and it lacks activity against Pseudomonas aeruginosa. Quinolones can reduce the occurrence of fever and infections in patients with neutropenia but do not provide adequate coverage against gram-positive bacteria, and inappropriate use can induce resistance among gram-negative organisms. Routine antibacterial prophylaxis is not recommended for patients likely to develop neutropenia. Antifungal prophylaxis is appropriate in settings in which fungal infections are frequent. Fluconazole is recommended for patients who are to undergo hematopoietic stem cell transplantation; it can be considered for elderly patients with acute leukemia who are to receive intensive chemotherapy. Itraconazole can also be used. Prophylaxis with antiviral agents is generally not indicated; however, it should be given to hematopoietic stem cell transplant recipients.
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PMID:Antimicrobial prophylaxis in febrile neutropenia. 1525 25


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