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[pneumocystis carinii pneumonia in hiv infection: better prognosis because of early diagnosis].the clinical presentation of 60 consecutive pneumocystis carinii pneumonias in 58 hiv-infected patients (48 men, 10 women, mean age 34 [22-53] years) was prospectively evaluated from april to august 1989 and compared with 60 consecutive p. carinii pneumonias in 59 hiv-infected patients (55 men, 4 women, mean age 37.5 [22-60] years) between 1981-88. mortality rates within 14 days after diagnosis of p. carinii pneumonia were 50% (8 of 16 patients) until 1985, 20.5% (9 of 44) between 1986 and augus ...19902226163
lung pathology in hiv positive patients.we describe the results of 43 bronchoscopic examinations carried out on 35 patients who were hiv positive. of these, 13 were intravenous drug abusers, 13 were homosexual or bisexual, six were haemophiliacs, two were homosexual intravenous drug abusers and one was a heterosexual contact of a drug abuser. all underwent investigation because of respiratory symptoms. aetiological diagnosis could not be made from physical examination, x-ray or routine laboratory tests but, was usually made using bron ...19902228531
systemic dissemination of pneumocystis carinii in a patient with acquired immunodeficiency syndrome.pneumocystis carinii is usually considered a respiratory tract pathogen; however, there are reported cases of limited and generalized dissemination of the organism from the lungs of immunocompromised patients. we present the autopsy findings of a 29-year-old male with acquired immunodeficiency syndrome (aids) and recurrent pneumocystis carinii pneumonia who developed abnormal liver function tests. the patient had received aerosolized pentamidine because of toxic reactions to other modes of thera ...19902228716
thyroiditis as the presenting manifestation of disseminated extrapulmonary pneumocystis carinii infection.a 38-yr-old male with acquired immunodeficiency syndrome developed neck pain in association with mild hyperthyroidism and a diffusely enlarged thyroid gland. radioactive iodine scanning was consistent with thyroiditis, and biopsy of the thyroid demonstrated the presence of pneumocystis carinii in thyroid tissue. treatment with pentamidine followed by trimethoprim sulfamethoxazole led to rapid normalization of thyroid size in association with the development of hypothyroidism. this case illustrat ...19902229322
glucocorticoid therapy for severe pneumocystis carinii pneumonia.the majority of patients with aids and pneumocystis carinii pneumonia respond to treatment with either high-dose cotrimoxazole or iv pentamidine. glucocorticoids have been given as 'adjuvant' therapy in those patients who fail to respond to cotrimoxazole or pentamidine. this article discusses the role of glucocorticoids therapy in the treatment of severe pneumocystis carinii pneumonia and reviews the evidence for their efficacy.19902230171
the use of corticosteroids in pneumocystis carinii pneumonia. 19902230267
mechlorethamine, vincristine, and procarbazine chemotherapy for recurrent high-grade glioma in adults: a phase ii study.we undertook a phase ii study of combination chemotherapy with mechlorethamine (nitrogen mustard) 6 mg/m2 intravenously day 1 and day 8, vincristine 2 mg intravenously day 1 and day 8, and procarbazine 100 mg/m2 orally days 1 through 14 (mop) in adults with recurrent high-grade glioma. there were 31 patients entered and 27 patients assessable for response. the median age was 49 years old. all patients had prior maximal radiotherapy, and eight had previous chemotherapy. responses were determined ...19902230893
histopathological changes in simian immunodeficiency virus infection.the histological lesions were studied in seven rhesus and three cynomolgus monkeys infected with simian immunodeficiency virus for periods ranging from nine weeks to 18 months. lymphoreticular changes included hyperplasia, follicular involution and depletion, and one animal had amyloidosis of the spleen. hyperplastic changes also took place in mucosa-associated lymphoid tissue and infiltrations occurred in the vaginal mucosa of one animal, which could be significant in sexual transmission of the ...19902231195
testicular carcinoma in patients positive and at risk for human immunodeficiency virus.patients with the acquired immunodeficiency syndrome are at increased risk for certain malignancies. because acquired immunodeficiency syndrome and testicular cancer affect primarily young men, the potential complications that acquired immunodeficiency syndrome might impose raise significant concern. to address this question we performed a retrospective review of all cases of testicular cancer during an 11-year period. of 140 patients 6 had human immunodeficiency virus infection and 7 were from ...19902231890
a novel diagnostic method of pneumocystis carinii. in situ hybridization of ribosomal ribonucleic acid with biotinylated oligonucleotide probes.the reactivity and specificity of the in situ hybridization of ribosomal rna in the diagnosis of pneumocystis carinii were investigated. three complementary oligonucleotide probes, 22 and 25 nucleotides long, corresponding to the species specific regions of 5s and 18s ribosomal rna of pneumocystis carinii were synthesized and labeled with biotinylated dupt at the 3' termini. in situ hybridization was performed on formalin-fixed paraffin-embedded human lung tissues using the mixture of these prob ...19902232708
disseminated histoplasmosis in the acquired immune deficiency syndrome: clinical findings, diagnosis and treatment, and review of the literature.histoplasmosis is a serious opportunistic infection in patients with aids, often representing the first manifestation of the syndrome. most infections occurring within the endemic region are caused by exogenous exposure, while those occurring in nonendemic areas may represent endogenous reactivation of latent foci of infection or exogenous exposure to microfoci located within those nonendemic regions. however, prospective investigations are needed to prove the mode of acquisition. the infection ...19902233233
