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Query: UMLS:C0348321 (Haemophilus)
 15,372 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic sinus pathology is a frequently encountered disease in HIV infected patients. The responsible bacterial agents and management are yet to be settled. The authors report the results of a retrospective study led in the unit of Head and Neck Surgery of the University Hospital of Nice. 25 patients where HIV holders and had a sinus pathology which had lasted more than 6 weeks, despite one or several antimicrobial drug administrations. Clinical and CT scan data are detailed as well as pathology results of the samples harvested during sinus surgery (bacteria free 32%, Pseudomonas aeruginosa 32%, Streptococcus pneumoniae 16%, Staphylococcus aureus 16%, Hemophilus influenzae 16%, anaerobic agents 16% and Toxoplasma gondii 4%). All patients underwent surgery (antral puncture with maxillary sinus drainage 17, functional endoscopic sinus surgery 8). Results where gathered at 4 months with 76% of relapse (100% in patients with less than 200/mm3 CD4 cells). In conclusion empiric antimicrobial drug therapy will be expected to be also effective on Pseudomonas aeruginosa, the surgical management being most often deceiving and leading to relapse especially when considering the frequency of bilateral morbidity and the level of CD4 cell below 200/mm3.
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PMID:[Chronic sinusitis in patients infected by HIV: therapeutic strategies]. 1039 32

A linguistic complexity measure was applied to the complete genomes of HIV-1, Escherichia coli, Bacillus subtilis, Haemophilus influenzae, Mycoplasma genitalium, and to long human and yeast genomic fragments. Complexity values averaged over entire genomic sequences were compared, as were predicted average values of intrinsic DNA curvature. We found that both the most curved and the least complex fragments are located preferentially in non-coding parts of the genome. Analysis of location of the most curved and the simplest regions in bacteria showed that the low-complexity segments are preferentially located in close proximity to the highly curved sequences, which are, in turn, placed from 100 to 200 bases upstream to the start of the nearest coding sequence. We conclude that the parallel analysis of sequence complexity and DNA curvature might provide important information about sequence-structure-function relationship in genomes.
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PMID:Sequence complexity and DNA curvature. 1040 19

Studies of immune function in human immunodeficiency virus (HIV)-infected children are important, because functional abnormalities can precede CD4+ T-cell loss and are associated with the development of opportunistic and bacterial infections. We sought to correlate clinical parameters and immunological function with HIV RNA plasma levels in 20 children. HIV RNA levels were measured by a polymerase chain reaction assay. We analyzed T-cell responses to mitogens (phytohemagglutinin, concanavalin A, and pokeweed [PWM]) and antigens (tetanus toxoid and Candida albicans); T-cell suppressor activity; and humoral immunity to Haemophilus influenzae, hepatitis B, tetanus, and diphtheria vaccines. The median age of the children was 6 years. Eight children had HIV RNA levels less than 200 to 9621 copies per milliliter (group I). Four children had 37,970 to 82,630 copies per milliliter (group II). Eight children had 102,100 to 191,200 copies per milliliter (group III). There were no differences in the HIV-related complications between group I and II children. Group I/II children had significantly higher CD4+ T-cell counts (P = 0.02), less symptomatic HIV disease (P = 0.005), and more detectable protective vaccine immunity (P = 0.014) compared with group III children. Responses to mitogens were conserved in most children. Group I children tended to have higher responses to tetanus toxoid than group II children and significantly higher responses than group III children (P = 0.01). Group I had significantly higher responses to C. albicans than groups II (P = 0.016) and III (P = 0.001). Group I/II children tended to have lower suppressor activity compared with group III children (median, 0 vs 64%). We demonstrated that humoral and cellular immune dysfunction exists at all stages of disease in HIV-infected children but was most severe in children with greater than or equal to 100,000 HIV RNA copies per milliliter. Function was the most intact in children with less than 10,000 copies per milliliter.
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PMID:Correlation of clinical parameters and immunological function with human immunodeficiency virus plasma viremia in children. 1041 60

