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

There is a well documented risk of late infection following both splenectomy and bone marrow transplantation. In asplenic patients, the phagocytic and antibody producing roles of the spleen are lost and there is a lifelong susceptibility to infection which may be overwhelming and fatal. Patients most at risk are children, those with underlying lymphoproliferative disorders and those receiving immunosuppressive therapy. Although it is hard to prove benefit from preventative strategies, patients are likely to benefit from prophylactic antibiotic therapy and from immunisation with pneumococcal, Haemophilus influenzae-B and meningococcal vaccine given prior to splenectomy. Following an allogeneic bone marrow transplant (BMT), recovery of immune function takes up to a year. During this time, patients are at high risk from cytomegalovirus (CMV) and varicella zoster virus (VZV) infections and also from pneumocystis pneumonia. Prophylactic medications are used to good effect. The major threat of late infection occurs in patients with chronic graft versus host disease (cGVHD)--there is increased susceptibility to bacterial, fungal and viral infections. Many patients without cGVHD recover immune function fully and many develop antibodies to specific recall antigens. This does not occur in all patients and although there is a low risk of infection with organisms against which vaccines are available. If it is not possible to measure specific antibody titres and consequently offer selective re-immunisation, then a universal vaccination strategy should be in force. Response to vaccines is likely to be poor before one year post BMT. For autologous transplant recipients, immune recovery is probably complete and routine re-immunisation is not likely to offer much benefit. For both asplenic and bone marrow transplant patients, education of patient and physician is important.
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PMID:Prophylaxis against late infection following splenectomy and bone marrow transplant. 781 19

Nontypeable Haemophilus influenzae (NTHi) is one of the leading causative agents of bacterial otitis media, and no vaccine has been shown to be effective against it. Three outer membrane lipoproteins of NTHi have been investigated extensively and are leading candidates for inclusion in a vaccine against this organism. Hi-PAL (P6), recombinant PCP (rPCP), and e (P4) proteins are antigenically conserved among NTHi strains and elicit bactericidal and protective antibodies. A genetic fusion of the rPCP and Hi-PAL proteins has also been reported. Mixtures of these proteins were used for active immunization experiments in the chinchilla model of otitis media. Chinchillas were immunized either with a mixture of all three lipoproteins or with the mixture of rPCP-PAL hybrid plus e protein. When these animals were challenged with a NTHi strain injected directly into the middle ears, no protection from infection or disease, as measured by otoscopy, was observed in either group. However, effusion and inflammation measured by tympanometry were significantly reduced in animals immunized with the three lipoproteins. Animals that had been immunized with either whole NTHi cells or total outer membranes and then challenged with the homologous strain were significantly protected from both infection and disease, as determined by tympanometry and otoscopy. Unlike other animals antisera, chinchilla antisera against the purified proteins had no bactericidal activity against NTHi but did fix complement on the cell surface. Thus, the chinchilla immune responses to mixtures of these lipoproteins differ from the immune responses observed in other animal species. Further evaluation of these proteins for their vaccine potential remains to be done.
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PMID:Evaluation of mixtures of purified Haemophilus influenzae outer membrane proteins in protection against challenge with nontypeable H. influenzae in the chinchilla otitis media model. 847 84

Patients with HIV infection are at increased risk for community-acquired bacterial pneumonias, due in part to their defects in B-cell function. Streptococcus pneumoniae is the commonest cause of community-acquired pneumonia, with the second most common bacterial agent being Haemophilus influenzae. These two organisms account for about two-thirds of community-acquired bacterial pneumonias. Frequently bacterial pneumonias appear difficult to distinguish from Pneumocystis carinii pneumonia or other opportunistic lung infections, because of their atypical clinical and radiologic presentations. Community-acquired pneumonias may be recurrent but have low fatality rates. In comparison, nosocomial pneumonias occur primarily in patients with AIDS and are usually due to Staphylococcus aureus, Pseudomonas aeruginosa and other aerobic gram-negative bacilli. Nosocomial pneumonias have high fatality rates. S.aureus is an important cause of morbidity and mortality in patients with AIDS and has emerged as a secondary opportunist in lungs of patients with opportunistic diseases. While appropriate laboratory study is being done, empiric antibiotic therapy should be directed against the microorganisms above described.
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PMID:Bacterial pneumonia in adult patients with HIV infection. 856 41