extrapulmonary pneumocystosis: clinical features in human immunodeficiency virus infection.pneumocystis carinii infection is reported with increasing frequency as a cause of disease outside of the respiratory tract in patients with human immunodeficiency virus (hiv) infection. extrapulmonary pneumocystosis is not limited to patients in any discrete risk group for hiv infection. patients with hiv infection who develop extrapulmonary pneumocystosis frequently do not have concurrent p. carinii pneumonia. signs and symptoms of extrapulmonary pneumocystosis are nonspecific but when present ...19902233234
corticosteroids as adjunctive therapy for severe pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. a double-blind, placebo-controlled trial.preliminary reports suggest that patients with the acquired immunodeficiency syndrome (aids) and pneumocystis carinii pneumonia may benefit from the addition of corticosteroid treatment to antibiotic therapy.19902233916
a controlled trial of early adjunctive treatment with corticosteroids for pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. california collaborative treatment group.pneumocystis carinii pneumonia remains a common cause of serious morbidity and mortality in patients with the acquired immunodeficiency syndrome (aids). the extensive lung injury that accompanies pneumocystis-associated respiratory failure and the reports of clinical benefit from the use of adjunctive corticosteroids provided the rationale for this prospective multicenter trial.19902233917
oral histoplasmosis as a presenting disease in acquired immunodeficiency syndrome.a 43-year-old homosexual man visited his dentist with painful, nodular, ulcerated lesions on the soft palate, right buccal mucosa, and right posterior maxillary gingiva. serologic studies for exposure to human immunodeficiency virus, performed before biopsy, were positive. biopsy of the maxillary gingiva demonstrated sheets of histiocytes containing small intracellular yeasts, which on culture were identified as histoplasma capsulatum. bilateral leukoplakic lesions with some vertical furrowing i ...19902234884
survival of aids patients in norway.the survival function of the 100 first aids patients in norway is presented and analyzed with respect to four factors obtained at the time of diagnosis; a) year of diagnosis b) initial aids related disease c) knowledge of hiv seropositivity prior to onset of aids and d) age at time of diagnosis. the median survival was 9.3 months. among the known seropositive aids patients there were almost twice as many with pneumocystis carinii pneumonia as initial aids related disease, as among the not known ...19902237333
pneumocystis carinii pneumonia manifested as a hilar mass and cavitary lesion: an atypical presentation in a patient receiving aerosolized pentamidine prophylaxis.a case of pneumocystis carinii pneumonia (pcp) in a patient with aids was manifested radiographically as a hilar mass and cavitary lesion. the patient had been receiving aerosolized pentamidine as prophylaxis against pcp. nonuniform deposition of aerosolized pentamidine was probably responsible for this atypical radiographic appearance of pcp.19902237561
[an atypical radiologic finding in a case of pneumocystis carinii pneumonia]. 19902237646
aids and tuberculosis.the diagnostic and therapeutic implications of human immunodeficiency virus (hiv) infection and tuberculosis in south africa, where tuberculosis remains a major health problem, are reviewed. mycobacterium tuberculosis is a high-grade pathogen and is able to establish infection early in immunodeficiency. with hiv infection showing significant entry into the heterosexual population in the rsa, an increasing number of cases with both infections can be expected to occur. the radiological appearance ...19902237687
pulmonary disease in aids patients.pulmonary disease remains a major complication of the human immunodeficiency virus (hiv). over the past decade several changes in the pattern of disease have occurred. pneumocystis carinii pneumonia (pcp) remains the most common opportunistic pathogen in aids patients, though its incidence on bronchoscopy has declined and empiric therapy often occurs without a specific diagnosis. changes in the management of patients with pcp have included different dosages and routes of administration for chemo ...19902240021
biodistribution, tissue reaction, and lung retention of pentamidine aerosolized as three different salts.aerosolized pentamidine isoethionate is retained in the lung and appears to prevent pneumocystis carinii pneumonia (pcp) in many aids patients. we evaluated alternative formulations of pentamidine that might reduce the airway irritation associated with aerosolized pentamidine isoethionate. specifically, we assessed the biodistribution, histologic response, and lung retention of the isoethionate, gluconate, and lactate salts of pentamidine after aerosol administration to mice. for each of the thr ...19902240839
atypical presentations of pneumocystis carinii pneumonia in patients receiving inhaled pentamidine prophylaxis.inhaled pentamidine is used commonly to prevent pneumocystis carinii pneumonia (pcp) in patients with advanced human immunodeficiency virus infection. case reports indicate that pcp can recur in patients who receive inhaled pentamidine and that clinical features may be atypical. to determine the magnitude of this problem, we reviewed retrospectively the medical records of patients with proven pcp during a 30-month period at two hospitals. four (31 percent) of 13 patients with previous pcp who re ...19902245676
pathologic dependence of oxygen consumption on oxygen delivery in acute respiratory failure secondary to aids-related pneumocystis carinii pneumonia.oxygen consumption is pathologically dependent on oxygen delivery in ards and sepsis. we asked whether oxygen consumption is dependent on oxygen delivery in severe acute respiratory failure secondary to aids-related pcp. in five patients who had aids-related pcp, diffuse bilateral pulmonary infiltrates, no evidence of bacterial infection, and acute respiratory failure requiring mechanical ventilation with arterial oxygen tensions less than 75 mm hg while breathing at least 50 percent oxygen, and ...19902245689
granulomatous pneumocystis carinii pneumonia in a patient with the acquired immunodeficiency syndrome.a patient with an unusual granulomatous response to infection with pneumocystis carinii is described. the diagnosis was made by open lung biopsy after two negative bronchoalveolar lavages.19902247869