HIV-seropositive adults may be at increased risk of infection due to Haemophilus influenzae type b (Hib) as compared with HIV-seronegative adults. Protein conjugate vaccines have been demonstrated to induce protective levels of antibodies against Hib in immunocompetent infants and also in HIV-seropositive infants. In this study we determined the immunogenicity of three protein conjugate Hib vaccines (PRP-D, HbOC, HbNOMP) in 135 HIV-seropositive adults who received one dose of Hib vaccine. Anti-polyribosylribitol phosphate (PRP) antibodies were measured at 0, 1, 3 and 12 months postimmunization by the Farr method. We demonstrate that all three vaccines are highly immunogenic and result in protective (> 1.0 microg/ml) levels of antibody. Overall the anti-PRP antibody level was > 1.0 microg/ml in 26% of patients preimmunization, 91% at both 1 and 3 months, and 79% at 12 months postvaccination. Comparison of responses to the three vaccines over time demonstrated differences in the mean geometric anti-PRP antibody level at 1 month (p=0.03) and the 12 month time points (p=0.03) with lower geometric mean levels in the HbNOMP group, though baseline differences in groups limit the interpretation of these findings. In a univariate analysis of baseline characteristics which predicted poor vaccine response, low total IgG2 levels preimmunization predicted a poor antibody response at 1 month (p < 0.01) and at 12 months (p=0.05), while low CD4 T-cell count predicted poor response at 12 months (p < 0.01). We conclude that all three US licensed protein conjugate Hib vaccines are immunogenic in HIV-seropositive adults, and that baseline CD4 T-cell count and IgG2 levels predict the likelihood of antibody response to vaccine.
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PMID:Immunogenicity of three Haemophilus influenzae type b protein conjugate vaccines in HIV seropositive adults and analysis of predictors of vaccine response. 1043 47

Streptococcus pneumoniae (pneumococcus) is a Gram-positive, encapsulated bacteria that is a major cause of human disease in people of all ages. It is the most important cause of bacterial pneumonia in infancy, childhood and adult life, and the most important cause of meningitis in all age groups except children of 3 months to 2 years in whom Haemophilus influenzae type b (Hib) predominates (in the absence of Hib vaccination). Antibodies to the pneumococcal polysaccharide capsule are protective, and at present 90 capsular serotypes are recognized. The global burden of pneumococcal disease is poorly understood. It is believed to be responsible for 1-2 million deaths among children under 5 years of age every year and probably a similar number among adults. Thus, the global burden of pneumonia in adults is probably significantly underestimated at present. Strategies for the control of pneumococcal disease include control of risk factors, treatment of established cases and vaccination. In children, improved nutrition, better housing and reduced indoor air pollution are difficult to address, but should eventually reduce pneumonia rates. In adults, the risk factors are even more difficult to address, although control of alcohol and tobacco consumption and reduced transmission of HIV should all affect pneumococcal disease rates. Penicillin-resistant pneumococci are now widespread throughout the world. Where penicillin resistance occurs, penicillin should not be used to treat pneumococcal meningitis; however, penicillin, at higher doses if necessary, remains the drug of choice for the treatment of pneumococcal pneumonia, even where penicillin resistance is prevalent. There are three approaches to pneumococcal vaccination: polysaccharide vaccines (covering 23 serotypes), polysaccharide-protein conjugate vaccines (covering 9-11 serotypes) and common protein vaccines (which are not serotype-specific). Only polysaccharide vaccines are available now, but conjugate vaccines will be available soon. Polysaccharide vaccines probably have a role in protecting the elderly from pneumococcal disease, especially those at high risk. The potential role of conjugate vaccines in infants is unclear.
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PMID:Strategies for the control of pneumococcal diseases. 1047 Nov 87

Bacterial pneumonia is significantly more common in persons who are HIV-infected than in the general population and is most common among injection drug users and in persons with advanced HIV disease and immunosuppression. The clinical features of bacterial pneumonia are similar to those in HIV-seronegative persons, but bacteremia is more common. When a pathogen is identified, Streptococcus pneumoniae is consistently the most common, occurring in 20% to 70% of cases. Haemophilus influenzae, Staphylococcus aureus, Escherichia coli, and other gram-negative organisms are mainly responsible for the remainder of bacterial pneumonia episodes in the United States, Central Africa, Australia, and England. In some studies, Chlamydia pneumoniae was recognized as a common cause in persons with early HIV disease, whereas Pseudomonas aeruginosa is recognized as a community- and hospital-acquired lower respiratory tract pathogen in patients with severe immunosuppression. Although antimicrobial therapy is frequently empiric, it should be tailored to the severity of illness, local prevalence of infections, resistance patterns, or when an etiologic agent is identified. The treatment response is similar in patients with and without HIV infection, but bacterial pneumonia may accelerate the progression of HIV disease. Preventative measures include use of the polyvalent pneumococcal vaccine, especially early in the course of HIV infection, when it is most likely to be effective. The incidence of bacterial pneumonia is also reduced in HIV-seropositive persons who use trimethoprim-sulfamethoxazole to prevent Pneumocystis carinii pneumonia.
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PMID:Bacterial pneumonia. 1063 12

