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1.
J Clin Invest ; 76(1): 225-32, 1985 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-3160725

RESUMO

An antibodylike paraprotein has been isolated from a patient with multiple myeloma and autoimmune hyperlipoproteinemia. The paraprotein bound to apolipoprotein B (apo B)-containing lipoproteins that formed macromolecular aggregates, and globules thought to be aggregated complexes of lipoproteins and reactive immunoglobulins were observed circulating within the retinal blood vessels of this patient. This binding specificity permitted purification of the paraprotein from both the agglutinated immune complexes and from the plasma. The protein is an IgA, kappa-immunoglobulin which exists primarily in a polymeric state. Capillary immunoprecipitation demonstrated reactivity with very low density lipoproteins (VLDL) and low density proteins (LDL), but not with high density lipoproteins (HDL). Delipidated apo B and apo E, but not apo A or apo C, formed precipitates with this immunoglobulin. In using a radioimmunoassay format, the affinity of the immunoglobulin was greatest for VLDL and decreases sequentially for intermediate density lipoproteins and LDL. No binding occurred with a dispersion of LDL lipids or with HDL. Deglycosylation did not change the binding to LDL. The apolipoproteins B and E bound with similar affinity, but no binding occurred with apo A-I or apo A-II. Weak binding appeared to occur with apo C. This paraprotein immunoprecipitated apo B-containing lipoproteins from all classes of vertebrates tested. Displacement of the lipids of LDL by Triton X-100 resulted in the formation of an apo B-Triton complex which, however, did not bind to the immunoglobulin; apparently the binding site on apo B was lost. Upon enzymatic digestion with the IgA-specific protease from Streptococcus sanguis the immunoglobulin was cleaved into Fc and Fab fragments, and the binding of LDL occurred only with the latter, consistent with the behavior of an immunoglobulin. The immunoreactivity of this paraprotein with apo B and apo E raises the interesting possibility that it may be binding to a site on these apolipoproteins which is reactive with the apo B, E receptor of the plasma membrane, a site which is conserved throughout the vertebrate phylum.


Assuntos
Hiperlipidemias/imunologia , Doenças do Complexo Imune/sangue , Mieloma Múltiplo/sangue , Idoso , Complexo Antígeno-Anticorpo , Apolipoproteínas B/imunologia , Apolipoproteínas E/imunologia , Humanos , Imunoglobulina A/imunologia , Lipoproteínas LDL/imunologia , Lipoproteínas VLDL/imunologia , Masculino , Mieloma Múltiplo/imunologia , Paraproteinemias/sangue , Paraproteínas/imunologia
2.
Arch Intern Med ; 147(8): 1502-3, 1987 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-3632156

RESUMO

A 37-year-old homosexual man was evaluated for a one-week history of hematochezia. Results of a physical examination were remarkable only for grossly bloody stool. Sigmoidoscopy to 30 cm showed a friable mucosa compatible with an acute colitis, and a rectal biopsy specimen demonstrated an increased plasma cell infiltrate. Stool cultures subsequently yielded Aeromonas hydrophila; serum human T-cell lymphotropic virus type III antibody titer was positive. The patient responded to a course of treatment with sulfamethoxazole and trimethoprim with resolution of his symptoms and restoration of the bowel to a normal sigmoidoscopic appearance. Aeromonas hydrophila infection should be considered in the differential diagnosis of acute proctocolitis, particularly in patients with underlying immunodeficiency states.


Assuntos
Síndrome da Imunodeficiência Adquirida/imunologia , Infecções Bacterianas/etiologia , Colite/etiologia , Homossexualidade , Proctocolite/etiologia , Adulto , Aeromonas/isolamento & purificação , Humanos , Masculino , Infecções Oportunistas/imunologia
3.
AIDS ; 14(11): 1601-10, 2000 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-10983647