atypical presentation of pneumocystis carinii pneumonia.pneumocystis carinii is a common cause of pneumonia in the immunosuppressed patient. its radiological findings are usually homogeneous, diffuse and bilateral. we present a 27-year-old woman with non-hodgkin's lymphoma presenting with unilateral right lung parenchymal infiltrates due to pneumocystis carinii. in the immunosuppressed host, pneumonia limited to one lung should not preclude the diagnostic possibility of pneumocystis carinii infection.19902249932
[acute respiratory insufficiency in pneumonia caused by pneumocystis carinii with normal thoracic radiography]. 19902250554
[pulmonary toxoplasmosis in aids. report of 3 cases].pulmonary toxoplasmosis in aids is rare. its frequency is estimated to be between 0.2 and 3.7% but is probably underestimated; however, it is lower than that of neurotoxoplasmosis and is rarely identified prior to autopsy. we describe herein 3 cases diagnosed in living patients. the clinical presentation is usually severe interstitial pneumonitis, occurring in profoundly immunodeficient patients. toxoplasma gondii, the infectious agent, must always be sought in the bronchoalveolar lavage of such ...19902256591
pneumocystis carinii pneumonia. 19902257411
prevention of infections in neutropenic patients with pefloxacin.bacterial infections remain a major source of morbidity and mortality in neutropenic patients. therefore, optimal methods of prevention seem mandatory and various means have been tested, in particular specific modalities such as chemoprophylaxis, which remains controversial. overall, non-absorbable antibiotics have been disappointing and are less commonly used because of the poor compliance of most patients. co-trimoxazole has been shown to be effective under certain circumstances but the emerge ...19902258354
pneumocystis carinii pneumonia in young children with aids.we present our experience with 54 episodes of pneumocystis carinii pneumonia in 50 young children with aids, all but one representing congenitally acquired infection. findings at history and physical examination are not helpful in suggesting the diagnosis. the diagnosis is suggested by marked hypoxemia, diffuse disease on chest radiograph, and elevated serum ldh level. because important aspects of the history may be withheld, a high index of suspicion may be necessary for the correct diagnosis. ...19902259558
prevention of pneumocystis carinii pneumonia relapse by aerosolised pentamidine, 60 mg biweekly, using an acorn system 22 nebuliser.the effectiveness of biweekly administration of 60 mg aerosolised pentamidine (ap) as secondary prophylaxis against relapse of pneumocystis carinii pneumonia (pcp) was investigated in 45 male aids patients. the nebuliser used was an acorn system 22. in total the patients received ap for a mean period of 13.8 months (3.4-28.8). six episodes of recurrent pcp were recorded. relapse per full year of treatment on ap was 12%.19902259861
pneumocystis carinii pneumonia treated with eflornithine in aids patients resistant to conventional therapy.eflornithine (dfmo) was used to treat 31 aids patients with confirmed pneumocystis carinii pneumonia who had clinically failed treatment with pentamidine, sulphamethoxazole-trimethoprim or both agents as their first-line therapy. twenty-one of 31 (68%) responded to second-line treatment with 400mg/kg per day of eflornithine. five patients discontinued treatment because of bone marrow toxicity. eflornithine appears to be a useful salvage therapy in patients failing first-line treatments.19902261116
extrapulmonary pneumocystosis: the first 50 cases.over the last 35 years, 50 cases of extrapulmonary infection with pneumocystis carinii have been reported in the literature throughout the world. use of prophylactic aerosolized pentamidine may have facilitated the relative prevalence of extrapulmonary disease because of its inadequate systemic distribution. an increase in reported cases of infections due to p. carinii has been seen in conjunction with aids, but extrapulmonary pneumocystosis represents less than 1% of all cases of infection with ...19902267488
pneumocystis carinii pneumonia in danish piglets. 19902267715
[respiratory manifestations of hiv infections in children].respiratory disorders during the course of infections in children who are hiv positive are frequent. these are interstitial pneumonia (ip) and bacterial pneumonia. the acute ip are most often infectious in particular opportunist infection, and are dominated by pneumocystis carinii (pc, 82 to 86% of the infectious agents isolated). this is often a presenting feature of an hiv infection and the radiological picture is very variable and the diagnosis rests on bronchoalveolar lavage which is readily ...19902270339
[survival of hiv-positive patients hospitalized in intensive care for respiratory insufficiency and pneumocystis carinii pneumonia].respiratory failure secondary to pneumocystis carinii pneumonia (pcp) is associated with high mortality in aids patients. in a search for prognostic indicators, we reviewed hospital charts of 13 aids patients admitted to our intensive care service from 1982 to 1989. mortality rate was higher from 1982 to 1987 (4/5 patients) than later (3/8 patients). there was no significant difference between survivors and non survivors of this acute episode with regard to sex. hiv risk factors, time elapsed si ...19902270446
pneumocystis carinii pneumonia.pneumocystis carinii (pcp) pneumonia is the most common pulmonary infection associated with the acquired immunodeficiency syndrome (aids). patients at risk for pcp have defects in t lymphocyte function and include cancer and transplant patients who are on immune suppressing agents and corticosteroids. in west virginia, pcp accounted for 53 percent of pulmonary infections in 144 cases of aids from 1984 to may 1990. nationally, at least 100,000 cases of pcp are projected for the early part of this ...19902270682
diagnosis of pneumocystis carinii pneumonia from non-invasive sampling of respiratory secretions.an infant infected with hiv presented with fever, tachypnoea, hypoxia, and radiological evidence of bilateral pneumonitis. fluorescent antibody technique identified pneumocystis carinii within 24 hours from secretions obtained by nasopharyngeal aspiration. this rapid, non-invasive method should be the first line investigation of suspected p carinii pneumonia in immunocompromised patients.19902270945
