1/85. Thoracic lymphadenopathy in hiv patients: spectrum of disease and differential diagnosis.To evaluate the etiology and differential features of intrathoracic lymphadenopathy (LAD) in hiv patients, chest computed tomography (CT) records from an 18-month period were reviewed to identify all hiv-positive patients with intrathoracic LAD (nodal size > or = 1 cm). medical records were reviewed for the documentation of specific diseases causing LAD and the CD4 count at the time of imaging. Of 45 hiv-positive patients with LAD, 40 had specific diagnoses including 22 (55%) infections and 17 (43%) tumors; one patient had both (3%). Mycobacterial disease accounted for 78% of infections; five cases were secondary to bacterial pneumonia and sepsis. Of tumors, lymphoma (7 cases, 39%) was most common, followed by lung cancer, germ cell tumors, and Kaposi's sarcoma. Mean CD4 cell count in patients with tumors was much higher than in patients with infections (314 vs. 62, p < .01). patients with tumors were somewhat more likely than patients with infections to demonstrate axillary adenopathy (29 vs. 5%, p = .068). Cavitary disease was only observed in patients with infections (27%, p < .03). CT and clinical findings may help direct the differential diagnosis of LAD in AIDS, and promote expedient definitive diagnosis and therapy.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
2/85. hiv-infected patient with a rhodococcus equi pneumonia.The case history of a hiv patient with a pulmonary infect of rhodococcus equi is presented. He recovered after prolonged treatment with antibiotics and lobectomy. The rhodococcus equi infection was the presenting symptom of his impaired immune status caused by hiv infection.- - - - - - - - - - ranking = 4keywords = pneumonia (Clic here for more details about this article) |
3/85. Pneumococcal cellulitis in an hiv-infected adult.streptococcus pneumoniae is an uncommon cause of cellulitis. In almost all of the reported cases, the infection occurred in immunosuppressed patients, especially in those with connective tissue diseases. We report a case of cervical cellulitis associated with septicemia which occurred in an hiv-infected adult.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
4/85. Human herpesvirus type 8 in hiv-infected patients with interstitial pneumonitis.OBJECTIVES: The new human herpesvirus type 8 (HHV-8) has been detected in all types of Kaposi's sarcomas, as well as in body-cavity lymphomas and Castleman's disease. Recently, HHV-8 has also been associated with encephalitis in hiv-positive and hiv-negative patients. Interstitial pneumonitis, combined with detection of HHV-8 in non hiv-infected patients, indicates a pathogenetic role of HHV-8 in unexplained lung diseases. We have studied two hiv-infected patients, with otherwise unexplained interstitial pneumonitis for the presence of HHV-8. methods: Lung biopsies of both patients were investigated for HHV-8 sequences. A nested PCR method was used for amplification of HHV-8 dna fragments, and the nature of the amplification products was confirmed by Southern blot hybridization. In addition, we used an in situ hybridization technique and immunohistochemical staining for detection of HHV-8 infected cells. RESULTS: Amplification of HHV-8 dna fragments was seen with template dna from lung biopsies of both cases and the appropriate positive controls, but not with negative controls. in situ hybridization and immunohistochemical staining demonstrated HHV-8 infected lymphoid cells and alveolar macrophages in both patients as well. CONCLUSIONS: HHV-8 was found in hiv-infected patients with otherwise unexplained interstitial pneumonitis, but the pathogenic role of HHV-8 in patients with interstitial pneumonia remains unclear.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
5/85. pneumocystis carinii pneumonia as a complication of immunosuppressive therapy.BACKGROUND: patients receiving immunosuppressive therapy with corticosteroids and cytotoxic agents may develop opportunistic infections such as pneumocystis carinii pneumonia (PCP). This indicates a severe T-cell defect, but so far there are no established criteria for identifying patients at risk. patients AND methods: CD4 and CD8 T-lymphocyte counts were determined by flow cytometry in seven hiv-negative patients who developed PCP as a complication of immunosuppressive treatment. RESULTS: CD4 T-lymphocyte counts (T-helper phenotype) were less than 200/microl in all seven patients (mean 90.6/microl). The markedly reduced CD4 counts measured in these patients are similar to those observed in organ transplant recipients who developed PCP during immunosuppressive therapy for prevention of graft rejection and in hiv-positive patients with PCP as an AIDS-defining illness. CONCLUSION: Measuring CD4 T-lymphocyte counts may be helpful in determining the risk of PCP not only in hiv-positive patients, but also in patients receiving immunosuppressive therapy. The risk of acquiring PCP seems to increase when CD4 lymphocyte counts drop below 200/microl, regardless of the underlying disease.- - - - - - - - - - ranking = 5keywords = pneumonia (Clic here for more details about this article) |