Although Haemophilus influenzae is a common etiologic agent of pneumonia in patients infected with human immunodeficiency virus (HIV), the characteristics of this pneumonia have not been adequately assessed. We have prospectively studied features of H. influenzae pneumonia in 26 consecutive HIV-infected inpatients. Most of these patients were severely immunosuppressed; 73.1% had a CD4+ cell count <100/microL. A subacute clinical presentation was observed in 27% of the patients and was associated with a higher degree of immunosuppression (P=.04). Bilateral lung infiltrates were noted radiographically in 57.7% of the cases. The mortality attributable to H. influenzae pneumonia was 11.5%. Thus, pneumonia caused by H. influenzae affects mainly patients with advanced HIV disease, and since its clinical and radiological features may be diverse, this etiology should be considered when pneumonia occurs in patients with advanced HIV infection. The mortality rate associated with H. influenzae pneumonia is not higher than that occurring in the general population.
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PMID:Haemophilus influenzae pneumonia in human immunodeficiency virus-infected patients. The Grupo Andaluz para el Estudio de las Enfermedades Infecciosas. 1072 28

To improve the management of lower respiratory tract infections (LRTI) in human immunodeficiency virus type 1 (HIV-1)-infected children, we assessed the burden of disease, clinical outcome and antibiotic susceptibility of bacteria causing severe community-acquired LRTI in children. A prospective, descriptive study was performed in the pediatric wards at a secondary and tertiary care hospital in South Africa. Urban black children aged 2-60 months admitted with severe acute LRTI from March 1997 through February 1998 were enrolled. HIV-1 infection was present in 45.1% of 1215 cases of severe LRTI. Bacteremia occurred in 14.9% of HIV-1-infected and in 6.5% of HIV-1-uninfected children (P<.00001). The estimated relative incidence of bacteremic severe LRTI in children aged from 2 to 24 months were greater in HIV-1-infected than in -uninfected children for Streptococcus pneumoniae (risk ratio [RR], 42.9; 95% confidence interval [CI], 20.7-90.2), Haemophilus influenzae type b (RR, 21.4; 95% CI, 9.4-48.4), Staphylococcus aureus (RR, 97.9; 95% CI, 11.4-838.2) and Escherichia coli (RR, 49.0; 95% CI, 15.4-156). Isolation of Mycobacterium tuberculosis was also more common in HIV-1-infected than in -uninfected children (RR, 22.5; 95% CI, 13.4-37.6). In HIV-1-infected children, 60% of S. aureus and 85.7% of E. coli isolates were resistant to methicillin and trimethoprim-sulfamethoxazole, respectively. The case-fatality rates among HIV-1-infected children was 13.1%, and among HIV-1-uninfected children, 2.1% (adjusted odds ratio [AOR]; 6.52, 95% CI, 3.53-12.05; P<.00001). The changing spectrum of bacteria and antibiotic susceptibility patterns in HIV-1-infected children requires a reevaluation of the empirical treatment of community-acquired severe LRTI in children from developing countries with a high prevalence of childhood HIV-1 infection.
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PMID:Increased disease burden and antibiotic resistance of bacteria causing severe community-acquired lower respiratory tract infections in human immunodeficiency virus type 1-infected children. 1091 17

The clinical picture of myocarditis/myopericarditis is of importance in differential diagnosis, especially in younger patients with suspected myocardial infarction. Myocarditis/myopericarditis commonly presents with chest pain, and the diagnosis is usually established on clinical grounds. However, endomyocardial biopsy is necessary to confirm the diagnosis. We evaluated the characteristics of acute myocarditis over the years 1980-1998 in 54 patients of the Department of Medicine of the University Hospital, Zurich. Two to 6 patients per year were hospitalised with this diagnosis. In most cases the diagnosis was established by a combination of criteria, such as a preceding infection of the upper respiratory tract, thoracic pain, ST segment elevations in different precordial leads followed by T wave inversions, arrhythmias, elevation of cardiac enzymes, reversible hypokinesia by echocardiography and normal coronary arteries. At least 3 of 5 criteria were requested. In a first step we analysed retrospectively all patients with acute myocarditis/myopericarditis in the years 1980-1993. Among 30 cases of acute myocarditis/myopericarditis the following causes could be identified: one influenza B, one Toxoplasma gondii infection, 2 Epstein-Barr infections and one bacterial myocarditis with gram-negative rods. The aetiology of the other 25 cases remained unknown. The majority of myocarditis/myopericarditis healed without complications. One patient with Epstein-Barr myocarditis and one with Toxoplasma gondii infection died. Two patients developed dilated cardiomyopathy. In a second phase we analysed prospectively all cases with acute myocarditis/myopericarditis over the period 1994-1998: 24 patients with acute myocarditis/myopericarditis were hospitalised. At that time coronary angiography and endomyocardial biopsies were performed more frequently. We found 2 patients with giant cell myocarditis and 2 with Toxoplasma gondii infection and HIV, all of whom died. In addition, there were 2 patients with eosinophilic myocarditis, one with Lyme carditis, one with Epstein-Barr myocarditis, one with myopericarditis after Campylobacter enteritis and one histologically proven myocarditis after pneumonia with Haemophilus influenzae. The aetiology of the remaining 13 cases with myocarditis/myopericarditis could not be established. Three patients with probable viral myocarditis developed cardiogenic shock requiring intraaortic balloon pump, and fully recovered. The patient with Lyme carditis manifested with total atrioventricular block and was treated with a temporary pacemaker. One patient with lymphocytic myocarditis required heart transplantation because of terminal heart failure and one female patient with histologically proven diffuse lympho-monocytic myocarditis died of cardiogenic shock. All the other cases healed without complications. Serologies are of little diagnostic value and should be restricted to serologies with therapeutic implications. We believe that the apparent increase in myocarditis/myopericarditis in recent years is a result of better diagnostic tools, such as more specific cardiac enzyme tests, coronary angiography and endomyocardial biopsies. In most cases the therapy remains symptomatic. In elected, severe cases steroids and other immunosuppressive drugs are sometimes used.
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PMID:[Diagnosis and course of myocarditis: a survey in the medical clinics of Zurich University Hospital 1980 to 1998]. 1102 70