a sequential ultrastructural study of rat lungs infected with pneumocystis carinii to investigate the appearances of the organism, its relationships and its effects on pneumocytes.a sequential study of the lungs of rats infected with pneumocystis carinii is reported. the aim was to investigate variations in the appearance of the organism from the inception of infection until the death of the host and, during this period, the relationships of the organism with one another and changes occurring within pneumocytes. trophozoites predominated at all stages of infection and were those first recognized but no clear role for the filopodia was evident. organisms were related with ...19902278829
mycobacterium kansasii infection limited to skin and lymph node in a patient with aids.the case of a 36-year-old hiv-1-positive patient is presented. after an episode of pneumocystis carinii pneumonia and cytomegalovirus retinitis a pruritic lesion developed on the thigh with subsequent intracutaneous abscess formation and regional lymph-node enlargement. mycobacterium kansasii was demonstrated in lymph-node and abscess material. with a tuberculostatic triple-drug regimen the lesions resolved completely. cutaneous involvement in the course of non-tuberculous mycobacteriosis in the ...19902279345
[aerosol-pentamidine for pneumocystis carinii pneumonia: development and 4-year personal experiences]. 19902281076
human immunodeficiency virus infection in singapore--the first 50 cases.as at 31 may 1990, fifty singaporeans with the human immunodeficiency virus (hiv) infection had been detected. of these, nineteen had the acquired immunodeficiency syndrome (aids). the majority of infected persons had been infected through sexual contact (homosexual 52%; bisexual 24%; heterosexual 20%) with men and women from countries where hiv infection was prevalent. the majority of infected patients (88%) were in the age range 20-39 years. there was one case of blood transfusion-associated a ...19902281356
detection of hiv-1 in human lung macrophages using the polymerase chain reaction.we have used the polymerase chain reaction to investigate hiv-1 infection of lung macrophages from 44 aids patients with pneumonia. proviral hiv-1 dna was detected in the lung macrophages of 47% (21 of 44) of patients tested; 32% (seven of 21) of the patients had pneumocystis carinii pneumonia (pcp), and 56% (11 of 21) had pneumonia caused by other aetiological agents. matched peripheral blood specimens were obtained from 22 patients in this study, and hiv-1-specific dna was detected in 100% (22 ...19902282185
low-dose dapsone prophylaxis of pneumocystis carinii pneumonia in aids and aids-related complex.the efficacy, toxicity and cost of orally administered dapsone (50-100 mg/day) for prophylaxis of pneumocystis carinii pneumonia (pcp) were evaluated in 30 patients with aids or aids-related complex (arc). six patients received primary and 24 secondary prophylaxis. ten patients received a maximum dose of 100 mg/day and 20 a maximum of 50 mg/day for a median duration of 19 weeks; 22 of the 30 patients continue to receive prophylaxis as of may 1989. four patients have died, none of pneumocystis in ...19902282188
pathological characteristics for the diagnosis of pneumocystis carinii pneumonia. a retrospective autopsy study.the clinical records of 63 patients who during the period 1980-1983 showed pneumocysts in lung specimen imprints obtained at autopsy have been reviewed in order to establish possible characteristics for the diagnosis of pc pneumonia. autopsies were performed at 2 copenhagen hospitals, rigshospitalet and the finsen institute. the 63 pc-positive cases included 9 with blood diseases, 27 with solid tumors, 5 with immunological disorders and 22 with other diseases. the characteristic extensive change ...19902282205
fiberoptic bronchoscopy and sputum examination for diagnosis of pulmonary disease in aids patients in stockholm.for diagnosing pulmonary disease on 82 occasions in 68 patients (64 males) aged 39 (23-73) years infected with hiv-1 we used flexible fiberoptic bronchoscopy (ffb) with bronchoalveolar lavage (bal) or washing with or without transbronchial lung biopsy (tbb) and brushing. a clinical diagnosis of lower respiratory tract disease was obtained in 68/82 episodes (83%). an etiological diagnosis was reached by ffb in 59/82 episodes (72%). pneumocystis carinii (pc), the dominating pathogen causing pneumo ...19902284573
deferoxamine and eflornithine (dl-alpha-difluoromethylornithine) in a rat model of pneumocystis carinii pneumonia.the iron chelator deferoxamine and the polyamine biosynthesis inhibitor eflornithine (dl-alpha-difluoromethylornithine) were examined for anti-pneumocystis carinii activity in the rat model of p. carinii pneumonia. the activity of deferoxamine at 250, 500, and 1,000 mg/kg given intraperitoneally provides evidence that iron chelation is a promising novel approach to p. carinii chemotherapy. results with eflornithine at 2, 3, and 4% in drinking water confirm and extend previously reported activity ...19902285303
choroidal lesions in patients with aids.seven cases of bilateral, scattered, yellow-white choroidal lesions have been seen in aids patients since january 1988. one resulted from presumed extension of cryptococcal meningitis into the optic nerve and choroid. all the remaining six patients had pneumocystis pneumonia at some time during the course of the disease and were receiving aerosolised pentamidine therapy. none died quickly of disseminated pneumocystis carinii infection, unlike previously reported patients. mycobacterial infection ...19902285685
infection prophylaxis in neutropenic patients with acute leukaemia--a randomized, comparative study with ofloxacin, ciprofloxacin and co-trimoxazole/colistin.preliminary results are presented of an ongoing, prospective, randomized, study comparing ofloxacin, ciprofloxacin and co-trimoxazole/colistin for the prevention of infection in patients with acute leukaemia. the results for 59 patients (median age 47 years, range 21-72) included 88 episodes of neutropenia, each associated with a course of cytotoxic therapy. the main factor measured was the time elapsed from the beginning of neutropenia (neutrophils less than 500/microliter) until the first infe ...19902286588
