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

Up to June 1991 a total of 6,604 AIDS cases were reported to the central AIDS-registry at the Federal Health Office. As typical for "pattern I" countries most of the AIDS-cases are homo/bisexual men (70%), followed by i.v. drug users (IDU, 13%). However, the proportion of homo/bisexual men is constantly decreasing since 1986 while the proportion of IDU's is increasing. As also observed in other industrialized countries a flattening off in the AIDS incidence curve is seen since 1989. Probable reasons for this observation are a decrease of new infections since 1984/85 (due to early saturation of the populations at highest risk and to the early onset of prevention campaigns in these populations) and improved therapeutic strategies in the prevention of AIDS indicating diseases. However, since about 60,000 people are estimated to be HIV infected in the FRG today AIDS incidence will remain on a stable level for the next years regardless the number of new infections occurring today. Since 1988 major changes in the distribution of AIDS indicating diseases are seen. While Kaposi's sarcoma is constantly decreasing non Hodgkin lymphomas, HIV encephalopathy and wasting syndrome are increasing. Due to the effective primary prophylaxis of pneumocystis carinii pneumonia (PCP) by pentamidine the proportion of PCP as AIDS-indicating opportunistic infection decreased from more than 60% in 1988 to 41% in 1991. The second most frequent opportunistic infection is now toxoplasmosis (19%). The changes in the distribution of AIDS-indicating diseases and the increasing proportion of IDU's have major implications on patient care as well as diagnostic and therapeutic procedures.
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PMID:[The epidemiology and acquired immunodeficiency syndrome--status and trends]. 172 53

The clinical manifestations of cytomegalovirus (CMV) infection in persons with AIDS are described, and recent advances in the management of these syndromes with antiviral agents are reviewed. CMV infection is the most common serious opportunistic viral infection in AIDS patients. Clinical manifestations include chorioretinitis, gastroenteritis, hepatitis, pneumonia, CNS infection, adrenalitis, and a wasting syndrome. The diagnosis of CMV infection requires laboratory demonstration of a serologic response to the virus, detection of viral components or products, or isolation of the virus. Ganciclovir is an acyclic nucleoside analogue marketed for the treatment of CMV-related retinitis in immunocompromised hosts. After i.v. ganciclovir induction therapy, more than 80% of patients show improvement or stabilization of retinitis. Relapse is common in AIDS patients, however, and low-dose i.v. maintenance therapy is recommended. The most serious dose-limiting effect is neutropenia. Intravitreal injection of ganciclovir has been well tolerated and efficacious. Ganciclovir has shown some efficacy in the treatment of other life-threatening CMV infections, especially gastroenteritis, but data are limited. Ganciclovir-resistant strains have been reported. Foscarnet, a pyrophosphate analogue with activity against both human CMV and human immunodeficiency virus, is undergoing clinical trials. Foscarnet has shown promise in the therapy of CMV-related retinitis, but results for other CMV infections are disappointing. Nephrotoxicity is the major dose-limiting effect. AIDS patients with sight-threatening and rapidly progressive CMV-related retinitis should be treated with ganciclovir. Foscarnet may offer an alternative when it becomes available. More must be learned about the efficacy of these drugs in the treatment of CMV infection in patients with AIDS.
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PMID:Management of cytomegalovirus infection in patients with acquired immunodeficiency syndrome. 216 89

Cell-mediated immunity plays a pivotal role in the pathogenesis and in the recovery mechanisms of visceral leishmaniasis (V.L.). This disease, observed in two patients with AIDS, has peculiar anatomical and clinical characteristics and it is usually characterized by a severe clinical course. In addition, V.L. has been proposed to be included among the relevant infections for the case definition of AIDS. We describe two cases of V.L. occurred in association with AIDS. The most relevant characteristics of our cases are the followings: Diagnosis has been achieved by the identification of Leishmania donovani in the macrophages of the bone marrow in both the patients, and of the lymph node in one patient. The detection of anti-Leishmania antibodies was positive in one patients only. A significant defect of CD4+ cells was documented in both the patients. V.L. was associated in one patient with esophageal candidiasis, disseminated tuberculosis, P. carinii pneumonia; and in the other one with cerebral toxoplasmosis, pulmonary tuberculosis, esophageal candidiasis, Kaposi's sarcoma, CMV hepatitis. Specific chemotherapy has been partially or totally ineffective in both the patients. In fact, chemotherapy led to an apparent transient recovery in one patient, followed by a symptom-free period of more than one year. We think that V.L. has been the first infection occurred in this patients, beside of HIV infection. At the time of the first observation, the clinical conditions of this patient were satisfactory and there was only a slight alteration in cellular immunity. The detection of leishmania in bone marrow was coincident with the onset of fever, the development of a wasting syndrome and a dramatic decrease in cell-mediated immunity. A second cycle of specific treatment has been ineffective and the patient died. On the contrary, the second patient did not respond to the specific treatment and died. Two important anatomo-pathological characteristics were present in our cases: a) the presence of the parasite in several organs, namely bone marrow, spleen, liver. b) the absence of granulomatous lesions which indirectly indicates the defect in cell mediated immunity.
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PMID:[Visceral leishmaniasis in patients with AIDS. Description of 2 cases]. 263 90

