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

This report presents the first case described in the English literature of dual infection with Cryptococcus neoformans and Streptococcus pneumoniae in the cerebrospinal fluid of an AIDS patient. The patient was a 32-year-old, HIV-positive South African woman who had been diagnosed with disseminated tuberculosis 5 months prior to the index admission. Her chief complaints at presentation were abdominal pain, chronic diarrhea, and vaginal discharge, suggesting a diagnosis of pneumonia and pelvic inflammatory disease. Persistence of confusion led to a lumbar puncture; gram-positive and budding yeasts were observed and subsequent India-ink staining revealed capsulated yeast typical of C. neoformans. S. pneumoniae and C. neoformans were cultured 24 and 48 hours, respectively, after incubation. The woman died within 24 hours of hospital admission, precluding further investigation. It is presumed that this woman already had disseminated cryptococci at the earlier presentation, but was incorrectly diagnosed as having tuberculosis. The finding of pneumococci, in the absence of inflammatory cells in cerebrospinal fluid, suggests the terminal event was fulminant pneumococcal meningitis in the setting of chronic cryptococcal meningitis. This case supports the importance of performing both the Gram- and India-ink stains and cryptococcal antigen test on cerebrospinal fluid specimens from immunocompromised patients, even when biochemical and cellular parameters are normal.
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PMID:Meningitis due to a combined infection with Cryptococcus neoformans and Streptococcus pneumoniae in an AIDS patient. 957 Jun 64

In the present report we describe 4 previously healthy women who developed cryptococcal pneumonia during pregnancy, and 1 pregnant woman with cryptococcal meningitis. These cases illustrate a previously uncharacterized spectrum of cryptococcal disease. We also discuss 24 patients previously reported who had cryptococcal meningitis during pregnancy. Finally, we review the available data for each therapeutic option and present an algorithm for management based on appraisals of disease severity and risk to the unborn fetus. This report emphasizes the need for heightened awareness of cryptococcosis in the differential diagnosis of pneumonia, chest pain, and hypoxemia in the pregnant patient, but at present, there are insufficient epidemiologic data to determine whether incidences of pulmonary or disseminated cryptococcosis actually increase during pregnancy. The risk of congenital cryptococcosis to the unborn fetus is low, and the most likely mechanism whereby neonates acquire invasive fungal pulmonary infection is through aspiration. While it is unclear whether there is any real increased risk of spontaneous abortion or premature labor, the data indicate that overall fetal outcome depends on effective treatment of maternal infection. For patients with dense air-space consolidation, progressive pulmonary disease, or dissemination, antifungal therapy is necessary. Optimal treatment is determined by the acuity and severity of the clinical presentation. Amphotericin B (approximately 1 g) with or without flucytosine represents the choice for initial treatment of the more acutely ill patient with disseminated or progressive pulmonary cryptococcosis who requires hospitalization (whether during or after pregnancy). Oral fluconazole appears to be safe and effective alternative therapy after delivery for the less severely ill patient who can be managed on an outpatient basis. While the use of fluconazole during pregnancy generally appears safe in terms of fetal outcome (49, 58), the class C status and single report of fetal malformation (62) preclude confident recommendation for its use during pregnancy. The risks and benefits of this effective and generally less toxic drug should be discussed with the parents and weighed against the use of amphotericin B. For pregnant women with limited pulmonary cryptococcosis (segmental or nodular infiltrates) and no evidence of dissemination, we recommend close follow-up without antifungal therapy similar to the recommendation for normal hosts with minimal disease. However, it is important to note that there is no extensive experience upon which to base this recommendation for pregnant individuals (45, 55, 103, 108). It is prudent to use frequent physical examinations (for example, every 1-2 months), combined with chest roentgenograms and serum cryptococcal antigens to monitor progression and/or development of disease in both the mother and child for approximately 6 months postpartum. In conclusion, cryptococcosis during pregnancy presents a special challenge to the clinician. A balanced therapeutic approach holds great promise for successful maternal and fetal outcomes.
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PMID:Cryptococcal pneumonia complicating pregnancy. 965 27

From 1994 through 1998, the clinical and demographic features and risk behaviors of 101,945 adolescent and adult patients with acquired immunodeficiency syndrome (AIDS) were reported to the Ministry of Public Health in Thailand. The number of reported cases of AIDS infection increased from 12,005 in 1994 to 24,722 in 1997. Nearly 40% of the cases were reported from the northern provinces, which contained only approximately 20% of the adult population. About 80% of cases were among male patients, and 87% had been acquired via sexual contact. Tuberculosis was the most commonly reported opportunistic infection, occurring in 28.9% of patients; it was more commonly reported among injection drug abusers, especially in Bangkok. Pneumocystis carinii pneumonia and cryptococcal meningitis each occurred in nearly 20% of patients and were more frequently reported in patients with risk factors related to sex than in injection drug abusers. Penicillium marneffei infections were reported in 6.8% of patients from the northern provinces but less frequently elsewhere. These data suggest that AIDS is common in Thailand, and human immunodeficiency virus-infected persons should be given prophylaxis for tuberculosis, fungal infections, and P. carinii pneumonia.
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PMID:Clinical presentation and risk behaviors of patients with acquired immunodeficiency syndrome in Thailand, 1994--1998: regional variation and temporal trends. 1124 18