[infection prophylaxis in patients with hematological malignancies (i)--successful prophylaxis of pneumocystis carinii pneumonitis with sulfamethoxazole-trimethoprim].in a retrospective study to evaluate the efficacy of sulfamethoxazole-trimethoprim (smx-tmp) for the prevention of pneumocystis carinii pneumonitis, we studied 1760 patients wit hematological malignancies over a twenty-year period (1970-1989). 449 patients received oral smx-tmp, most of all received 400 mg of smx and 80 mg of tmp twice per day. none of the patients receiving smx-tmp developed p carinii pneumonitis, whereas twenty-six (2.0%) of the 1311 patients who did not receive smx-tmp develo ...19902287067
trimethoprim-sulfamethoxazole anaphylactoid reactions in patients with aids: case reports and literature review.adverse effects are common in patients with acquired immunodeficiency syndrome (aids) who receive trimethoprim-sulfamethoxazole (tmp-smx). two patients experienced a rare anaphylactoid syndrome. within hours of receiving a double-strength tmp-smx tablet, a 28-year-old human immunodeficiency virus (hiv)-positive man developed fever, hypotension, and bilateral pulmonary infiltrates. broad-spectrum antimicrobial therapy was begun but discontinued 2 days later when signs and symptoms resolved and sp ...19902287564
adult t-cell leukemia/lymphoma of the tongue.a case of posterior tongue lymphoma associated with adult t-cell leukemia (atl) that occurred as a lesion in the lingual dorsal portion is reported in a 64-year-old woman. initially, a diagnosis of hodgkin's lymphoma was considered as no findings associated with atl except lymphadenopathy and serum anti-atla antibodies were present. combined radiotherapy and chemotherapy were administered with favorable results; however, 4 months later, pneumocystis carinii pneumonia developed, and 2 months late ...19902290650
[the value of bronchoalveolar lavage in the diagnosis of interstitial lung diseases].bronchoalveoläre lavage (bal) allows microscopic, cytologic and immunocytologic diagnosis of alveolar and interstitial lung disease. the indications for bal depend on chest x-rays, signs and symptoms and lung function tests, e.g., spirometry or whole-body plethysmography, co-diffusion capacity and blood gases during exercise. supporting laboratory parameters are angiotensin converting enzyme, antinuclear antibodies and serum precipitins. pulmonary parenchymal pathology documented on chest x-rays ...19902290924
[drug-induced changes in the lungs].there is a growing number of drugs with lung toxicity, and radiologists are increasingly confronted with nonspecific patterns of possibly drug-induced lung disease. the present article reviews clinical symptoms, pathological findings and radiographic features associated with drugs causing lung disease. roentgen-morphological categorization is based on the predominant pattern and distinguishes five groups of drugs that cause interstitial opacities, air space consolidation, mixed interstitial and ...19902290925
improved short-term survival of aids patients initially diagnosed with pneumocystis carinii pneumonia, 1984 through 1987.i analyzed trends in the survival of 36,847 adults who were diagnosed with acquired immunodeficiency syndrome between january 1984 and september 1987 under the pre-1987 surveillance definition of acquired immunodeficiency syndrome. for patients in whom pneumocystis carinii pneumonia was among the first manifestations of acquired immunodeficiency syndrome, the estimated 1-year survival increased from 42.7% for those diagnosed in 1984 and 1985 (95% confidence interval, 41.5% to 44.3%) to 54.5% for ...19902294306
survival trends for patients with aids.to evaluate trends in the length of survival for patients with acquired immunodeficiency syndrome, we calculated survival following diagnosis of acquired immunodeficiency syndrome for 4323 cases reported in san francisco, calif, between july 1981 and december 31, 1987. patients were followed up prospectively through december 31, 1988. the median survival for all patients was 12.5 months, with a 5-year survival rate of 3.4%. significantly improved survival was observed for patients diagnosed with ...19902294307
extrapulmonary pneumocystis carinii infection in aids: ct findings.clinical and computed tomographic (ct) findings in three cases of extrapulmonary pneumocystis carinii infection in patients with acquired immunodeficiency syndrome (aids) were reviewed. proved sites of involvement included the spleen (n = 2), bone marrow (n = 1), liver (n = 1), and peritoneal and pleural fluid (n = 1). ct findings included focal low-attenuation splenic lesions that became progressively calcified in rimlike or punctate fashion; punctate calcifications in the liver, renal cortices ...19902294543
pneumocystis carinii: improved models to study efficacy of drugs for treatment or prophylaxis of pneumocystis pneumonia in the rat (rattus spp.).rats which were immunosuppressed with adrenal corticosteroids then transtracheally inoculated with pneumocystis carinii were evaluated as models for study of drug efficacy. trimethoprim/sulfamethoxazole, known to be effective against pneumocystis, was given in therapeutic and prophylactic regimens and its long-term effectiveness determined by a protocol to study relapse. untreated animals uniformly developed severe infection with differences in numbers of organisms between untreated and treated ...19902295322
retrospective analysis of the efficacy of open lung biopsy in acquired immunodeficiency syndrome.open lung biopsy (olb) was performed on 66 patients with acquired immunodeficiency syndrome from november 1981 through december 1987. twenty-two patients with severe respiratory failure died within a month, 3 during operation. fourteen patients with negative transbronchial biopsy and 19 with failure of treatment based on transbronchial biopsy died within a year. six were alive and 5 were lost to follow-up. the most common organism found in patients with severe respiratory failure was pneumocysti ...19902297257
use of bronchoalveolar lavage to diagnose bacterial pneumonia in mechanically ventilated patients.we studied the efficacy and safety of bronchoscopy with bronchoalveolar lavage (bal) in mechanically ventilated patients. seventy-seven patients, 60 of whom underwent bal, were analyzed. of the patients undergoing bal, 30 had clinical pneumonia, 24 had a diagnosis other than pneumonia by clinical criteria or autopsy, and six could not be classified but clinically improved without changing their antibiotic therapy. of the 30 pneumonia patients, 18 had bacterial cultures felt to be diagnostic of b ...19902298009
