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Query: UMLS:C0032285 (pneumonia)
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Enzyme immunoassays (EIA) were used to measure serum antibodies to Cryptosporidium in four immunocompetent adults with recent proven cryptosporidial infection, 379 healthy children and 73 adult volunteers in Melbourne, Australia, and 205 children in Papua New Guinea (PNG) (47 healthy children; 158 with pneumonia). Antibodies peaked 3-6 weeks after infection and fell to baseline within a few months. A high level (5000 EIA units/ml) or a significant change between paired sera, of IgG or IgM, were taken as evidence of recent infection and found in 24% of PNG children and in 8% of children and 5% of adults in Melbourne. Among PNG children with pneumonia who had high cryptosporidial antibody levels, those with measles (6/8) were significantly more likely (P = 0.002) to have diarrhoea than the remainder (4/28). Symptomatic cryptosporidiosis may be associated with transient immune suppression due to viral infection. This study indicates that serological surveys can contribute to an understanding of the epidemiology of cryptosporidosis.
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PMID:Seroepidemiology of cryptosporidiosis in children in Papua New Guinea and Australia. 799 59

This report describes the epidemiology of Penicillium marneffei infections among HIV infected children who were seen at Chiang Mai University Hospital, Thailand, between April 1989 and January 1995. HIV infections among children 18 months old and older were determined by both enzyme-linked immunosorbent assay and particle agglutination tests. Confirmation of HIV infection was made among younger children by signs and symptoms and repeated reactive serum tests. Diagnosis of P. marneffei infection was determined by isolation of the organism from clinical blood or tissue specimens. Antifungal agents were administered and improvement was recorded. There were 23 cases of P. marneffei among the 362 children diagnosed with HIV infection during the study period. One case was a non-HIV infected girl and another was a thalassemic patient who had received an HIV infected blood transfusion. The remaining 21 children acquired the infection perinatally. All mothers of the 21 children had acquired the HIV infection as prostitutes or from husbands who used prostitutes. All 21 children had clinical cases of HIV infection at the onset of the P. marneffei infection. The median time of presentation was 32 months. Fever was a primary symptom. 67% had skin lesions and most lesions were on the face and extremities. Other laboratory findings are reported. 9 of the 21 children had other HIV-related opportunistic infections diagnosed at the same time as the diagnosis of P. marneffei. There were 4 cases of Salmonella bacteremia, 2 cases of cryptosporidiosis, 1 case of Pseudomonas aeruginosa bacteremia, 1 case of Pneumocystis carinii and cytomegalovirus pneumonia, and 1 case of nontyphoid Salmonella bacteremia and herpes zoster. All 7 culture-proved patients who did not receive antifungal therapy died. 9 culture-proved and 3 other cases responded to antifungal treatment. Findings suggest that P. marneffei infection should be included as another AIDS-defining illness. The case fatality rate of patients with P. marneffei infection was very high, mostly due to late diagnosis.
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PMID:Disseminated Penicillium marneffei infection in human immunodeficiency virus-infected children. 858 58

Worldwide, there are more than 18 million persons infected with HIV, the cause of AIDS. As HIV disease progresses, HIV-infected persons become vulnerable to various opportunistic infections that tend to vary from region to region. Tuberculosis is the most frequent serious opportunistic infection in sub-Saharan Africa. It is more prevalent in Latin America and in Asia than in the US. Bacterial and parasitic infections are common in sub-Saharan Africa. Toxoplasmosis, cryptosporidiosis, isosporiasis, and other fungal diseases are prevalent in Latin America. Fungal diseases, particularly cryptococcoses, and Penicillium marneffei infection, seem to also be prevalent in Asia. These regions have limited health resources. Regimens designed to prevent opportunistic infections that prolong and improve the quality of life of HIV-infected persons include trimethoprim-sulfamethoxazole to prevent Pneumocystis carinii pneumonia, toxoplasmosis, and bacterial infections; isoniazid to prevent tuberculosis; and 23-valent pneumococcal vaccine to Streptococcus pneumonia pneumonia. Scientists need to conduct research to identify the spectrum of opportunistic infections and the efficacy of different prevention measures in resource-poor countries. Health officials need to develop a minimum standard of care for HIV-infected patients. Since HIV/AIDS continues to grow in developing countries, scientists and health providers should pay as much attention to HIV/AIDS as to other tropical diseases.
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PMID:Preventing opportunistic infections in human immunodeficiency virus-infected persons: implications for the developing world. 870 12