Although most infants infected with HIV manifest no symptoms of their infected status at birth, HIV-infected children usually develop clinical signs of HIV/AIDS much sooner after infection than do adults. A small percentage of children manifest no signs of HIV infection until reaching age 10 years or older. More than half of all HIV-infected children live for more than 5 years. It is extremely important that HIV-infected children lead normal lives, being allowed to play with friends, go to school, and play sports. Such children cannot transmit HIV to others through everyday activities. HIV status need not be known for the majority of infections an HIV-infected child is likely to have. Rather, such children need the same preventative care as all children, including routine immunization, good nutrition, basic hygiene, the prompt treatment of illnesses, and regular growth monitoring. Common illnesses in children with HIV infection include candidiasis, recurrent fever, recurrent bacterial infections, persistent diarrhea, chronic cough, and skin diseases. HIV-specific illnesses include pneumocystis carinii pneumonia, cerebral toxoplasmosis, and cryptococcal meningitis. Supportive care should be provided to sick children to relieve symptoms and reduce pain.
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PMID:Managing illness. 1229 36

Aquired Immune Deficiency Syndrome (AIDS) has succeeded in creating an unprecedented wave of panic among the Western public and some sections of the medical profession. Research clearly shows that the AIDS virus is transmissible in a number of ways: from man to woman and vice versa during sexual intercourse, through semen and possibly vaginal fluids; from mothers to their children through breast milk; through exchange of saliva (but not through just a casual kiss); and through blood and blood products. Far from being exclusive to homosexuals, studies in Europe have shown that female virus carriers can transmit AIDS to healthy men through sexual intercourse--the predominant means by which transmission appears to occur in Central Africa. Although cases of AIDS began being diagnosed in a few Central African countries at the beginning of the 1980s, at the same time as they were first being observed in Europe and North America, many commentators assumed that the virus originated in Africa. Yet, it is safe to say that the nature of the virus, let alone its origins, remains controversial among scientists and virologists. 1 supporter of the theory that the AIDS virus has African origins is Robert Gall of the US National Institute of Health (NIH). He is one of the co-discoverers of the virus, which he named HTLV3 (Human T-cell Lymphotropic Virus 3). The virus also was discovered at France's Pasteur Institute by Luc Montaigner, who called it LAV (Lymphadenpathy Associated Virus). Gallo named the virus as he did because he believes it to be related to a pair of other viruses, HTLV1 and HTLV2, which like the AIDS virus attack the body's immunity system. Unlike AIDS, these 2 viruses, do not destroy the T-cells but cause them to replicate into cancer tumors. In Gallo's view, HTLV1 has long been endemic to some parts of Africa, from where he believes it spread via the slave trade to other parts of the world. Montaigner does not agree. He denies that the AIDS virus is related to either HTLV1 or HTLV2, claiming that ist shape and behavior makes it closer to a group of viruses known as lenti-viruses, so called because they can lie dormant in an animal host for between 5-20 years before becoming active. Prior to the appearance of AIDS, lenti-viruses were hardly ever found in humans. Due to this controversy, the virus has been HTLV3/LAV by the scientific community. What is evident from studies of the disease in Africa, Europe, and the US, is that there are no easy remedies for this highly complex syndrome. Nor is it possible to generalize about it from 1 country to another, let alone 1 continent from another. The way the disease presents itself in Zaire is different from the way it presents itself in Uganda, and both are very different from the way it presents itself in Europe and the US. In Zaire, chronic diarrhea, tuberculosis, pneumonia, and cryptococcal meningitis could all be symptoms of the AIDS patient. AIDS is a recognized public health problem in a number of Central African countries. In those areas where the disease's presence has been confirmed, sexual promiscuity has been singled out as a high risk factor for its transmission. In all affected countries, health authorities are aware of the need to launch health education campaigns.
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PMID:AIDS: the frightening facts. 1231 86

Cryptococcal meningitis (CM) is common in the immunocompromised (especially due to AIDS), but also occurs in immunocompetent subjects. CM can complicate cryptococcal pneumonia (CP) not only in the immunocompromised but also in the immunocompetent. We describe a healthy 26-year-old man who developed a prolonged lung infection. Diagnosis of cryptococcal pneumonia was established from bronchoscopic washings. He recovered spontaneously, so no antifungal treatment was given. 4 months later he was admitted with cryptococcal meningitis and was treated successfully with amphotericin B. An extensive immunologic study revealed no abnormalities. Since CM can complicate cryptococcal pneumonia, it is recommended that patients with CP be followed, even if recovery is apparently complete.
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PMID:[Cryptococcal meningitis following cryptococcal pneumonia in an immunocompetent]. 1241 73