The macaque immunodeficiency syndrome has many parallels to AIDS in humans. Affected monkeys develop profound, prolonged T lymphocyte dysfunction and die of lymphomas or opportunistic infections. We recently isolated a virus that we call SIV from four sick macaque monkeys. The morphology, growth characteristics, and antigenic properties of this virus indicate that it is related to the causative agent of human AIDS. The pathogenicity of this newly isolated virus was tested in macaque monkeys. Five of six died between 127 and 352 days following inoculation. The animals developed a wasting syndrome and died with adenovirus pancreatitis and/or pneumonia and primary retroviral encephalitis. Immunological abnormalities in these animals included a decrease in circulating T4+ lymphocytes and depressed peripheral blood lymphocyte proliferative response to pokeweed mitogen. The SIV monkey model holds great promise for testing antiviral agents and for the development of vaccines against AIDS.
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PMID:Simian models for AIDS. 348 63

Incidence of clinical outcomes defining acquired immunodeficiency syndrome (AIDS) may be expected to change as a consequence of progressive immunosuppression and use of chemoprophylaxis before the onset of AIDS. Using Poisson regression methods, we examined trends in the incidence of initial and secondary AIDS-defining illnesses from 1985 to 1991 among 2,627 homosexual men participating in the Multicenter AIDS Cohort Study who were seropositive for human immunodeficiency virus type 1. The incidence of Pneumocystis carinii pneumonia rose steeply until 1987 but has declined since then (p < 0.001), while the other AIDS-defining conditions have showed significant (p < or = 0.039) upward trends. Trends for Kaposi's sarcoma, lymphoma, neurologic disease, and cytomegalovirus/herpes simplex virus infections were explained by progressive immunosuppression, but residual downward and upward trends were present for P. carinii pneumonia and other opportunistic infections (bacterial, fungal, and protozoal infections and wasting syndrome). Despite selection bias, those receiving P. carinii pneumonia chemoprophylaxis showed a significantly lower incidence of P. carinii pneumonia (relative risk = 0.32, 95% confidence interval 0.16-0.63), and the time trends of P. carinii pneumonia were explained by progressive immunosuppression and use of prophylaxis. No significant effects on all other diagnoses were seen in those selected to receive antiretroviral therapy. Secondary diagnoses showed a strongly significant (p < 0.001) increase in non-P. carinii pneumonia and non-Kaposi's sarcoma among those with initial diagnoses of Kaposi's sarcoma. Overall, the trend observed in the incidence of other opportunistic infections underscores the need for developing and testing new strategies to curtail or delay the onset of these diseases.
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PMID:Trends in the incidence of outcomes defining acquired immunodeficiency syndrome (AIDS) in the Multicenter AIDS Cohort Study: 1985-1991. 809 56

While at the start of the AIDS epidemic, corticosteroids were considered to be contraindicated, about 10 indications have since been identified for the specific use of glucocorticoids in HIV infection. Some of these indications have already been confirmed in controlled scientific studies, for example, pneumocystis carinii pneumonia or HIV-induced high-grade non-Hodgkin's lymphoma. In the case of other indications, for example, cerebral toxoplasmosis or certain forms of the wasting syndrome, clinical observational studies and, in particular, empirical data provided by large groups working on AIDS, are available. The use of corticoids for such other indications as pulmonary involvement in the case of Kaposi's sarcoma, or thrombopenia in HIV patients, is still experimental. To date, the initially feared high rate of side effects due to the theoretically possible impairment of immunological function, has not been observed. The effect of the corticosteroids appears to be concentrated more in their anti-inflammatory action than in substitution in the event of adrenal insufficiency. The carefully considered and selective use of corticosteroids can both improve the quality of life and lengthen the life expectancy of many HIV victims.
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PMID:[Adjuvant corticoid administration within the scope of HIV disease. Indications in wasting syndrome and other diseases within the scope of AIDS]. 817 98