The authors present the AIDS cases (CDC '93) observed in Brescia from 1983 to 1994. They observed 1189 subjects (M 84%, F 16%) with a mean age of 32.7 years (intra-venous drug users 75.1%, heterosexuals 14%, homosexuals 9.6%). The mean survival observed was 56.7 weeks from the diagnosis of AIDS (mortality per year 78%). The most frequent AIDS-defining events were Visceral Candidiasis, P. carinii Pneumonia (PCP) and Neurotoxoplasmosis, while the longest and shortest mean survival was for Kaposi's Sarcoma (89 weeks) and Wasting Syndrome (8.4). The mean value of CD4+ lymphocyte counts on AIDS diagnosis was 72.6/microl (1166 cases) and the highest and lowest were in non-Hodgkin's Lymphoma (NHL; 147.6/microl) and Cryptosporidiosis (18.8/microl). Antiretroviral therapy had been given for at least a month in 41.4% subjects (mean treatment duration of 74.8 weeks). The Cox model has demonstrated the favourable effect on survival of high CD4+ lymphocyte counts on diagnosis, antiretroviral therapy, the diagnosis of Tuberculosis (TBC) and PCP as initial markers and the diagnosis of TBC, PCP or Cytomegalovirus infection (CMV) during the entire clinical evolution. Moreover, the unfavourable effect of high age, diagnosis of Progressive Multifocal Leucoencephalopathy (PML), Wasting Syndrome and NHL as initial markers and diagnosis of PML or NHL in any moment of the disease has been demonstrated.
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PMID:Prognostic factors correlated with survival in AIDS patients. 1055 11

Although people with HIV are living longer than ever before, they continue to suffer from infections that are associated with low T4-cell counts. The U.S. Public Health Service (PHS) and the Infectious Diseases Society of America (IDSA) have updated the guidelines for preventing opportunistic infections, including their positions on when prophylaxis is indicated. Summaries are given for preventing the following infections: cytomegalovirus (CMV), cryptosporidiosis, fungal infections, human papillomavirus (HPV), herpes-related infections, mycobacterium avium complex (MAC), pneumocystis carinii pneumonia (PCP), streptococcal pneumonia, toxoplasmosis, and tuberculosis.
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PMID:Latest opportunistic infection prevention guidelines. 1136

Infection is regarded as an imbalance between microbial pathogenicity factors and the host defense systems. Opportunistic infections are defined as infections rarely observed in humans with normal immune responses. The term immunocompromised (compromised) host refers to host in which one or more defence mechanisms are inactive and in which the probability of infection is therefore increased. Hospital patients are often compromised host. Compromised hosts exist even outside the hospital (smoking, intravenous drug use, poor nutrition and other). A good example is HIV (human immunodeficiency virus). HIV causes acquired immunodeficiency syndrome (AIDS) by destroying the CD4 T lymphocytes, involved in the immune response. The most common AIDS-associated opportunistic infections include pneumonia caused by the fungus Pneumocystis carinii, systemic candidiasis (Candida albicans) and cryptococcosis (Cryptococcus neoformans), protozoal infections such as cryptosporidiosis (Cryptosporidium spp.) and toxoplasmosis (Toxoplasma gondii), viral infections due to HSV, CMV, EBV, HPV or HHV8, tuberculosis and other bacterial infections. Pneumocystis carinii pneumonia (PCP) is the most common opportunistic disease observed in AIDS patients. Disease does not necessarily follow exposure to a given causal agent (pathogen 01 opportunistic pathogen). In fact, the occurrence (or otherwise) of disease typically depends on various factors--including the degree of sensitivity of the host (as above) and the virulence factors of the pathogens. Overtly aggressive products such as toxins and aggressins are clearly virulence factors. However, so too are those products and strategies which help a pathogen to become established in the host and to evade the host's defences. Certain virulence factors can be induced in the pathogen via signal transduction pathways from environment.
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PMID:[The essence of infection by opportunistic microorganisms]. 1198 68

A prospective observational study was conducted to determine the prevalence and the clinical impact of intestinal parasitic infections in diarrheal illness among HIV-infected and HIV-uninfected children hospitalized with diarrhea in Bangkok, Thailand. Stool samples were examined for intestinal parasites using a simple smear method, a formalin-ether concentration method, a modified acid-fast stain and a modified trichrome stain. Intestinal parasites (IP) were identified in the stool specimens of 27 of 82 (33%) HIV-infected and 12 of 80 (15%) HIV-uninfected children (p=0.01). Microsporidia and Cryptosporidium were the most common IP found. Eighty-two percent of HIV-infected and 97% of HIV-uninfected groups presented with acute diarrhea and 76% of each group had watery diarrhea. Pneumonia was the most common concurrent illness, found in 22%. Clinical findings were unable to differentiate children infected with IP. Sixty-three percent of HIV-infected and 83% of HIV-uninfected children who had IP made a satisfactory recovery without specific anti-parasitic therapy. However, 9 children (7 HIV-infected and 2 HIV-uninfected) with persistent diarrhea who also had cryptosporidiosis and/or microsporidiosis did not respond to azithromycin and/or albendazole respectively. HIV-infected children with cryptosporidiosis were older and had more advanced HIV infection than those with microsporidiosis. Routine stool examination for IP should be considered due to the absence of clinical markers. The lack of effective therapy for the major IP found underscores the importance of preventive measures.
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PMID:Intestinal parasitic infections among human immunodeficiency virus-infected and -uninfected children hospitalized with diarrhea in Bangkok, Thailand. 1204 52