6/85. Influenza in human immunodeficiency virus-infected patients during the 1997-1998 influenza season.A cluster of cases of severe influenzal disease was recognized in hiv-infected individuals during the 1997-1998 influenza season. Both primary influenza pneumonia and concomitant viral and bacterial pneumonia were found.- - - - - - - - - - ranking = 2keywords = pneumonia (Clic here for more details about this article) |
7/85. Neutrophil-rich anaplastic large cell lymphoma of T-cell lineage. A report of two cases arising in hiv-positive patients.Neutrophil-rich anaplastic large cell lymphoma (ALCL) is an uncommon morphologic variant of ALCL. We report 2 cases of neutrophil-rich T-cell ALCL that presented as scalp masses in hiv-positive men. Histologically, the neoplastic cells extensively infiltrated the dermis and subcutaneous tissue. The neoplastic cells strongly expressed CD30 and were of T-cell lineage, positive for CD3 and CD45RO, and negative for CD20. The neoplastic cells were negative for anaplastic lymphoma kinase-1. Numerous admixed neutrophils also were present, representing up to 70% of all cells in some microscopic fields. Neither patient had peripheral blood leukocytosis. One patient had relative neutrophilia, 79% (0.79; reference range, 50%-70% [0.50-0.70]). The absolute CD4 counts were 160 cells/microL (160 x 10(6)/L) and 150 cells/microL (150 x 10(6)/L), respectively (reference range, 431-1,623/microL [431-1,623 x 10(6)/L]). Both patients were treated with multiagent chemotherapy but died of pneumocystis carinii pneumonia within 6 months of diagnosis. In our review of the literature, we identified 5 similar T-cell cases, including 1 in an hiv-positive patient. Neutrophil-rich T-cell ALCL is a rare morphologic variant of ALCL that should be considered in the histologic evaluation of neutrophil-rich biopsy specimens.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
8/85. trimetrexate glucuronate associated with anti-Kaposi sarcoma effect.trimetrexate glucuronate, a dihydrofolate reductase inhibitor related to methotrexate, was developed by Parke-Davis as an alternative antineoplastic agent for tumors, especially sarcomas, that had developed resistance to methotrexate. This is a report on a patient with AIDS who developed pneumocystis carinii pneumonia, which was treated with trimethoprim sulfamethoxazole (Bactrim) with poor response, then with pentamidine with poor response, and finally with trimetrexate glucuronate (Neutrexin) and leucovorin rescue, with good response. The patient also suffered from cutaneous and visceral Kaposi's sarcoma (KS), which had been treated with high- dose HCG1 and well recognized chemotherapeutic protocols. Both HCG and chemotherapy resulted in tumor regression. The patient's KS flared, however, when he developed pneumocystis pneumonia. When trimetrexate glucuronate and leucovorin rescue were administered, his tumor burden decreased significantly, suggesting that trimetrexate glucuronate may have some activity against KS. The regression of KS in this anecdotal observation may be secondary to a delayed response from HCG and/or chemotherapy, or secondary to a spontaneous partial regression. Such regression may only be of the decreased edema around the KS lesions and not the neoplastic tissue itself. If other clinicians see this same phenomenon, however, it is possible that trimetrexate glucuronate may have an anti-KS effect. Such future clinical observations would warrant further testing at the basic science level.- - - - - - - - - - ranking = 2keywords = pneumonia (Clic here for more details about this article) |
9/85. myoclonus secondary to the concurrent use of trazodone and fluoxetine.A 39-y-o male with a history of human immunodeficiency virus infection and depression was admitted for diagnosis and treatment of tuberculosis and pneumocystis carinii pneumonia infections. Prior to admission, he was on 50 mg trazodone every evening for 2 mo for depression. He was admitted with a 2-w history of fever chills and fatigue and on admission had hand tremors which disappeared at rest. Four days post-admission the trazodone dose was increased to 100 mg and 20 mg fluoxetine was initiated. He became increasingly anxious and his hand tremor worsened 3 d after initiation of the regimen. To rule out drug induced tremor, both trazodone and fluoxetine were discontinued and symptoms resolved in 7 d. Clinicians should be aware of the potential for excessive seratonergic activities secondary to trazodone fluoxetine interactions causing a worsening myoclonus adverse event.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
10/85. Disseminated vaccine strain varicella as the acquired immunodeficiency syndrome-defining illness in a previously undiagnosed child.The food and Drug Administration licensed a live-virus varicella vaccine (Varivax; Merck & Co Inc, West Point, PA) in March 1995. Prelicensure adverse events were minimal; however, since licensure and increased vaccine use, rare previously undetected risks have arisen. Presented here is the clinical course of a previously undiagnosed, human immunodeficiency virus-infected boy who developed dissemination of the vaccine strain of varicella zoster after immunization. chickenpox, human immunodeficiency virus, pneumonia, encephalopathy, varicella vaccine, adverse events, dissemination.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
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