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

Earlier diagnosis and improved therapies for the opportunistic infections have led to improved quality of life as well as survival time of patients with advanced HIV-related immunodeficiency. Most of the therapies can be administered on an outpatient basis. Outpatient treatment further contributes to improving the quality of life of the patients. Presentation, clinical aspects, treatment and prophylaxis of the five most frequent opportunistic infections in HIV-infected patients with advanced immunodeficiency in our outpatient clinic (oral and esophageal candidiasis, pneumocystis carinii pneumonia, herpes zoster, herpes simplex virus infection and cerebral toxoplasmosis) are discussed with respect to the practical implications.
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PMID:[Ambulatory therapy and prevention of the most frequent HIV-associated opportunistic infections]. 192 48

This study assessed the effect of aerosolized pentamidine prophylaxis on the clinical presentation and diagnostic sensitivity of induced sputum examination for Pneumocystis carinii pneumonia. Between January 1, 1988 and October 27, 1990, 348 induced sputum examinations were performed as the initial diagnostic procedure for P. carinii pneumonia in patients infected with the human immunodeficiency virus (HIV). Medical records were reviewed for all induced sputum examinations, and the study group consisted of patients who either had not received prophylactic therapy (n = 193) or had received aerosolized pentamidine prophylaxis (n = 126). A total of 29 induced sputum examinations in patients receiving either other prophylactic regimens or ongoing therapy for previously documented P. carinii pneumonia were excluded from the study group. A total of 72 consecutive episodes of P. carinii pneumonia were subsequently documented by induced sputum examination (n = 54), bronchoalveolar lavage (n = 16), thoracocentesis (n = 1), or autopsy (n = 1). A total of 44 episodes occurred in patients who had not received antipneumocystis prophylaxis, and 28 episodes occurred in patients who had received aerosolized pentamidine. Of patients capable of producing a sputum specimen for analysis, induced sputum examination had a significantly lower diagnostic yield of 64.3% in patients who had received aerosolized pentamidine prophylaxis compared with 92.3% in patients who did not receive prophylaxis (p less than 0.02, Fisher's exact test). When the data were analyzed on an intention to treat basis, although there was a trend suggesting a lower overall yield in the aerosolized pentamidine patients, the difference was not statistically significant (64.3 versus 81.8%, p = 0.17, Fisher's exact test).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of aerosolized pentamidine prophylaxis on the diagnosis of Pneumocystis carinii pneumonia by induced sputum examination in patients infected with the human immunodeficiency virus. 192 45

Bacterial pneumonia (BP) has recently been reported to be more frequent in human immunodeficiency virus (HIV)-infected patients than in normal hosts. This study reviews the clinical and radiologic manifestations of BP in 132 consecutive pulmonary episodes over a 15-month period. BP was defined on a clinical basis as a pulmonary infiltrate accompanied by fever and improving in a few days with conventional antibiotics (trimethoprim-sulfamethoxazole excluded). In patients undergoing bronchoscopy (97 procedures), semiquantitative cultures and cell differentials of bronchoalveolar lavage (BAL) were performed, in addition to conventional staining and cultures for opportunistic infections. BP were frequent (45%), and the usual community-acquired pathogens were found. The radiologic manifestations of BP were often unusual, however, and 47% were indistinguishable from the typical appearance of Pneumocystis carinii pneumonia. BAL cultures had a sensitivity of 83 or 23%, depending on whether antibiotics were administered before bronchoscopy, using a cutoff value of greater than or equal to 10(4) bacteria/ml. The specificity of BAL culture was of 80.5% if patients with P. carinii pneumonia were taken as a control group. We conclude that BP is frequently encountered in HIV-infected patients. The clinical and radiologic presentation of BP may be indistinguishable from that of opportunistic infections. Semiquantitative cultures of BAL appear a valuable diagnostic tool to avoid unnecessary invasive diagnostic procedures or treatments.
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PMID:Mode of presentation and diagnosis of bacterial pneumonia in human immunodeficiency virus-infected patients. 192 71

