Cases reported "Pneumonia, Pneumocystis"

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1/20. Management of opportunistic infections in acquired immunodeficiency syndrome. I. Treatment.

    A case report of a patient infected with human immunodeficiency virus (hiv) is described. The patient presents with a multitude of medical complaints that are of acute or subacute onset. The medical examination of these complaints is described and includes algorithms for the diagnosis and treatment of the most common hiv-related opportunistic infections, including pneumocystis carinii pneumonia, toxoplasmosis, mycobacterium avium complex, cytomegalovirus infection, and cryptococcal meningitis.
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2/20. recurrence of pneumocystis carinii pneumonia in an hiv-infected patient: apparent selective immune reconstitution after initiation of antiretroviral therapy.

    Although several studies have reported that it is safe to discontinue secondary pneumocystis carinii pneumonia (PCP) prophylaxis in patients infected with hiv who experience a sustained immune response as a result of antiretroviral therapy, we describe a patient who developed recurrent PCP <3 months after discontinuing trimethoprim-sulfamethoxazole prophylaxis. He developed disease despite a sustained CD4 T-cell count above 200 cells/microL for more than 3 years while on antiretroviral therapy, as well as an apparent immune reconstitution against disseminated mycobacterium avium complex (MAC) and histoplasma capsulatum, for which he also discontinued therapy but without adverse effects. Thus, although increasing evidence continues to indicate that hiv-infected patients receiving combinations of antiretroviral therapies may regain specific immunity against opportunistic infections, our patient's experience suggests that this immune recovery may be selective and incomplete.
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3/20. pneumocystis carinii pneumonia: a late presentation following treatment for stage IV neuroblastoma.

    This report describes a child who develops pneumocystis carinii pneumonia 7 months after high-dose chemotherapy for stage IV neuroblastoma. In addition to chemotherapy the child had also been treated with abdominal radiotherapy and 13-cis-retinoic acid. Standard practice has been to treat patients with prophylactic co-trimoxazole for 3 months after high-dose therapy, but this report highlights the intensity and complexity of current treatment for stage IV neuroblastoma and the need to be aware of prolonged lymphopenia after such treatment.
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4/20. 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.
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keywords = mycobacterium
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5/20. 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)
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keywords = avium-intracellulare
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6/20. vitiligo and chronic photosensitivity in human immunodeficiency virus infection.

    A 56-year-old man was admitted with hemiparesis and shortness of breath. He was positive to human immunodeficiency virus (hiv) antibody and was diagnosed as acquired immunodeficiency syndrome (AIDS) with Kaposi's sarcoma and pneumocystis carinii pneumonia. He developed chronic photosensitivity and vitiligo preceding the onset of the aids-related complex (ARC). association of the two skin lesions with hiv infection is very rare. Although the role of hiv infection in these skin lesions is not significant, the immunological responses in the early course of hiv infection may have contributed to the development of both of these skin lesions.
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7/20. Pediatric acquired immunodeficiency syndrome with negative human immunodeficiency virus antibody response by enzyme-linked immunosorbent assay and Western blot.

    A 5-month-old white girl having persistent oral candidiasis was brought to medical attention because of acute respiratory distress, pneumonia, and hypoxia that worsened despite supportive care and antibiotics. Bronchial lavage fluid yielded pneumocystis carinii. The diagnosis of acquired immunodeficiency syndrome (AIDS) was suspected, although enzyme-linked immunosorbent assay (ELISA) and Western blot tests were both negative for human immunodeficiency virus (hiv) antibody. Immunologic evaluation included the following results: a low normal CD4/CD8 ratio 0.88, CD4 lymphocytes 493/microL, and elevated IgA 539 mg/dL and IgM 175 mg/dL with normal IgG 492 mg/dL. Lymphocyte stimulation study results were depressed. lymphocytes sent for culture were subsequently positive for hiv. The mother was hiv antibody positive by enzyme-linked immunosorbent assay and Western blot but belonged to no high-risk group and was asymptomatic except for chronic diarrhea. The father was hiv antibody negative. The patient was treated with pentamidine and IV gamma-globulin with good clinical response and a rapid decrease of IgM and IgA toward normal values. Subsequent candidal pneumonia and candidal esophagitis were treated successfully with amphotericin b. The patient has received prophylactic IV gamma-globulin infusions for 6 months and remains hiv negative by enzyme-linked immunosorbent assay and Western blot. This case of pediatric AIDS highlights the need to consider hiv infection in the differential diagnosis of any child with physical findings or illnesses suggestive of aids-related complex or AIDS, even when hiv serologic findings are negative and parents belong to no high-risk group. Parental testing for hiv antibody is suggested in such cases.
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8/20. Desensitization to trimethoprim sulfamethoxazole in patients with acquired immune deficiency syndrome and pneumocystis carinii pneumonia.

    In three of eight patients with the acquired immune deficiency syndrome the pneumocystis carinii pneumonia treated with intravenous trimethoprim sulfamethoxazole, drug-related reactions occurred 9, 10, and 13 days after therapy. The symptom complex consisted of a maculopapular eruption, fever, eosinophilia, and leukopenia. Oral desensitization with graded doses of trimethoprim sulfamethoxazole was successfully achieved in two of the three patients.
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9/20. Fatal toxic epidermal necrolysis during prophylaxis with pyrimethamine and sulfadoxine in a human immunodeficiency virus-infected person.

    The combination of pyrimethamine and sulfadoxine (Fansidar) has been reported to cause severe skin reactions including erythema multiforme, stevens-johnson syndrome, and toxic epidermal necrolysis. Recently, this drug combination has been used for prophylaxis of pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. After two months of weekly prophylaxis with pyrimethamine and sulfadoxine, a 48-year-old homosexual man who was antibody positive for human immunodeficiency virus developed severe widespread erythema, blisters, and loss of skin in sheets, and subsequently died. To our knowledge, this is the first reported case of fatal toxic epidermal necrolysis occurring in a patient with acquired immunodeficiency syndrome-related complex. The lack of absolute safety of prophylaxis with pyrimethamine and sulfadoxine is emphasized in our case, and mandates cautious use and the consideration of less toxic prophylactic measures such as therapy with the recently introduced aerosolized pentamidine.
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10/20. Lymphocytic interstitial pneumonia in patients at risk for the acquired immune deficiency syndrome.

    Three patients with the acquired immune deficiency syndrome (AIDS) or aids-related complex and lymphocytic interstitial pneumonia are reported. All patients presented with progressive dyspnea, nonproductive cough, fever, anorexia, weight loss, and arterial hypoxemia. Chest roentgenograms exhibited bilateral diffuse reticular-nodular densities. The diagnosis of lymphocytic interstitial pneumonia was made by fiberoptic bronchoscopy or open lung biopsy. Two patients were treated with corticosteroids, with significant improvement. The third patient died of pneumonia due to pneumocystis carinii six months after the diagnosis of lymphocytic interstitial pneumonia was established. serum antibodies to human immunodeficiency virus (hiv) were demonstrable in the two patients in whom the test was performed. Lymphocytic interstitial pneumonia is probably another pulmonary manifestation of AIDS or aids-related complex. Although the clinical presentation may be identical to the more common opportunistic infections, the treatment differs, and the prognosis may be better.
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