Pulmonary infections are a very common complication in acquired immune deficiency syndrome (AIDS) patients. These infections may be severe enough to initiate the admission of these patients to intensive care units (ICU). Pneumocystis carinii pneumonia (PCP) is the most frequent cause of ICU admission because of acute respiratory failure. Mortality of ICU-admitted patients with this infection has changed with time. Initial reports confirmed a high mortality (80% to 90%). After 1985, the mortality rate decreased (50%). Factors such as the use of corticosteroids, better patient care, and a better knowledge of the disease probably explain this change. In recent years (1990 to 1995), mortality has worsened again, perhaps, because ICU facilities were offered more liberally to patients failing aggressive conventional treatment, including adjuvant therapy with corticosteroids. However, for those patients able to be discharged, the prognosis is not worse than expected according to the stage of their human immunodeficiency virus-1 (HIV-1) infection and immunologic status. Consequently, at least a limited period of ICU care and some respiratory support (either continuous positive airway pressure or mechanical ventilation) should be considered and offered to all HIV-1-infected patients with PCP and respiratory failure. Cytomegalovirus may be another cause of severe pulmonary infection in AIDS patients. This infection is difficult to diagnose; hence, it should be suspected when patients with PCP do not progress appropriately, or when no responsible pulmonary pathogen is found. When associated with PCP, mortality is very high. Disseminated tuberculosis is another potential cause of severe respiratory failure and respiratory secretions should be routinely examined for acid-fast bacilli in AIDS patients with pulmonary infiltrates. Finally, bacterial pneumonia (Streptococcus pneumoniae, Neisseria catarrhalis, Haemophilus influenzae, Staphylococcus aureus, and Pseudomonas aeruginosa) may also be the etiological agents of severe acute respiratory failure. Empiric antibacterial treatment to cover these microorganisms should be given when a bacterial agent is suspected.
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PMID:Severe pulmonary infections in AIDS patients. 877 81

Procalcitonin (ProCT) is a recently described marker of severe sepsis. It was decided to assess the value of proCT as a marker of secondary infection in patients infected with HIV-1. ProCT plasma levels were measured by immunoluminometric assay in a prospective study in 155 HIV-infected individuals: 102 asymptomatic and 53 with lever or suspected secondary infections. The baseline plasma level of ProCT was low (0.5 ng/ml +/- 0.37), even in the latest stages of the disease, and did not differ from the values of healthy subjects (0.54 ng/ml +/- 0.08). EDTA-treated whole blood was collected from patients before starting specific antimicrobial therapy. No elevation of ProCT level was detected in HIV-infected patients with evolving secondary infections including PCP (n = 4), cerebral toxoplasmosis (n = 4), viral infections (n = 9), mycobacterial infections (n = 5), localized bacterial (n = 12) and fungal infections (n = 4), malignancies (n = 3), and in various associated infectious and non-infectious febrile events (n = 13). All these plasma values were lower than 2.1 ng/ml. In contrast, high ProCT plasma levels were detected in one HIV-infected patient with a septicaemic Haemophilus influenzae infection (16.5 ng/ml) and another one with a septicaemic Pseudomonas aeruginosa infection (44.1 ng/ ml), ProCT values decreased rapidly under appropriate therapy. ProCT seems to be a specific marker of bacterial sepsis in HIV-infected patients, as no increase in other secondary infections could be detected in those patients. A rapid determination of ProCT level could be useful to confirm or refute bacterial sepsis for a better management of febrile HIV-infected patients.
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PMID:Procalcitonin as a marker of bacterial sepsis in patients infected with HIV-1. 927 23

We studied retrospectively 132 episodes of infectious pneumonias in 89 patients examined from 1990 to 1995. Pneumocystis carinii was found to be the most common cause of pneumonia (33 patients). The other causes were: Streptococcus pneumoniae (15), Mycobacterium tuberculosis (14), Pseudomonas aeruginosa (8), Staphylococcus aureus (5), Cytomegalovirus (4), Haemophilus influentiae (4), Mycobacterium avium intracellulare (2), Klebsiella pneumoniae (2), E. coli (2), Serratia marcescens (1). No etiologic agent was found in 40 cases. We stress the need of a more frequent use of invasive diagnostic procedures in the study of focal lung consolidations because this radiologic sign is highly aspecific and may be caused by too many different pathogenic agents, needing different therapies-i.e., Streptococcus pneumoniae (15 cases), Pseudomonas aeruginosa (8), Staphylococcus aureus (5), Klebsiella pneumoniae (2), Escherichia coli (2), Pneumocystis carinii, Serratia marcescens and Haemophilus influentiae (1). Since there is an increase in mortality among patients treated with empiric antibiotic therapy, we stress the need of the routinary use of bronchoalveolar lavage in HIV+ patients with lung consolidation to perform specific therapy. Moreover, Pneumocystis carinii is by far the most frequent cause of diffuse interstitial infiltrates, and PCP has very suggestive clinical (dyspnea), radiologic (diffuse perihilar interstitial infiltrates; ground glass opacities; pneumatoceles) and laboratory (CD3+CD4 < 200/mcl; LDH > 600 UI/dl; PO2 < 70 mmHg) patterns, always related to the discovery of Pneumocystis carinii in escreatum. Thus, we decided to treat 15 patients with specific therapy for Pneumocystis carinii pneumonia with the above diagnostic algorithm, obtaining in all of them complete clinical and radiologic recovery. To conclude, in critical patients, invasive procedures should be performed only in the cases in which PCP is clinically improbable.
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PMID:[Diagnostic imaging and therapeutic implications in lung infections in patients with HIV-1 infection]. 928 Sep 34