Over the past decades, the differentiation of bacterial strains for epidemiological purposes had been based on conventional phenotypic characters. More recently, methods studying the directly coded molecules or semantides (nucleic acids or proteins) have allowed, concomitantly with the technical progresses of electrophoresis, the description of stable, discriminant, reproducible markers, which were applicable to large series of isolates. Initially applied to study nosocomial infections in industrialised countries, these methods appear to be particularly suitable for an approach of the epidemiology of endemic bacterial infections in sub-Saharan Africa. The fact that these tools remain costly and technically complicated explains that most of these studies are conducted in the laboratories of industrialized countries. This research reveals the epidemiological complexity of most of these infections. Thus, the epidemiology of trachoma was studied by the analysis of polymorphism of the major outer membrane protein gene of Chlamydia trachomatis in a village of Gambia. A PCR based technique was used to determine the frequency of infection in symptomatic and clinically negative subjects and to specify the prevalence of the genotypes. The epidemiology of plague was studied by the restriction fragment length polymorphism (RFLP) analysis of the ribosomal RNA genes (ribotyping). Distinct ribotypes differentiated the strains of the first two pandemics from the third one. The strains of African origin were particularly heterogeneous, especially in Kenya. This diversity may be explained by the fact that the plague focus is extremely ancient in Central Africa. Bacterial agents of meningitis were also studied. The electrophoretic polymorphism of outer membrane proteins of Haemophilus influenzae of b type was used to specify the epidemiology of meningitis in Gambia. The invasive strains exhibited distinct profiles from non-invasive strains. Different types were evidenced in the west, east and central parts of the country. The antigenic polymorphism of outer membrane proteins of Neisseria meningitidis allowed the differentiation of the strains isolated in Mali according to the period of isolation. Thus, the endemic strains of A serotype were distinguished from those belonging to the same serotype, which were responsible for the 1994 epidemic. Several molecular methods were applied to the typing of Vibrio cholerae strains, particularly those of the seventh pandemic. The enzyme electrophoretic polymorphism (MLEE), a technique based on RFLP analysis of toxin genes, the arbitrarily primed PCR (AP-PCR) and mainly the ribotyping were applied. This last method revealed that in Africa several clones of V. Cholerae El Tor were responsible for the seventh pandemic. Moreover the technique has evidenced the intercontinental spread of a clone of V. Cholerae isolated in 1993 in Calcutta and identified a year later in Guinea-Bissau. Tuberculosis is at present the first opportunistic infection linked to HIV infection in sub-Saharan Africa. Tuberculosis incidence is particularly high and is expected to increase. Several molecular methods, including IS 6110 RFLP analysis, AP-PCR and spoligotyping were used to study the epidemiology of tuberculosis in various countries: South Africa, Tanzania, Zimbabwe, Kenya and Malawi. The aims of this research varied: prevalence of reactivation and of recently acquired infections, routes of contamination, degree of genetic diversity of the organisms isolated in a given geographic area, urban and rural origins of the infections, comparison of isolates from HIV seropositive and HIV seronegative patients. Identical profiles in the strains isolated from several patients could correspond to clusters of infections. However, the identification of epidemiological links in most clusters is hard to obtain. (ABSTRACT TRUNCATED)
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PMID:[Molecular epidemiology of large bacterial endemics in Sub-Saharan Africa]. 1103 62


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