Individuals with human immunodeficiency virus (HIV) infection are more susceptible to bacterial infections because of defects in both cellular and humoral immunity. The most common causes of community-acquired pyogenic bacterial pneumonia in HIV-infected patients are Streptococcus pneumoniae and Haemophilus influenzae. The clinical presentation of HIV-infected patients with pyogenic pneumonia does not seem to differ significantly from that of patients without HIV infection. Response to therapy is generally good, and complications relatively few. Prevention of bacterial pneumonia is very important in the care of HIV-infected persons. The pneumococcal vaccine is currently recommended for all HIV-seropositive individuals, although its efficacy is unknown is this setting. Other forms of prevention require further investigation but may prove to be helpful.
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PMID:Pyogenic bacterial pneumonia in the acquired immunodeficiency syndrome. 194 96

Extrapulmonary infection with Pneumocystis carinii is an uncommon event in which the skin may be affected rarely. All cases heretofore described in immunocompromised hosts have involved the external auditory canal and mastoid areas. We describe two patients with acquired immunodeficiency syndrome and extrapulmonary cutaneous P carinii infection that involved the glabrous skin. The first was a 31-year-old white man seropositive for human immunodeficiency virus with prior episodes of P carinii pneumonia and infection with Mycobacterium avium-intracellulare evaluated for translucent papules on the skin with an appearance similar to molluscum contagiosum infection. Biopsy confirmed the diagnosis of cutaneous pneumocystosis. The second patient was a 36-year-old homosexual man with long-standing liver disease with a persistent cough, fever, and an abnormal chest roentgenogram. Cutaneous evaluation revealed a bluish macule on the sternal notch that on skin biopsy was diagnostic of cutaneous pneumocystosis. Treatment with intravenous pentamidine resulted in resolution of the pulmonary and cutaneous problems in both cases. Extrapulmonary P carinii infection may involve the skin at sites other than the external auditory canal and may have a nondescript appearance. Histologic findings are similar to those of pneumocystosis found elsewhere. Clinicians should be familiar with the nondescript nature of the eruption as skin biopsy may be helpful in establishing a diagnosis of systemic pneumocystosis.
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PMID:Cutaneous Pneumocystis carinii infection in patients with acquired immunodeficiency syndrome. 195 76

The incidence of bacterial pneumonia is increased in human immunodeficiency virus (HIV) infection, and bacteremia and recurrences occur frequently. Streptococcus pneumoniae and Haemophilus influenzae are the most common pathogens, but several other organisms have now been identified as etiologies. Several abnormalities in B-cells and humoral immunity, and possibly neutropenia and white blood cell dysfunction, predispose to bacterial pneumonia. Despite the severity of pneumonia in HIV infection, most patients respond well to specific antimicrobial chemotherapy. Potential preventive measures include vaccines, immunoglobulin therapy, and antimicrobial prophylaxis.
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PMID:Bacterial pneumonia in the HIV-infected patient. 195 96

We assessed the risk of pneumonia due to Pneumocystis carinii in 1665 participants in the Multicenter AIDS Cohort Study who were seropositive for human immunodeficiency virus type 1 (HIV-1) but did not have the acquired immunodeficiency syndrome (AIDS) and were not receiving prophylaxis against P. carinii. During 48 months of follow-up, 168 participants (10.1 percent) had a first episode of P. carinii pneumonia. The risk was greatly increased in participants with CD4+ cell counts at base line of 200 per cubic millimeter or less (relative risk, 4.9; 95 percent confidence interval, 3.1 to 8.0). Although most participants (60.7 percent) described no HIV-1-related symptoms at the clinic visit at which a CD4+ cell count of 200 per cubic millimeter or less was first noted, this finding during follow-up was also associated with an increased risk of P. carinii pneumonia. The development of thrush or fever significantly and independently increased the risk of P. carinii pneumonia in these patients (adjusted relative risks, 1.86 and 2.15 for thrush and fever, respectively). Most participants with CD4+ cell counts above 200 per cubic millimeter who had P. carinii pneumonia within six months were symptomatic. We conclude that P. carinii pneumonia is unlikely to develop in HIV-1-infected patients unless their CD4+ cells are depleted to 200 per cubic millimeter or below or the patients are symptomatic, and therefore that prophylaxis should be reserved for such patients.
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PMID:The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1. Multicenter AIDS Cohort Study Group. 197 Aug 53

