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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We conducted a retrospective cohort study to evaluate the occurrence of bacteremia and associated mortality among hospitalized patients who were seropositive for the human immunodeficiency virus (HIV) and who developed fever and neutropenia following antineoplastic chemotherapy or for other reasons. Review of medical records revealed 224 episodes in 142 patients. Of these episodes, 57% occurred following antineoplastic chemotherapy, and 43% occurred under other circumstances. Members of the chemotherapy group had significantly less-advanced HIV disease, a lower mean absolute-neutrophil-count nadir, and a shorter duration of hospitalization. There was no difference between the two groups in the frequency of bacteremia or mortality due to all causes when they were compared by multivariate analysis. Statistically significant univariate and multivariate predictors of bacteremia included sepsis syndrome and concurrent infection. Predictors of mortality included sepsis syndrome, concurrent infection, bacteremia, and antimicrobial therapy. This study suggests that the cause of neutropenia in HIV-seropositive patients is not a predictor of the outcome of fever and neutropenic episodes. Instead, clinical presentation and concomitant illnesses have a greater impact on outcome for a patient.
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PMID:Outcome for hospitalized patients with fever and neutropenia who are infected with the human immunodeficiency virus. 774 43

A clinical failure of pneumococcal vaccine is reported. A 22 year old African woman was given 23-valent pneumococcal vaccine at her initial presentation with HIV infection. She was asymptomatic and had a CD4+ lymphocyte count above 500 cells/mm3. Eighteen months later she died of meningitis and septicaemia due to Streptococcus pneumoniae type 9 (an antigen included in the 23-valent vaccine). Pneumococcal antibody levels performed on stored blood demonstrated no serological response to the vaccine. This is the first reported case of clinical failure of pneumococcal vaccine in an HIV infected patient who received vaccine whilst at the asymptomatic stage of HIV infection and with relatively intact immune function. The literature pertaining to pneumococcal vaccination in the context of HIV infection was reviewed. Pneumococcal vaccination is recommended for HIV positive patients in the UK by the Departments of Health. It is likely that many physicians are not aware of these recommendations or are concerned about the poor efficacy of the vaccine, and it may consequently be underused in clinical practice. But the potential gain to the HIV positive patient is such that the vaccine should be offered to all HIV positive patients as soon as they present for medical care, irrespective of the stage of HIV disease. Physicians and patients should be aware that the vaccine is not fully protective and that episodes of sepsis, pneumonia and meningitis could still be pneumococcal in origin and should be treated appropriately. Awareness of the substantial risks of pneumococcal disease in HIV infected patients with prompt diagnosis and effective treatment is the most important strategy to decrease morbidity and mortality.
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PMID:Pneumococcal vaccine and HIV infection: report of a vaccine failure and reappraisal of its value in clinical practice. 774 16

Autopsy or biopsy findings in 10 human immunodeficiency virus (HIV)-positive persons from Bangalore, India, revealed a wide spectrum of pathological changes. Patients' mean age was 33.4 years and the mean duration between symptom onset and death was 27.13 days. Nine patients had evidence of neuro-acquired immunodeficiency syndrome (AIDS) and 8 of them succumbed to various opportunistic infections. Histologic examination showed diffuse cryptococcal meningitis in 5 cases; 2 cases showed disseminated systemic cryptococcosis. Pulmonary tuberculosis was present in 3 patients. Despite no signs of associated neurotuberculosis in any patient, 4 autopsied and 1 biopsied case showed evidence of systemic tuberculosis. Toxoplasma encephalitis was present in 2 cases; observed in this series was the first case, in India, of co-existent toxoplasma and acanthamoeba. Other bacterial infections such as meningococcal meningitis and psudomonas septicemia were found in 3 cases; pneumocystis carinii pneumonia was present in 1 case. Evidence of early HIV leukoencephalopathy was observed in the only asymptomatic HIV-positive individual (who died in a traffic accident). AIDS-associated bacterial infections caused by organisms other than Mycobacterium tuberculosis are often underdiagnosed and should be considered in developing countries. In cases of cryptococcal and tuberculosis meningitis or multiple parasitic infections, patients should be screened for associated HIV infection.
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PMID:Pathological lesions in HIV positive patients. 775 Oct 41

From December 1990 to December 1993, 130 patients who had a lesion localized to the spinal cord were admitted to the Tikur Anbessa Hospital, Department of Internal Medicine, Addis Ababa. These patients accounted for 18.0% of all neurological admission to this department. The male/male female ratio was 1:8:1; the mean age was 40 years for these patients; 52% were from Addis Ababa City and 48% of them were coming from the rest of the country. Paraparesis or paraplegia (77%) and quadriparesis or quadriplegia (23%) were the commonest presenting complaints. Sensory level, sphincter dysfunction and bedsores were found in 70%, 54% and 14% of the cases respectively. Tuberculous spondylitis was found to be the leading cause accounting for 35 (26.9%), and HIV-1 myelopathies was the second common type accounting for 22 (16.9%) of spinal cord disease. Metastatic cord compression, tropical spastic paraparesis, (progressive non compressive myelopathy), cervical spondylosis, primary cord tumours and transverse myelitis were also not uncommon. Death related to sepsis or other causes were documented in 14 (10.8%). Follow-up was arranged on discharge, and only 45 (38.8%) patients were able to attend at least once the neurology referral clinic. Myelopathy is an important neurological disease and currently HIV-1 associated myelopathy has become the second important presumed cause.
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PMID:Myelopathies in Ethiopia. 778 55