A 40-year-old man had a 6-week history of severe frontal headaches and dry cough. Chest x-ray showed hilar adenopathy with bilateral parenchymal infiltrates. A diagnosis of atypical pneumonia was made. Four weeks later he was admitted with persistent headache. Infectious screen was negative. Brain MR post contrast, revealed cerebellar enhancement and swelling with moderate tonsillar herniation; findings which precluded the performance of a lumbar puncture. High resolution CT thorax confirmed hilar abnormalities; shown by microscopy to represent non caseating granulomata. A presumptive diagnosis of sarcoidosis was reached. Despite an initial symptomatic improvement his headache persisted. Repeat MRI, eleven days after admission, showed reduced cerebellar enhancement and swelling with no change in the degree of tonsillar herniation. He deteriorated acutely and died two weeks after admission. Autopsy revealed cerebral oedema with tonsillar herniation secondary to cryptococcal meningitis variety neoformans. There was no evidence of neurosarcoid. Active and inactive sarcoid was identified in the lungs and hilar nodes with no evidence of systemic sarcoid. Focal evidence of cryptococcal pneumonitis was present in the lung as a necrotic focus. A strong index of clinical suspicion is necessary to diagnose the rare association of cryptococcus complicating sarcoidosis.
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PMID:July 2004: 40-year-old man with headaches and dyspnea. 1577 43

We determined total and Cryptococcus neoformans glucuronoxylomannan (GXM)-reactive antibody repertoires of human immunodeficiency virus (HIV)-infected and HIV-uninfected Ugandans in a retrospective, case-control study of participants in a randomized controlled trial of pneumococcal vaccination. The study included 192 adults: 48 who subsequently developed cryptococcal meningitis (CM); (HIV+ CM+); 2 individuals who matched them in CD4+ T-cell level, stage of HIV disease, and age but did not develop CM (HIV+ CM-); and 48 HIV-uninfected individuals. Total serum immunoglobulin concentrations and titers of immunoglobulin M (IgM), IgG, and IgA to GXM, pneumococcal polysaccharides, and antibodies expressing certain V(H)3 idiotypes were determined with banked sera obtained before the development of cryptococcosis for HIV+ CM+ subjects. The results showed that HIV-infected subjects had significantly lower levels of IgM to GXM but higher levels of total immunoglobulin and IgG and IgA to GXM than those of HIV-uninfected subjects. HIV-infected subjects with a history of pneumonia had higher levels, and those with a history of herpes zoster had lower levels of GXM-binding antibodies than subjects with no history of either disease. Minimal to no cross-reactivity was demonstrated between antibodies to GXM and polysaccharides in a pneumococcal vaccine. No significant differences between the antibody repertoires of HIV+ CM+ and HIV+ CM- subjects were identified, but among subjects without a history of pneumonia, there was a trend towards lower V(H)3-positive antibody levels among HIV+ CM+ than among HIV+ CM- subjects. Our findings demonstrate an association between previous infectious diseases and differences in the total and GXM-reactive antibody repertoires of HIV-infected subjects and suggest the question of whether certain microbes modulate subsequent antibody responses to GXM deserves further study.
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PMID:Cryptococcus neoformans-reactive and total immunoglobulin profiles of human immunodeficiency virus-infected and uninfected Ugandans. 1621 Apr 79

Infliximab, a tumor necrosis factor-alpha inhibitor, is increasingly used for the therapy of different inflammatory conditions. We report the first case of cryptococcal meningitis in a patient treated with infliximab and other immunosuppressive agents, and review a further 5 reported cryptococcal infections. All of them involved fungal pneumonia. Outcome was favorable in all cases.
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PMID:Cryptococcal meningitis in a patient treated with infliximab. 1724 Jan 11

Rabbit anti-thymocyte globulin (ATG) and alemtuzumab have been used for induction or preconditioning and for the treatment of acute rejection in organ transplant recipients in many centers. Such regimens may lead to a substantial decline in the CD4 lymphocyte count to levels seen in other population groups at high risk of cryptococcosis. In view of this, we examined the impact of such therapy on the cumulative incidence of cryptococcosis among liver and kidney recipients. A total of 834 liver and 727 kidney transplants were performed during the study period. Seven hundred and eighty-one patients did not receive ATG or alemtuzumab; 646 received 1 dose of either drug, and 134 patients received 2 doses of either drug. The cumulative incidence of cryptococcosis was 0.26% (2/781) among those who did not receive ATG or alemtuzumab; 0.3% (2/646) among those who received only 1 dose, and 2.24% (3/134) among those who received 2 doses (P=0.03). There were 5 cases of cryptococcosis in liver recipients and 2 in kidney recipients. There were 3 cases of cryptococcal meningitis, 3 of pneumonia, and 1 of disseminated disease. The 2 kidney recipients had meningitis. Diagnosis occurred at a median of 255 days (range 7-517) after transplantation. The mortality rate was 14.2%. We conclude that the use of 1 dose of ATG or alemtuzumab is not associated with an increased cumulative incidence of cryptococcosis, but that those patients receiving 2 doses are at increased risk.
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PMID:Cryptococcosis in liver and kidney transplant recipients receiving anti-thymocyte globulin or alemtuzumab. 1731 67


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