1/8. Mycobacterium simiae: a previously undescribed pathogen in peritoneal dialysis peritonitis.peritonitis is a major complication of peritoneal dialysis (PD). coagulase-negative staphylococcus, staphylococcus aureus , and gram-negative bacteria cause the majority of these infections and usually are amenable to conventional antibiotic therapy, allowing continuation of PD. Mycobacterial and fungal peritonitis represent a more difficult clinical challenge. The infecting organism is often difficult to isolate and can rarely be eradicated without catheter removal. Immunocompromised patients are susceptible to opportunistic infection and, in the context of PD, may have PD peritonitis with different organisms from immunocompetent patients. Here the authors report for the first time PD peritonitis caused by Mycobacterium simiae , a nontuberculous mycobacterium, in a human immunodeficiency virus-positive patient. In addition the difficulty in diagnosing and managing nontuberculous PD peritonitis is discussed.- - - - - - - - - - ranking = 1keywords = mycobacterium (Clic here for more details about this article) |
2/8. The causes of death in patients with human immunodeficiency virus infection: a clinical and pathologic study with emphasis on the role of pulmonary diseases.The clinical records and autopsy data of 75 patients dying with AIDS were reviewed to determine the frequency of individual diseases diagnosed premortem and postmortem, the significance of pulmonary processes found in the lungs at autopsy, and the clinical and pathologic causes of death. Cytomegalovirus (CMV) infection was identified histologically either premortem or postmortem in 81% of patients. The lungs and adrenal glands were infected most commonly. Only one-half of CMV infections were recognized premortem. Pneumocystis pneumonia and Kaposi sarcoma occurred in 68% and 59% of patients, respectively, but were not unsuspected premortem in any patient. Visceral involvement with Kaposi sarcoma, however, was frequently recognized only at autopsy. While disseminated M. avium-intracellulare infection was common (31% of patients), histologically documented pulmonary disease was uncommon (3% of patients). Cryptococcal infection, diagnosed in 10 patients, was confined to the central nervous system in only 1 patient. toxoplasma, in contrast, infected the brain of only 6 patients. All 75 patients had one or more disease processes identified in their lungs or pleurae at autopsy. These processes included opportunistic infections in 76% of patients, neoplasms in 37% (Kaposi sarcoma in 36% and lymphoma in 3%), and other processes in 60%. The most prevalent pathogen, CMV was found in pulmonary tissue from 44 patients and caused significant disease in 21 patients. Five patients died due to CMV pneumonia. pneumocystis carinii was found at autopsy in 24 patients. In spite of treatment, pneumocystis pneumonia was fatal in 11 patients. One patient died with concomitant CMV and pneumocystis pneumonia. Kaposi sarcoma, identified in the lungs of 23 patients, led to death in 5 patients via upper airway obstruction, hemorrhage, or parenchymal destruction. Other fatal pulmonary processes included bacterial pneumonia in 9 patients, idiopathic diffuse alveolar damage in 5, cryptococcosis in 2, and pulmonary hemorrhage in 1. Specific clinical criteria were used to determine the cause of death due to organ system failure. Fifty-one percent of patients died due to respiratory failure; 16% from neurologic disease; 17% from hypotension that was not caused by respiratory, neurologic, or cardiac disease; and 3% from cardiac dysfunction. Thirteen percent of deaths did not meet the clinical criteria defining these 4 categories. This clinical assessment was combined with autopsy data to identify specific diseases as causes of death.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 40.389274860127keywords = avium-intracellulare (Clic here for more details about this article) |
3/8. histoplasmosis in the acquired immune deficiency syndrome.This report describes the experience with disseminated histoplasmosis in seven of 15 patients with the acquired immune deficiency syndrome (AIDS) diagnosed in Indianapolis since 1981. Three were homosexual, two were intravenous drug addicts, one was the spouse of another patient with AIDS and disseminated histoplasmosis, and the seventh was a hemophiliac. Six had associated infections: candidiasis in three, pneumocystis carinii pneumonia, recurrent mucocutaneous herpes simplex infection, and disseminated Mycobacterium avium infection in two each, and disseminated infection with an unidentified mycobacterium in one. Clinical diseases suggested sepsis in four. histoplasma fungemia occurred in five, but the diagnosis was established first by visualization of organisms in blood or bone marrow in three. Results of histoplasma serologic tests were positive in each. Three died before receiving 50 mg of amphotericin b, three had prompt improvement with amphotericin b, and one was treated with ketoconazole to prevent dissemination. However, two of the three patients treated with amphotericin b had relapses after a 35 mg/kg course, and the third died within a month following therapy. Disseminated histoplasmosis is a major opportunistic infection in patients with AIDS from endemic areas. AIDS should be strongly considered in otherwise healthy persons with disseminated histoplasmosis, especially if risk factors for AIDS are present. amphotericin b is not curative in these patients.- - - - - - - - - - ranking = 1keywords = mycobacterium (Clic here for more details about this article) |