The objective of this study was to describe the epidemiology and clinical presentation of HIV infection among upper middle class patients in Mexico City. A retrospective review of outpatient and hospital records of all HIV-infected patients was accomplished by one of the authors between 1984 and 1990. A total of 115 patients were seen during the study period, 109 men and 6 women. One hundred and seven patients acquired HIV infection through sexual contact, six patients had HIV infection associated with blood transfusion and two were homosexual men who also had a history of intravenous drug use. The mean age of the patients was 36.2 years (range 13 - 65 years). CDC classification at presentation was predominantly stage IV (65%) with the most common AIDS associated diseases at presentation being wasting syndrome in 30 (42.2%), P. carinii pneumonia in 22 (30.9%), cytomegalovirus infection in 11 (15.5%), Cryptosporidium parvum diarrhea in 7 (9.8%), and Kaposi's sarcoma in 6 (8.4%). CD4+ T-lymphocyte cell counts at the time of HIV diagnosis were available in 87 patients (median = 150 cells/microliters; mean = 224 cells/microliters, SD +/- 219). Zidovudine was used in 37 patients after 1988 when it first became available in Mexico, in six patients the drug had to be discontinued because of serious hematologic toxicity. The average follow-up on zidovudine was 8.5 months. Similar age, gender, age distribution, risk categories and CDC classification at presentation was seen compared to other series reported from Mexico. However, the spectrum of opportunistic infections found were similar to that seen in the United States.
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PMID:The spectrum of HIV infection in patients seen at a private hospital in Mexico City: 115 patients seen from 1984 to 1990. 869 65

Cryptococcosis is an epidemiological and immunological indicator due to the absence of Cryptococcus neoformans as a saprophyte in immunocompetent humans and the advantage of specific C. neoformans culture. On this basis, a report is presented on the CD4 lymphocyte count of 36 AIDS patients suffering from cryptococcosis and other concomitant or missing opportunistic AIDS-defining infections. In 26 out of 36 patients, i.e. 72%, a CD4 lymphocyte count of < or = 50/microL (mean value 39.5%) was found. Cryptococcosis as the sole opportunistic infection was diagnosed in 5 cases (13.9%). In 31 cases, various combinations of AIDS-associated diseases were found: Pneumocystis carinii pneumonia (PCP) (n = 19), cytomegalovirus infection (CMV) (n = 10), Kaposi's sarcoma (n = 6), Mycobacterium avium intracellulare infection (MAI) (n = 5), pneumonia (n = 2), toxoplasmosis (n = 2), Candida esophagitis (n = 1), tuberculosis (n = 1), lambliasis (n = 1), salmonellosis (n = 1) and wasting syndrome (n = 5). The conspicuous simultaneous occurrence or succession of pneumocystosis and cryptococcosis and the contrasting absence of aspergillosis and mucormycosis (zygomycosis) are commented. Based on the present observations in HIV-infected persons in Berlin, a CD4 lymphocyte count of < 150/microL may be used as a parameter indicating a predisposition for cryptococcosis as an airborne AIDS-defining infection. Attention is drawn to bird droppings as the sole habitat of C. neoformans and accidental niche of various other microorganisms.
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PMID:Cryptococcosis in HIV infection of man: an epidemiological and immunological indicator? 883 78

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

A wasting disease characterized by progressive weight loss and dyspnea has been observed in weaning pigs on a farm in Yamagata Prefecture in 1998. Histopathologic findings in an affected pig were bronchointerstitial pneumonia and intracytoplasmic clusters of basophilic inclusions in macrophages of lymph nodes, which were similar to those in pigs with postweaning multisystemic wasting syndrome (PMWS) recently reported in North America and Europe. Porcine circovirus (PCV)-like particles were observed in bronchial lymph node of the pig by electron microscopy, and PCV antigens were detected in the lesions by immunohistochemical staining. PCV DNA was also detected in the lung and tonsil by PCR, and restriction fragment length polymorphism analysis of the PCR products with HinfI showed the same type of the PCV associated with PMWS (pmws PCV). Homology of nucleotide sequences between the PCR product and corresponding regions of published pmws PCV genomes was very high. These results indicated that virus detected in this study was pmws PCV. To our knowledge, this is the first report on the presence of pmws PCV in Japan.
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PMID:Detection of porcine circovirus from lesions of a pig with wasting disease in Japan. 1056 89


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