pneumothoraces and pneumocystis carinii pneumonia in two aids patients receiving aerosolized pentamidine.two cases of focal recurrent pneumocystis carinii pneumonia (pcp) associated with pneumothorax occurred in patients with aids who had received aerosolized pentamidine therapy. a resected lung specimen from one patient suggested that subpleural cavitary lung destruction by p carinii was pathogenically responsible for the pneumothorax. this report represents the first case known to the author documenting the etiology of pcp-associated pneumothorax by pathologic examination.19902298076
immunocytochemical detection of chitin in pneumocystis carinii.polyclonal antisera against chitin and chitin oligomers were used to stain pneumocystis carinii by the immunoperoxidase technique in formalin-fixed, paraffin-embedded sections of four human lung biopsies and in alcohol-fixed, paraffin-embedded cell blocks of two bronchioloalveolar lavage specimens from infected human patients. in all cases, the antisera bound p. carinii but did not bind the host tissue elements. moreover, the antisera bound not only to the cyst forms of p. carinii but also to th ...19902298484
localization of host immunoglobulin g to the surface of pneumocystis carinii.in immunoblotting studies of pneumocystis carinii surface proteins, we found that a secondary antibody, anti-human immunoglobulin g (igg), recognized a 52-kilodalton (kda) band in homogenates of p. carinii purified from human autopsy lungs and bronchoalveolar lavage fluids, even when serum as a source of primary antibody was omitted. the electrophoretic mobility of the 52-kda band is identical to that of igg heavy chains. in addition to affinity-purified, anti-human igg, monoclonal antibodies sp ...19902298486
role of fibronectin in pneumocystis carinii attachment to cultured lung cells.attachment of pathogens to host cells is a prerequisite for the development of many infections. pneumocystis carinii (pc) pneumonia is characterized by attachment of pc trophozoites to the alveolar epithelium. the mechanism of this process is unknown. fibronectin (fn) is a glycoprotein present in the alveolar space known to mediate cell-cell attachment, including the attachment of certain pathogens to host epithelial cells. in this study the binding of fn to pc trophozoites has been characterize ...19902298909
pneumocystis carinii: inhibition of lung cell growth mediated by parasite attachment.pneumocystis carinii pneumonia is a significant cause of mortality in immunocompromised patients. current concepts suggest that attachment of p. carinii to alveolar epithelium is required for development of pneumonia. we examined the mechanism of p. carinii adherence to cultured a549 cells, a permanent cell line derived from human alveolar epithelium. p. carinii adherence was quantified by measuring attachment of 51cr-labeled p. carinii to cultured a549 cells. after 8 h of incubation, 37.4 +/- 4 ...19902298914
pneumocystis carinii involvement of the liver and spleen: ct demonstration.patients with acquired immunodeficiency syndrome (aids) are subject to a variety of infections, including mycobacteria avium intracellulare, cytomegalovirus, cryptosporidium, and pneumocystis carinii. pneumocystis is most commonly associated with a potentially fatal pneumonia in aids patients. other organ involvement by pneumocystis is rare. we present a patient with hepatic and presumed splenic infiltration by pneumocystis.19902298983
widespread visceral calcifications in disseminated pneumocystis carinii infection: ct characteristics.a case of disseminated pneumocystis carinii infection is presented. calcifications of similar character were found by ct in the lymph nodes, spleen, liver, and kidneys. biopsy of a calcified axillary lymph node demonstrated necrotizing granulomatous lymphadenitis, with pneumocystis organisms and dystrophic calcifications clustered centrally within the granulomas.19902298984
serologic responses to pneumocystis carinii antigens in health and disease.serum antibodies to human pneumocystis carinii antigens were measured in greater than 400 specimens from different population groups by the immunoblotting technique. serologic responses varied during the first 2 years of life, but in children greater than or equal to 2 1/2 years and in adults antibodies to a 40-kda band were found in greater than 85% of the specimens; antigens to bands of 66, 92, and 116 kda were also detected frequently. the prevalence of serum antibodies in immunosuppressed pa ...19902299209
a randomized trial of open lung biopsy versus empiric antimicrobial therapy in cancer patients with diffuse pulmonary infiltrates.twenty-four cancer patients with diffuse interstitial pneumonitis (dip) were randomized to undergo an open lung biopsy (olb) within 8 hours of presentation (12 patients) or to receive empiric antimicrobial therapy (et) with trimethoprim-sulfamethoxazole (tmp-smx) erythromycin for a minimum of 4 days (12 patients). patients whose condition deteriorated underwent an olb on day 4. eight of 12 patients (67%) having olb survived versus 10 of 12 (83%) receiving et (p = .64). morbidity occurred in nine ...19902299367
successful treatment with an unrelated-donor bone marrow transplant in an hla-deficient patient with severe combined immune deficiency ("bare lymphocyte syndrome").an 8-month-old white female infant with pneumocystis carinii pneumonia had a normal blastogenic response to mitogens but no response to a variety of antigens, as well as a poor response to allogeneic cells in one-way mixed lymphocyte culture assays. the patient's mononuclear cells had defective class i (hla-a, -b, -c) and absent class ii (hla-d) antigen expression on their surface, thus establishing the diagnosis of hla-deficient severe combined immune deficiency (bare lymphocyte syndrome). fami ...19902299498
serum triiodothyronine values. prognostic indicators of acute mortality due to pneumocystis carinii pneumonia associated with the acquired immunodeficiency syndrome.a feasibility study was undertaken prospectively to identify early clinical and laboratory factors predictive of acute hospital mortality in patients with the acquired immunodeficiency syndrome and concurrent pneumocystis carinii pneumonia. twenty-six patients hospitalized with bronchoscopy-proved p carinii pneumonia were studied. nineteen patients survived their episode of p carinii pneumonia, while 7 subjects did not. the only clinical factor associated with mortality was a history of a shorte ...19902302016
