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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sera from 37 Nigerian men with Kaposi's sarcoma were examined for evidence of infection with human T-cell lymphotropic virus type III (HTLV-III), cytomegalovirus (CMV), Epstein-Barr virus (EBV), hepatitis B virus (HBV), hepatitis A virus (HAV), and Candida albicans. For comparison purposes, sera from 30 patients with primary cell liver carcinoma and 150 health young adults were also assessed. The Kaposi's sarcoma patients were in poor general condition, with severe anemia and gross sepsis. In each case, cutaneous disease affected only the limbs-- a finding that is in contrast with the visceral organ involvement seen in most black African victims. The serologic testing provided clear evidence that tropical African Kaposi's sarcoma is not associated with HTLV-III infection; non of the 217 serum samples analyzed from the 3 study groups showed antibodies to this virus. A widespread pattern among the Kaposi's sarcoma and liver carcinoma patients was depression of peripheral blood monocyte chemotaxis and a diminished, delayed-type hypersensitivity reaction to tuberculin. All patients in these 2 groups demonstrated circulating antibodies to CMV, EBV, HBV, AND HAV. Candida albicans was isolated from 30 of the 37 Kaposi's sarcoma patients and all 30 liver carcinoma patients compared with none of the health controls. These findings suggest that endemic tropical African Kaposi's sarcoma is a different disease than the epidemic AIDS-linked Kaposi's sarcoma reported from the US, and it is probable that different etiologic agents are involved in each case.
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PMID:Kaposi's sarcoma and HTLV-III: a study in Nigerian adult males. 302 63

A patient with acquired immunodeficiency syndrome (AIDS) who required aggressive nutritional intervention via home parenteral nutrition therapy is described, and nutritional status, etiology and therapeutic management of AIDS-associated malnutrition, role of nutrition support, and factors for consideration in using parenteral nutrition in AIDS patients are discussed. Parenteral nutrition therapy was initiated in a 30-year-old AIDS patient with Kaposi's sarcoma lesions of the gastrointestinal tract because of rapid weight loss, low serum protein levels, and malnutrition. He had previously undergone a small-bowel resection and a jejunojejunostomy, and radiation and antineoplastic-drug therapy was planned. During parenteral nutrition therapy, the patient demonstrated increased physical strength and was able to care for himself during most of the time spent at home or in a long-term-care facility. Aggressive measures, including parenteral nutrition therapy, were discontinued 11 days before the patient's death. Complications of therapy included one episode of sepsis and a tear in the external catheter tubing. Malabsorption and diarrhea mainly caused by gastrointestinal disease, reduced food intake because of oral and esophageal infections, adverse effects from medication, and depression are factors that can contribute to AIDS-associated malnutrition. Also, hypermetabolism resulting from infections and fevers may contribute to malnutrition in AIDS. The extent to which this malnutrition affects the underlying immune dysfunction occurring in the syndrome and the response to other more direct drug therapies in AIDS is not known. Available methods for nutritional intervention are based on clinical experience and anecdotal reports. Because of gastrointestinal disease, an oral diet, supplements, and enteral tube feedings may not meet nutritional goals for an AIDS patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Parenteral nutrition in the management of gastrointestinal Kaposi's sarcoma in a patient with AIDS. 313 64

Available is a case of mycobacterial sepsis in patients with immunodeficiency of undetermined origin and presenting morphologically with disseminated Kaposi's sarcoma. The disease ran the course and exhibited morphological manifestations similar in some details to AIDS. The author advocates a differentiated approach to evaluation of clinical and pathological findings in cases close in appearance.
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PMID:[Kaposi's sarcoma combined with generalized miliary tuberculosis]. 325 Mar 86

A 52-year-old man presented with a history of chronic lymphocytic leukemia and Kaposi's sarcoma. Three days after admission for clinical sepsis, yeast forms were noted within monocytes and neutrophils on a routine peripheral blood smear. Blood cultures yielded a pure culture of Candida parapsilosis. Despite antifungal therapy, the patient died 22 days after admission. This case represents the first reported instance of C parapsilosis sepsis diagnosed through a peripheral blood smear.
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PMID:Candida parapsilosis diagnosed by peripheral blood smear. 377 48

A patient with acquired immunodeficiency syndrome presented with multiple pruritic papules and nodules over the trunk and extremities. Biopsy specimens from two of these lesions contained granules within abscesses of the papillary dermis. There were numerous gram-positive cocci within the granules. Culture of one lesion failed to produce growth. A mouse inoculated with tissue from a lesion revealed no evidence of sepsis or organ involvement. The skin lesions showed no obvious response to systemic antimicrobial therapy but gradually resolved after treatment had been discontinued. Such lesions should be clinically distinguished from other cutaneous manifestations of acquired immunodeficiency syndrome, such as Kaposi's sarcoma.
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PMID:Cutaneous botryomycosis in a patient with acquired immunodeficiency syndrome. 381 60