Eight cases of mother-to-child transmission of HIV-2 were documented by ELISA and Western blot in Gambia between January 1988-September 1989 from a hospital-based screening of 205 malnourished children, 864 subjects in a malaria study, 34 patients with probable immunodeficiency and 24 children of 17 HIV-2 seropositive mothers. AIDS was diagnosed by WHO clinical definition. Diagnosis of HIV-2 was made if sera were positive by ELISA and Western blot (LAV Blot2, Diagnostics Pasteur, Marnes-La-Coquette, France) and negative by Wellcozyme I competitive ELISA to HIV-a (Wellcome Diagnostics, Dartford, UK). The children ranged in age from 17 months-5 years, and in ponderal index from 50-90%. 6 had CD4 percentages or counts below the normal range. 7 of the 8 could only have been infected pre- or perinatally, while 1 had been transfused from her mother. The clinical features included 5 with diarrhea 1 month; 3 with Cryptosporidium, 3 with Candida, a pneumonia, an interstitial pneumonia by x-ray, a streptococcus abscess, a staphylococcus abscess, 1 infant with failure to thrive and 1 4-year old who was asymptomatic. This group of patients was more severely affected than a series reported from Guinea Bissau: their mothers also had advanced AIDS in comparison to asymptomatic mothers in the other series. While mother-to-child transmission of HIV-1 occurs in approximately 33% of children of HIV-1 seropositive mothers, these data cannot estimate the actual rate of transmission of HIV-2.
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PMID:AIDS following mother-to-child transmission of HIV-2. 197 26

We describe three patients with Pneumocystis carinii pneumonia as the initial presentation of severe combined immunodeficiency disease. The pneumonia in the first patient was treated successfully with trimethoprim/sulphamethoxazole (Tmp/Smz). The second patient died despite therapy with Tmp/Smz and pentamidine. The third patient failed to respond to therapy with Tmp/Smz and pentamidine. He was subsequently treated with trimetrexate and leucovorin. Treatment with the new folic acid antagonist trimetrexate resulted in complete recovery. The case histories of these children serve to illustrate the clinical symptoms and new therapeutic modalities of P. carinii pneumonia in patients with immunodeficiency disease.
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PMID:[Pneumocystis carinii pneumonia in patients with a severe combined immunodeficiency]. 199 Mar

A hydroxynaphthoquinone compound (566C80) has been shown to be effective in the prevention and treatment of murine Pneumocystis carinii pneumonitis. In a phase I study, five cohorts of four human immunodeficiency virus-infected men received 100, 250, 750, 1500, and 3000 mg of the compound orally once daily for 12 days. A sixth cohort received 750 mg three times daily for 5 days, then twice daily for 16 days. Evaluation included clinical, hematologic, and biochemical studies and the pharmacokinetics of 566C80. The only drug-related adverse effect was a maculopapular rash in one patient that resolved without discontinuation of the drug. With the largest dosage tested (3000 mg) the following pharmacokinetic measures were achieved: maximum plasma concentration, 39 micrograms/ml; time to maximum plasma concentration, 8.0 h; area under plasma concentration-time curve at steady state, 1088 h.micrograms/ml; plasma half-life, 51 h; and total plasma clearance, 4.09 l/h. Compound 566C80 offers promise as a new drug class for P. carinii pneumonia.
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PMID:Safety and pharmacokinetics of 566C80, a hydroxynaphthoquinone with anti-Pneumocystis carinii activity: a phase I study in human immunodeficiency virus (HIV)-infected men. 201 Jun 37


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