pneumocystis carinii infection of bone marrow in patients with malignant lymphoma and acquired immunodeficiency syndrome. original report of three cases.pneumocystis carinii (pc) pneumonia was reported with increased frequency in patients presenting with acquired immunodeficiency syndrome (aids) or in patients receiving immunosuppressive chemotherapy for hemopathies. extrapulmonary dissemination of pc is rare. in this study, three patients had pc infection of the bone marrow. two of them presented with malignant lymphoma that had apparent immunosuppression, and the third patient presented with aids. in all three cases, such an infection was obse ...19902302020
domiciliary nebulized pentamidine for secondary prophylaxis against pneumocystis carinii pneumonia.the viability of a programme for delivering aerosolized pentamidine within the patient's home setting for the secondary prophylaxis of pneumocystis carinii pneumonia (pcp) has been explored with seven homosexual aids patients, the major objectives being the assessment of the safety and acceptability of the treatment and the discovery of the most suitable care setting (home, ward, outpatient clinic) for the administration of therapy. it is concluded that a domiciliary prophylaxis programme is a v ...19902304047
thin-walled cavities, cysts, and pneumothorax in pneumocystis carinii pneumonia: further observations with histopathologic correlation.thin-walled pulmonary cystic lesions were found in five immunocompromised patients, four with acquired immunodeficiency syndrome (aids). four patients had pneumocystis carinii pneumonia (pcp), and one had pulmonary lesions and disseminated p carinii infection. two patients demonstrated p carinii within necrotizing, thin-walled, smaller intraparenchymal cavities lined by organisms, exudate, and chronic inflammation. larger, typically apical and subpleural cysts, lined by fibrosis and/or alveolar ...19902305052
prolonged zidovudine therapy: confounded by pneumocystis carinii prophylaxis? 19902308199
pneumocystis carinii pneumonia: advances in diagnosis and therapy.as the aids epidemic has evolved, so have improvements been made in diagnosis and treatment of pneumocystis carinii pneumonia, the most common opportunistic infection in aids. advances, changes, and current research are discussed.19902308571
disseminated pneumocystis carinii infection causing extrapulmonary organ failure: clinical, pathologic, and immunohistochemical analysis.pneumocystis carinii pneumonia is an important infection in the immunocompromised host, and the rate of symptomatic infections has risen dramatically with the advent of immunosuppressive therapies and infections with the human immunodeficiency virus (hiv). however, dissemination of p. carinii is thought to be an unusual event, and it is rarely suspected of causing extrapulmonary symptomatology. we have recently examined the cases of patients with acquired immunodeficiency syndrome (aids) who dem ...19902308917
[aids: prevention of pulmonary complications. pneumocystis carinii pneumonia--mycobacterial infections]. 19902312028
aids behind bars. epidemiology of new york state prison inmate cases, 1980-1988.during the last five years, aids has become the preeminent health care problem in new york state correctional facilities. through december 31, 1988, 915 cases of aids had been diagnosed among inmates. this represented approximately 1% of the cumulative aids cases in the united states, 4% of those in new york state, and 40% of those reported in state correctional systems nationwide. an analysis of epidemiologic data on these cases showed an annual increase in cases from 3 in 1981 to 227 in 1988, ...19902314719
thoracic lymphadenopathy and disseminated pneumocystis carinii in aids. 19902314721
resolution of cavitary pneumocystis carinii pneumonia. 19902314723
[prognostic value of hiv serum antigens].human immunodeficiency virus (hiv) antigens can be detected during early infection but usually disappear afterwards. their later reappearance in serum seems to herald a greater virus replication and a poor prognosis. the prognostic value of antigen detection at the first clinical visit was assessed among 37 symptomatic patients. patients with detectable antigenemia at the first visit progressed more rapidly towards the acquired immunodeficiency syndrome (p less than 0.0001). similarly, patients ...19902316061
severe hypomagnesemia induced by pentamidine.the use of pentamidine for treating pneumocystis carinii pneumonia in aids patients has increased the awareness of pentamidine-induced adverse reactions. we report a case of severe hypomagnesemia and concurrent hypocalcemia that occurred during therapy with intravenous pentamidine. pentamidine therapy was subsequently changed to the nebulized route. electrolyte imbalances were corrected after daily supplementation with high doses of magnesium and calcium. clinicians should monitor for electrolyt ...19902316230
the effect of hiv infection on phagocytosis and killing of staphylococcus aureus by human pulmonary alveolar macrophages.pulmonary alveolar macrophages (pam) play a central role in host defense against pulmonary infection. the authors studied the number, viability, and ultrastructure of pam recovered by bronchoalveolar lavage from normal and hiv-infected subjects, and their ability to phagocytose and kill staphylococcus aureus. pam from hiv-infected subjects who did not have pneumonia were present in greater numbers and phagocytosed significantly more opsonized staphylococcus aureus (32.5% and 27.3% for nonsmokers ...19902316560
pneumocystis carinii pneumonia following methotrexate. 19902317451
[infections following kidney transplantation under threefold or fourfold immunosuppressive treatment].to determine, whether the infection rate after renal transplantation is influenced by the intensity of immunosuppressive treatment, the postoperative course of 100 consecutive renal transplantations in 64 men and 36 women (mean age 44.1 [18-72] years) was investigated prospectively. 87 patients received threefold basal immunosuppression with low-dose ciclosporin, azathioprine and prednisolone. in 13 risk patients (retransplantation and [or] high panel-reactive antibody titres), poly- or monoclon ...19902318113