Systemic corticosteroids have been used in the treatment of numerous medical conditions for approximately 50 years. Short-acting products such as hydrocortisone are the least potent. Prednisone and methylprednisolone, which are intermediate-acting products, are four to five times more potent than hydrocortisone. Dexamethasone is a long-acting, systemic corticosteroid; its potency is about 25 times greater than the short-acting products. Corticosteroids reduce the need for hospitalization in patients with croup and decrease morbidity and the incidence of respiratory failure in the treatment of patients with AIDS who have Pneumocystis carinii pneumonia. Other often overlooked indications for corticosteroids are the treatment of hyperthyroid states, including thyroid storm, subacute thyroiditis and ophthalmopathy of Graves' disease. Systemic steroids can be used as adjuvant analgesics in the treatment of neuropathic and cancer-related pain. They may also decrease mortality in patients with severe alcoholic hepatitis and concomitant encephalopathy. Corticosteroids can reduce complications in patients with meningitis caused by Haemophilus influenzae or Mycobacterium tuberculosis.
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PMID:A different look at corticosteroids. 971 98

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

Immunodeficiency with thymoma (Good syndrome, GS) is a rare, adult-onset condition that is characterized by thymoma, hypogammaglobulinemia, and low numbers of peripheral B cells. CD4+ T lymphopenia and an inverted CD4:CD8+ T-cell ratio may be present. Here we report 5 patients with GS and infectious complications who were seen at 3 institutions between 1983 and 1999. Three patients had recurrent sinopulmonary infections, 3 had severe cytomegalovirus (CMV) disease, and 1 had Pneumocystis carinii pneumonia. Review of the literature identified 46 other reports of infections in GS patients. The infections reported in all 51 patients included recurrent sinopulmonary infection (19 cases with documented respiratory pathogens), generally with encapsulated bacteria, most often Haemophilus influenzae (11 cases); CMV disease (5 cases); bacteremia (7 cases); oral or esophageal candidiasis (6 cases); persistent mucocutaneous candidiasis (5 cases); chronic diarrhea (5 cases with documented stool pathogens); urinary tract infections (4 cases); P. carinii pneumonia (3 cases); tuberculosis (2 cases); Kaposi sarcoma (1 case); disseminated varicella (1 case); candidemia (1 case); wound infection with Clostridium perfringens (1 case); Mycoplasma arthritis (1 case); and other infections. Patients with GS present with a spectrum of sinopulmonary infections and pathogens similar to common variable immunodeficiency (CVID). Compared with patients with CVID, opportunistic infections, including severe CMV disease, P. carinii pneumonia, and mucocutaneous candidiasis, appear to be more common in patients with GS, and patients with GS may have a worse prognosis. GS should be ruled out in patients with thymoma or CVID who develop severe, especially opportunistic, infections. Treatment with intravenous immune globulin is recommended for all patients with GS.
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PMID:Infections in patients with immunodeficiency with thymoma (Good syndrome). Report of 5 cases and review of the literature. 1130 88

The lung is a common site of infection in patients with cancer. The spectrum of pulmonary infection depends on the underlying immunologic deficit or deficits. In neutropenic patients, gram-negative bacterial infections predominate early, whereas fungal infections (Aspergillus, Zygomycetes, Fusarium species) are common if neutropenia persists. In patients with impaired cellular immunity, viral infections (cytomegalovirus, other herpes viruses) predominate and may coexist with bacterial (Legionella, Nocardia), mycobacterial, and fungal (Aspergillus, Histoplasma, etc.) infections. Pneumocystis carinii pneumonia is also common in this setting. Infections caused by Streptococcus pneumoniae and Haemophilus influenzae are the primary bacterial infections encountered in patients with impaired humoral immunity. In patients with primary or metastatic pulmonary neoplasms, postobstructive pneumonitis, lung abscess, and occasionally empyema of mixed bacterial etiology (Staphylococcus species, gram-negative bacilli, anaerobes) are frequent. Patients with brain tumors and head and neck cancer develop aspiration pneumonitis, which is usually caused by organisms living in the oropharynx and upper airways. Several immunologic deficits might be present in the same patient, making such a patient susceptible to a wide variety of opportunistic pathogens.
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PMID:The spectrum of pulmonary infections in cancer patients. 1142 77


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