4/8. culture-proven cytomegalovirus retinitis in a homosexual man with the acquired immunodeficiency syndrome.A 35-year-old homosexual man with cytomegalovirus viremia developed retinitis. He also had a new syndrome consisting of a persistent T-lymphocyte deficit, pneumocystis pneumonia, recurrent candida albicans esophagitis, skin ulcerations caused by herpes simplex virus, Type 2, disseminated mycobacterium avium-intracellulare infection, and molluscum contagiosum. Histopathologic examination revealed bilateral necrotizing retinitis with virions in retinal, choroidal, and optic nerve tissues. Postmortem cultures of retina and vitreous were positive for cytomegalovirus.- - - - - - - - - - ranking = 40.389274860127keywords = avium-intracellulare (Clic here for more details about this article) |
5/8. Mycobacterium avium-intracellulare: a cause of disseminated life-threatening infection in homosexuals and drug abusers.Five men developed disseminated infection with Mycobacterium avium-intracellulare. These patients all lived in the new york city area and presented with their illnesses between January 1981 and September 1981; four were homosexual and one was an intravenous drug abuser. Four patients died. All five patients had defects in the cell-mediated immune response. The infections were characterized histopathologically by poor or absent granulomatous tissue reaction. Clinical isolates of M. avium-intracellulare from all five patients agglutinated commonly used antimycobacterial drugs. The spectrum of opportunistic infections among populations of homosexuals and drug abusers should be expanded to include disseminated disease due to M. avium-intracellulare.- - - - - - - - - - ranking = 282.72492402089keywords = avium-intracellulare (Clic here for more details about this article) |
6/8. acquired immunodeficiency syndrome with pneumocystis carinii pneumonia and mycobacterium avium-intracellulare infection in a previously healthy patient with classic hemophilia. Clinical, immunologic, and virologic findings.A previously healthy patient with classic hemophilia who was on a home infusion program with factor viii concentrates developed an acquired immunodeficiency syndrome manifested by a dramatic weight loss (47 kg over 12 months), lassitude, transient thrombocytopenia, and opportunistic infections with Varicella zoster, pneumocystis carinii, and Mycobacterium avium-intracellulare. The patient was not homosexual and had no history of intravenous drug abuse. Immunologic studies showed a persistent lymphopenia with reversal of helper/suppressor-cytotoxic T-lymphocyte ratios, depression of human natural killer cell function, and in-vitro lymphocyte proliferative responses to mitogens and viral antigens. serum IgA levels were also elevated. serum antibodies against cytomegalovirus, herpes simplex viruses 1 and 2, Epstein-Barr virus, Varicella zoster, and hepatitis b virus were shown, suggesting previous infection by these agents. Reactivation of cytomegalovirus infection was suggested by a rising titer of antibodies against cytomegalovirus concurrent with pneumocystis pneumonia, and was confirmed by the growth of this virus in a throat culture 2 months later.- - - - - - - - - - ranking = 201.94637430064keywords = avium-intracellulare (Clic here for more details about this article) |
7/8. The acquired immunodeficiency syndrome and Mycobacterium avium-intracellulare bacteremia in a patient with hemophilia.A 27-year-old previously healthy man with hemophilia presented with Pneumocystis carinii pneumonia. The patient had several episodes of oral candidiasis followed by disseminated infection with Mycobacterium avium-intracellulare. He was not homosexual nor did he take illicit drugs, but he had been self-administering two to four monthly infusions of factor viii concentrate for 7 years. In-vitro lymphocyte studies showed findings consistent with the acquired immunodeficiency syndrome that had previously been reported only in homosexual men, drug addicts, and Haitian refugees. The cause of this syndrome is unknown, but the possibility that it is associated with a transmissible agent acquired through the use of blood products such as factor viii concentrate must be considered.- - - - - - - - - - ranking = 201.94637430064keywords = avium-intracellulare (Clic here for more details about this article) |
8/8. Disseminated mycobacterium avium-intracellulare infection in homosexual men dying of acquired immunodeficiency.Five homosexual men dying at UCLA Center for the health Sciences, los angeles, with acquired immunodeficiency and Pneumocystis pneumonia, Kaposi's sarcoma, or cryptosporidiosis since May 1981 have all had mycobacteria of the Mycobacterium avium-intracellulare complex cultured from tissues taken just before death or at postmortem examination. Each man had histological evidence of disseminated mycobacterial infection. Acid-fast organisms were seen in macrophages in the lung, spleen, and lymph nodes in all cases and in a variety of additional organs in two cases. Other severe infections were always found at postmortem examination--cytomegalovirus, cryptosporidiosis, and Pneumocystis. Disseminated M avium-intracellulare infection has been so striking in homosexual males dying with acquired immunodeficiency at our institution that we believe a vigorous search for mycobacteria should be made in all such patients. Empiric therapy for mycobacterial infection may be justified in selected cases of immunodeficiency before a specific microbiological diagnosis.- - - - - - - - - - ranking = 242.33564916076keywords = avium-intracellulare (Clic here for more details about this article) |