Between June 1986 and October 1992, disseminated toxoplasmosis was diagnosed in 16 AIDS patients. 13 cases were diagnosed at autopsy where multiple organ involvement was documented in all 13. Three patients were diagnosed intra vitam. All 3 survived with appropriate treatment. Clinical features indicative of disseminated toxoplasmosis were: fever of unknown origin between 39 degrees and 40 degrees C in 16 cases, clinical signs suggestive of sepsis or septic shock in 15, with progression to multiorgan failure in 10, disseminated intravascular coagulopathy in 6, confusion, disorientation or apathy in 13 and lack of a systemic pneumocystis carinii prophylaxis in all 16. Typical laboratory markers were: CD4 cell counts below 100 x 10(6)/l in 16 cases, elevation of serum lactic dehydrogenase in 16 and creatine phosphokinase (in 4/6), normal or only slightly elevated C-reactive protein (in 9/11), positive Toxoplasma gondii IgG antibodies in 15/16 and negative IgM antibodies in all 16. Lesions indicative of cerebral toxoplasmosis were visualized on cranial computerized tomography in only 3/10 evaluated patients. In patients with advanced HIV infection presenting with a systemic illness, including the clinical and laboratory features described above, systemic Toxoplasma gondii infection must be included in the differential diagnosis. In these patients, specific and if warranted, invasive diagnostic procedures followed by early vigorous therapeutic intervention should be considered.
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PMID:Disseminated toxoplasmosis in AIDS patients--report of 16 cases. 778 18

Whereas the risk of infant mortality is nine times higher in the least developed countries as compared to industrialized countries, the risk of maternal mortality is often more than 100 times higher. Approximately 75% of the 500,000 maternal deaths which occur each year are attributed to hemorrhage, sepsis, toxemia, obstructed labor, and the complications of unsafe abortion. Appropriate prenatal care would 1) prevent or detect and treat life- and health-threatening abnormalities; 2) prepare the mother for the demands of labor and motherhood and counsel her on diet, exercise, rest, and drug treatment; 3) prepare the mother psychologically and emotionally for child-bearing; and 4) provide general health screening. Special attention should be paid to complications, postpartum hemorrhage, reduction of low birth weight, resuscitation techniques for the newborn, and hygiene. The reduction in maternal and infant deaths will require an intersectoral approach and will benefit from the following: 1) giving high priority to maternal and infant deaths; 2) increasing the use of contraceptives and promoting safe and legal abortion; 3) providing HIV prevention education; 4) promoting the importance of prenatal care; 5) disseminating information about family planning; 6) improving health training programs; 7) developing health education campaigns; 8) using appropriate health care technologies; 9) strengthening community-based maternal health and delivery systems; 10) organizing operational research and evaluation procedures; 11) involving nurses and traditional birth attendants in existing health services; and 12) mobilizing and involving the community in all health programs.
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PMID:Safe motherhood: with whom the responsibility rests? 783 76

To determine trends in a number of hemodialysis associated diseases and practices, the Centers for Disease Control and Prevention, in collaboration with the Health Care Financing Administration, completed a mail survey of chronic hemodialysis centers in the United States in 1992. Of 2,321 centers surveyed, 2,170 (93%) representing 170,028 patients and 43,535 staff members responded. In 1992, 2,049 (94%) centers used bicarbonate dialysate as the primary method of dialysis, 765 (35)% used high flux dialysis, and 1,569 (72%) reused dialyzers, continuing the trends toward increased use of these methods. Central (subclavian or jugular) venous catheters were used in > or = 1 patient as permanent vascular access for hemodialysis at 69% of dialysis centers. Hepatitis B surface antigen was present at low frequency in patients (incidence = 0.1%, prevalence = 1.2%) and staff members (incidence - 0.03%, prevalence = 0.3%). Among centers that had > or = 1 hepatitis B surface antigen positive patient, the incidence of hepatitis B virus infection was lower in those centers that used a separate room for dialysis of patients positive for hepatitis B surface antigen. From 1991 to 1992, reported hepatitis B vaccine coverage increased from 17% to 24% among patients and from 56% to 69% among staff members; in absolute terms, these were the largest single year increases since introduction of hepatitis B vaccine. The prevalence of antibody to hepatitis C virus was 8.1% among patients and 1.6% among staff members. Pyrogenic reactions in the absence of septicemia were reported by 19% of centers and associated with use of high flux dialysis. New dialyzer syndrome was reported by 24% of centers, most frequently by centers using regenerated cellulose or cuprophan membranes. Human immunodeficiency virus was known to be present in 1.5% of patients; 34% of centers reported providing hemodialysis to one or more patients infected with HIV.
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PMID:National surveillance of dialysis associated diseases in the United States, 1992. 785 22