A prospective clinical study was conducted between January 1991 and June 1992 of 92 HIV seropositive patients attending the Adult Outpatient Clinic of the San Juan de Dios General Hospital in Guatemala City. 52 of the patients met the US Centers for Disease Control clinical criteria for AIDS. Limitations in the diagnostic and laboratory facilities of the hospital hampered identification of some opportunistic infections. 74 of the 92 patients were male. 3 of the 18 infected women gave birth during the study period; the status of their children is not yet known. 87% of the cases were in adults aged 18-40. 25 of the patients died during the 18-month study period and 9 were lost to follow-up. 57 of the 92 had lived in the US or Mexico. 43 of the 74 men reported homosexual relations. 6 reported use of intravenous drugs. 3 had received blood transfusions as the only known risk factor. 56 had histories of sexually transmitted diseases. 3 patients reported always using condoms, 57 never did so, and the rest did so occasionally. 52 of the patients had opportunistic infections. 18 had proven and 5 had presumptive extrapulmonary mycobacteria, probably tuberculosis. 2 had salmonella in the blood. 4 had presumptive cytomegalovirus, 6 had chronic mucocutaneous herpes, and 3 had presumptive HIV encephalopathy. 12 had esophageal candidiasis, 6 had extrapulmonary cryptococcosis, and 14 had pneumocystis carinii pneumonia. 13 had proven intestinal cryptosporidiosis, and 1 each had presumptive cerebral toxoplasmosis and extraintestinal strongyloidiasis. 3 had proven Kaposi's sarcoma and 1 had proven immunoblastic lymphoma. 10 had HIV-related weight loss.
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PMID:[Characteristics of human immunodeficiency virus infection in the San Juan de Dios General Hospital]. 1229 Jun 21

Cryptosporidium sp is a protozoan that displays an intracellular settlement primarily in the intestinal systems of humans and can result in diarrhoea. Undernourished children and persons with immunosuppression in developing countries are especially vulnerable to infection with this parasite. A 12-month-old female presented at Ege University, Faculty of Medicine, Department of Paediatrics with complaints of fever, diarrhoea, respiratory distress and growth-development retardation was diagnosed with CD40 deficiency (Hyper IgM Type 3). During the one year investigation process of the case with chronic diarrhoea and necrotic pneumonia, Cryptosporidium sp oocysts were found in nine of the 22 faecal examinations and also in transtracheal aspiration liquid examined using the Kinyoun Acid-fast staining method. In conclusion, it is thought that cryptosporidiosis should also be considered in the distinct diagnosis of immunodeficient infants who are presented with respiratory and gastrointestinal system complaints.
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PMID:Disseminated cryptosporidiosis in Turkey: case report. 1525 Jun 30

The purpose of this study was to determine the frequencies of opportunistic diseases among AIDS patients at the Jeanne Ebori Foundation (JEF) in Libreville, Gabon. A total 6313 file of patients treated in the internal medicine unit between 1994 and 1998 were analyzed. Findings showed that the main diseases related to AIDS classified according to seroprevalence were as follows: purigo (100%), cerebral toxoplasmosis (100%), oral candidiaisis (88%), bacteremia (87.8%), shingles (84.6%), minor salmonelosis (72%), and tuberclosis. The main diagnoses unrelated to AIDS at the JEF according to seroprevalene were typhoid (9.4%), common pneumonia (28%), bacterial meningitis (26.3%, hepatitis B (20.0%), and malaria (14%). In addition to these diseases there were nine cases of Kaposi's sarcoma, four cases of isosporosis, two cases of cryptococcosis, two cases of herpes Varicella, one case of cryptosporidiosis, and one case of isosporosis. The incidence of opportunistic disease was high in our study and must be taken in drug procurement.
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PMID:[Opportunistic diseases in HIV-infected patients at the Jeanne Ebori Foundation in Libreville, Gabon]. 1677 41


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