analogues of 1,5-bis(4-amidinophenoxy)pentane (pentamidine) in the treatment of experimental pneumocystis carinii pneumonia.a series of 33 analogues of the anti-pneumocystis carinii drug 1,5-bis(4-amidinophenoxy)pentane (pentamidine) was synthesized for screening against a rat model of p. carinii pneumonia (pcp). twenty-five of the compounds showed efficacy against pcp when compared to a saline-treated control group. two compounds, 1,4-bis(4-amidinophenoxy)butane (butamidine, 6) and 1,3-bis(4-amidino-2-methoxyphenoxy)propane (damp, 16), were statistically more effective than the parent drug in treating pcp in the rat ...19902319567
clindamycin/primaquine therapy and secondary prophylaxis against pneumocystis carinii pneumonia in patients with aids.we found a program of intravenous and subsequent oral clindamycin, combined with oral primaquine, to be effective for pneumocystis carinii pneumonia in nine patients with aids. the pneumonias were either primary or recurrent and sometimes severe, with cavity formation and/or pneumothorax. maintenance therapy at lowered dose by mouth was effective in preventing recurrence in seven patients. one patient died of other opportunistic infections on day 24, and therapy was discontinued in another on da ...19902321069
pentamidine-induced torsades de pointes in a renal transplant recipient with pneumocystis carinii pneumonia.pentamidine isethionate, an important agent used to treat pneumocystis carinii pneumonia, has been shown to be associated with the development of torsades de pointes in patients with aids. we have described a case of pentamidine-induced polymorphous ventricular tachycardia in a renal transplant recipient whose renal insufficiency may have prolonged the duration of arrhythmias. careful ecg monitoring should be done during pentamidine administration, especially in patients with renal insufficiency ...19902321077
aids and uk respiratory physicians: attitudes to confidentiality, infection control, and management.respiratory physicians are concerned in the management of most patients with aids. attitudes and practices of 463 respiratory physicians in the united kingdom in relation to confidentiality, infection control, and treatment were sought by questionnaire from december 1987 to march 1988; 266 replies were received. thirty eight per cent of respondents had not seen an hiv positive patient at the time of the survey. respiratory physicians followed general medical council guidelines in relation to con ...19902321178
bronchoalveolar lavage for pneumocystis pneumonia in hiv-infected children.bronchoalveolar lavage (bal) by flexible fiberoptic bronchoscopy is useful in the diagnosis of pneumocystis carinii pneumonia (pcp) in adults with acquired immunodeficiency syndrome. to evaluate the safety and efficacy of this procedure in children with human immunodeficiency virus in whom pcp was considered, we reviewed the records of 15 consecutive procedures performed on eight patients by a pediatric pulmonologist during a 19-month period. pneumocystis carinii pneumonia was identified after f ...19902321817
unusual pulmonary manifestations of pneumocystis carinii infection in immunocompromised patients.three proven cases and one presumed case of pneumocystis carinii pneumonia are presented in which the radiological appearance mimics tuberculosis. the classic and unusual x-ray findings of p. carinii pneumonia are discussed.19902322203
calcified hilar and mediastinal lymph nodes in an aids patient with pneumocystis carinii infection.an unusual radiologic manifestation of pneumocystis carinii infection (enlarged, calcified hilar and mediastinal lymph nodes) in a patient with acquired immunodeficiency syndrome is described. this atypical manifestation caused significant diagnostic confusion. recognition that p carinii infection can cause calcification of hilar and mediastinal lymph nodes may prevent this confusion and facilitate diagnosis and treatment.19902326459
prognostic implications of bronchoalveolar lavage neutrophilia in patients with pneumocystis carinii pneumonia and aids: effects of an aggressive therapeutic approach. 19902327642
ofloxacin versus co-trimoxazole for prevention of infection in neutropenic patients following cytotoxic chemotherapy.the efficacy of ofloxacin in preventing infection in neutropenic patients following cytotoxic chemotherapy was evaluated and was compared with that of co-trimoxazole. a total of 102 patients with hematological malignancies were randomly selected to receive either co-trimoxazole or ofloxacin. all patients were monitored for compliance, occurrence of infection, and drug-related side effects. a surveillance culture of a rectal swab was performed regularly. a total of 25 of the 52 patients (48%) who ...19902327768
efficacy of a hydroxynaphthoquinone, 566c80, in experimental pneumocystis carinii pneumonitis.the efficacy of a new class of drugs for pneumocystis carinii pneumonitis was demonstrated. 566c80, a hydroxynaphthoquinone, administered orally in a dose of greater than or equal to 100 mg/kg of body weight per day prophylactically prevented p. carinii pneumonitis in 90% or more of rats, while all untreated control animals developed pneumonitis. when 566c80 (100 mg/kg per day) was administered for 3 weeks after p. carinii pneumonitis was established, therapy was totally effective and all of the ...19902327770
legionella lung cavitation.pneumonia due to legionella has been identified in a small percentage of patients suffering from acquired immune deficiency syndrome (aids), with and without coexisting pneumocystis carinii pneumonia. on chest radiographs legionella typically produces focal parenchymal opacities and confluent lobar consolidation. the authors describe a case of cavitating legionella pneumonia, which occurred in a 38-year-old man who had aids. the main differential diagnoses are an unusual presentation of p. carin ...19902328418
aerosolized pentamidine: effect on diagnosis and presentation of pneumocystis carinii pneumonia.to determine the effect of previous aerosolized pentamidine therapy on diagnosis and presentation of pneumocystis carinii pneumonia.19902331119
megaloblastic pancytopenia associated with dapsone and trimethoprim treatment of pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. 19902331198
aerosolized pentamidine for pneumocystis carinii pneumonia. 19902331834
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