The effectiveness of fiberoptic bronchoscopy with the addition of bronchoalveolar lavage (BAL) was evaluated in 72 patients with the acquired immune deficiency syndrome (AIDS) and parenchymal pulmonary disease. The diagnostic yield varied for different pathogens and was 94% (45/48 cases) for Pneumocystis carinii, 67% (14/21 cases) for cytomegalovirus, and 62% (8/13 cases) for Mycobacterium avium intracellulare. Of the 11 cases of documented Kaposi's sarcoma in the lung parenchyma, none were diagnosed from bronchoscopy, although characteristic endobronchial lesions were seen in 6 cases. Overall, the yield of bronchoscopy for all pathogens was 65%. Both transbronchial biopsy and BAL had high independent yields (88 and 85%, respectively) for diagnosing P. carinii pneumonia but combining the procedures gave the best yield. Cytomegalovirus was most often diagnosed from examination and culture of the BAL. Recovery of Mycobacterium avium intracellulare was highest with culture of both washings and lavage. Neither granuloma nor organisms were seen on examination of histologic specimens. Bronchoscopy with BAL was well tolerated with few complications even in 5 patients with thrombocytopenia and 10 patients requiring mechanical ventilation. Sixteen patients (22%) had an increase in temperature after the procedure without hypotension or sepsis and 1 patient (1.5%) had a moderate pulmonary hemorrhage after transbronchial biopsy. Fiberoptic bronchoscopy with BAL is a safe procedure with a high diagnostic yield in AIDS patient with lung disease.
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PMID:Diagnosis of pulmonary disease in acquired immune deficiency syndrome (AIDS). Role of bronchoscopy and bronchoalveolar lavage. 609 9

Fourteen infants with clinical and laboratory features of an acquired immunodeficiency syndrome were identified in a single metropolitan area from November 1980 to July 1983. Patients were predominantly of Haitian parentage, although two cases occurred in offspring of non-Haitian intravenous drug abusers. Only one patient had received a blood transfusion before the development of clinical findings. The predominant clinical findings included failure to thrive, persistent infection of the oral mucosa by Candida albicans, chronic pulmonary infiltrates, hepatosplenomegaly, lymphadenopathy, and diarrhea. Immunologic studies showed most of the infants to have inverted ratios of T-cell subsets, greatly increased immunoglobulin levels, and circulating immune complexes. Lymphopenia was not common, as it is in adult patients. Infectious agents responsible for opportunistic infections in this series included Pneumocystis carinii, herpesviruses, particularly cytomegalovirus, and C. albicans. Bacterial infections were common, and gram-negative sepsis was the major cause of death in the seven infants who have died. At autopsy, two infants had disseminated lymphadenopathic Kaposi's sarcoma. These observations suggest the likelihood of transplacental, perinatal, or postnatal transmission of an as yet unidentified infectious agent that causes this disease.
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PMID:Acquired immunodeficiency syndrome in infants. 660 81

Researchers analyzed data on 52 HIV-positive patients with Kaposi's sarcoma (KS) aged 23-67 (74% Black, 26% White; male/female ratio = 2.8:1) referred to the Johannesburg General Hospital in South Africa during 1980-1990 to examine the hospital's experience with these patients. 23 patients had a fever and/or at least 10% weight loss. 34% had prior or coexistent opportunistic infection, particularly Pneumocystis carinii pneumonia, fungal disease, or tuberculosis. Possible risk factors among 21 patients were homosexual intercourse, history of sexually transmitted disease, and drug abuse. Almost all patients had skin disease, either localized or disseminated. Other KS sites included the oral cavity, regional lymph nodes, and large bowel. 90% of 20 patients treated with radiation responded to treatment. Response rates for radiation treatment among the 20 patients were 80% for symptomatic relief, 45% for complete remission, 45% for partial remission, and 10% for tumor progression. The recurrence-free period among irradiated patients was five months. Five patients developed radiation-induced mucositis of the oropharyngeal region. None of the 32 patients treated with chemotherapy and not radiation experienced complete remission. Chemotherapy induced partial remission in 38% and tumor progression in 62% of patients. 9% of chemotherapy-treated patients experienced symptomatic relief. Deteriorating performance status and/or debilitating side effects (severe mucositis and neutropenic sepsis) necessitated cessation of chemotherapy or dose modification. The clinical course of AIDS-related KS in this population paralleled that in Western countries. Based on these findings, the authors recommend local radiation therapy to treat AIDS-related KS or a watch-and-wait policy for asymptomatic, minimal disease in patients with an intact immune status.
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PMID:Epidemic AIDS-related Kaposi's sarcoma in southern Africa: experience at the Johannesburg General Hospital (1980-1990). 757 Aug 33

Despite the increasing number of patients with the human immunodeficiency virus (HIV) infection, surgical experience with these patients remains limited. A retrospective review over a 9 year period (January 1985 to December 1993) was undertaken to determine the indications, operative management, pathologic findings and outcome of major abdominal surgery in these patients. A total of 51 procedures were performed in 45 patients; 30 patients had acquired immunodeficiency syndrome (AIDS) and 15 patients had asymptomatic HIV infection. Indications included gastrointestinal bleeding, complicated pancreatic pseudocysts, cholelithiasis, bowel obstruction, immune disorders, acute abdomens, elective laparotomy, colostomy formation, menorrhagia and Caesarean section. Pathologic findings directly related to the HIV infection were found in 81% of the AIDS patients and 35% of the asymptomatic HIV infected patients (P < 0.05). These included opportunistic infections, non-Hodgkin's lymphoma, Kaposi's sarcoma, immune disorders, lymphadenopathy and pancreatic pseudocysts. It was noted that AIDS patients had more complications than asymptomatic HIV infected patients with most complications related to chest problems and sepsis (61 vs 7%; P < 0.01). Emergency operations carried a higher complication rate than elective operations though this was not significant. The hospital mortality was 12%. On follow up, 13 of the 25 AIDS patients had died with the median survival of 7 months, while three of the 14 asymptomatic HIV infected patients had died with the median survival of 40 months. Of the remaining patients, the 12 AIDS patients had a median postoperative follow up of 7 months and the 11 asymptomatic HIV infected patients had a median postoperative follow up of 29.5 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Abdominal surgery in HIV/AIDS patients: indications, operative management, pathology and outcome. 774 74

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


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