Soluble tumour necrosis factor receptors (sTNF-Rs) play a role as modulators of the biological function of tumour necrosis factor-alpha (TNF-alpha) in an agonist/antagonist pattern. In various pathologic states the production and release of sTNF-Rs may mediate host response and determine the course and outcome of disease by interacting with TNF-alpha and competing with cell surface receptors. The determination of sTNF-Rs in body fluids such as plasma or serum is a new tool to gain information about immune processes and provides valuable insight into a variety of pathological conditions. Regarding its immediate clinical use, sTNF-Rs levels show high accuracy in the follow-up and prognosis of various diseases. In HIV infection and sepsis, sTNF-Rs concentrations strongly correlate with the clinical stage and the progression of disease and can be of predictive value. Determination of sTNF-Rs also gives useful information for monitoring cancer and autoimmune diseases. The information provided is often even superior to that obtained with classical disease markers, probably due to the direct involvement of the "TNF system" in the pathogenetic mechanisms in these patients. The available data imply that the measurement of sTNF-Rs, especially of the sTNF-R 75kD type, is a useful adjunct for quantification of the Th1-type immune response, similar to other immune activation markers such as neopterin and beta 2-microglobulin. Endogenous sTNF-Rs concentrations appear to reflect the activation state of the TNF-alpha/TNF receptor system.
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PMID:Soluble receptors for tumour necrosis factor in clinical laboratory diagnosis. 785 70

In Zambia, 10-15% of urban adults are reported HIV positive, as are over 80% of prostitutes. The HIV seroprevalence rate in a Lusaka hospital's intensive care unit was 21% (27% for surgical and 18% for trauma admissions). HIV-infected patients could be clinically recognized by risk factors or symptoms and signs: weight loss, chronic cough, chronic diarrhea, sepsis, septic arthritis, subacute hematogenous osteomyelitis, a history of sexually transmitted diseases (STDs), death of a spouse or of a child under age 2, recent pregnancy unable to go to term, poor quality or thin hair, appearance of aging beyond years, mental slowness, persistent or unexplained fever, lymphadenopathy, aggressive atypical Kaposi's sarcoma, oral thrush, hairy leukoplakia of the tongue, shingles scars, and scars of maculopapular dermatitis. Common sites for HIV-related sepsis are the female genital tract, anorectum, pleural cavity, soft tissues (e.g., necrotizing fascitis), and bone and joints. Autologous blood transfusion and use of donor blood screened for HIV antibodies, preferably limited to emergencies, would reduce the likelihood of iatrogenic HIV transmission. Surgeons should wear two pairs of gloves, a waterproof gown, and goggles to protect themselves from HIV transmission. If they have skin rashes, cuts, or abrasions on the hands or arms, they should not perform operations. Proper cleaning and disinfection of endoscopes are required. The risk of infection from a needle stick is small ( 0.4%).
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PMID:Surgery, surgical pathology and HIV infection: lessons learned in Zambia. 786 25

Among a spectrum of renal disorders encountered in patients infected with the human immunodeficiency virus (HIV), the lesion studied most often has been the glomerular disease known as HIV-associated nephropathy. Of the other coincidental renal perturbations reported, the most significant are a heterogenous group encompassing potentially reversible acute renal failure (ARF), primarily acute tubular necrosis. While HIV-associated nephropathy may frequently be seen in asymptomatic HIV-seropositive individuals, acute tubular necrosis almost always is encountered in patients with clinical acquired immunodeficiency syndrome (AIDS). We analyzed our decade's experience in the management of 146 HIV disease patients with ARF (132 AIDS patients and 14 HIV-seropositive patients) and compared it with a contemporaneous group of 306 non-HIV subjects with ARF. All patients evaluated for ARF between January 1984 and December 1993 by the Renal Division at Kings County Hospital Center, Brooklyn, NY, were reviewed. Only those patients with ARF who reached a serum creatinine concentration of 530 mumol/L or higher were included in the analysis. Ninety-one percent of 146 HIV disease patients with ARF were less than 50 years old compared with only 33% of the 306 non-HIV subjects (P < 0.001). Septicemia was directly or indirectly responsible for 75% of patients with ARF in the AIDS group and for 39% in the non-HIV subjects (P < 0.006). Urinary tract obstruction was the cause of ARF in 54 of 306 (17%) non-HIV patients compared with none in the HIV group (P < 0.00001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Outcome of severe acute renal failure in patients with acquired immunodeficiency syndrome. 787 16


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