RESUMO

OBJECTIVE: Comparison of stavudine (d4T), didanosine (ddI) and indinavir (IDV) with zidovudine (ZDV), lamivudine (3TC) and IDV in HIV-1 infected patients. DESIGN: Randomized, open-label. SETTING: Fourteen HIV Clinical Research Centers. PATIENTS: Two-hundred and five patients with less than 4 weeks antiretroviral treatment, naive to 3TC and protease inhibitors and with CD4 cell counts > or = 200 x 10(6)/l and plasma HIV-1 RNA levels > or = 10,000 copies/ml. INTERVENTIONS: Stavudine 40 mg and ddI 200 mg twice daily plus IDV 800 mg every 8 h compared with ZDV 200 mg every 8 h or 300 mg twice daily, 3TC 150 mg twice daily plus IDV. MAIN OUTCOME MEASURES: The proportion of patients with plasma HIV-1 RNA levels < 500 copies/ml and < or = 50 copies/ml and changes in CD4 cell counts were compared. RESULTS: In an analysis of the primary endpoint, 61% of patients on d4T + ddI + IDV and 45% of patients on ZDV + 3TC + IDV had all HIV-1 RNA values obtained between weeks 40 and 48 < 500 copies/ml [95% confidence interval (CI) for the difference between proportions, 1.7-30.3%; P = 0.038]. In an intent-to-treat analysis, the percentage of all patients randomized with all HIV-1 RNA levels < 500 copies/ml between 40 and 48 weeks were 53% for the d4T + ddI + IDV arm and 41% for the ZDV + 3TC + IDV arm (95% CI, -1.4% to 25.7%; P = 0.068). At 48 weeks 41% and 35% were < or = 50 copies/ml for the stavudine- and ZDV-containing arms respectively (P > 0.2). The median time-weighted average increases in CD4 cells count over 48 weeks were 150 x 10(6)/l cells for the d4T arm and 106 x 10(6)/l cells for the ZDV arm (P= 0.001). The occurrence of serious adverse events was not significantly different between arms. CONCLUSION: The combination of stavudine, ddl and IDV resulted in potent antiretroviral effects over a 48-week period, comparable or superior to zidovudine, 3TC and IDV supporting the use of stavudine, ddI and a protease inhibitor as an initial antiretroviral treatment.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Didesoxinucleosídeos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , Indinavir/uso terapêutico , Inibidores da Transcriptase Reversa/uso terapêutico , Adolescente , Adulto , Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Didanosina/efeitos adversos , Didanosina/uso terapêutico , Didesoxinucleosídeos/efeitos adversos , Feminino , Infecções por HIV/imunologia , Infecções por HIV/virologia , Inibidores da Protease de HIV/efeitos adversos , HIV-1 , Humanos , Indinavir/efeitos adversos , Lamivudina/efeitos adversos , Lamivudina/uso terapêutico , Masculino , Inibidores da Transcriptase Reversa/efeitos adversos , Estavudina/efeitos adversos , Estavudina/uso terapêutico , Timidina/análogos & derivados , Carga Viral , Zidovudina/efeitos adversos , Zidovudina/uso terapêutico
4.
AIDS ; 12(18): 2439-46, 1998 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-9875582

RESUMO

OBJECTIVE: To determine the clinical and microbiologic benefit of adding amikacin to a four-drug oral regimen for treatment of disseminated Mycobacterium avium infection in HIV-infected patients. DESIGN: A randomized, open-labeled, comparative trial. SETTING: Outpatient clinics. PATIENTS: Seventy-four patients with HIV and symptomatic bacteremic M. avium infection. INTERVENTIONS: Rifampin 10 mg/kg daily, ciprofloxacin 500 mg twice daily, clofazimine 100 mg every day, and ethambutol 15 mg/kg orally daily for 24 weeks, with or without amikacin 10 mg/kg intravenously or intramuscularly 5 days weekly for the first 4 weeks. MAIN OUTCOME MEASURE: Clinical and microbiologic response at 4 weeks; quantitative level of bacteremia with M. avium. RESULTS: No difference in clinical response was noted with the addition of amikacin to the four-drug oral regimen, and only 25% in either group had a complete or partial response at 4 weeks. A comparable quantitative decrease in bacteremia was noted in both treatment groups, with 16% of patients being culture-negative at 4 weeks and 38% at 12 weeks. Toxicities were mainly gastrointestinal. Amikacin was well tolerated. Median survival was 30 weeks in both groups. CONCLUSIONS: The addition of amikacin to a four-drug oral regimen of rifampin, ciprofloxacin, clofazimine, and ethambutol did not provide clinical or microbiologic benefit.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Amicacina/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Ciprofloxacina/uso terapêutico , Clofazimina/uso terapêutico , Contagem de Colônia Microbiana , Etambutol/uso terapêutico , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Complexo Mycobacterium avium/efeitos dos fármacos , Complexo Mycobacterium avium/isolamento & purificação , Rifampina/uso terapêutico
5.
Clin Infect Dis ; 39(10): e100-5, 2004 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-15546070

RESUMO

BACKGROUND: A recent resurgence of primary and secondary syphilis has been observed in certain population groups, particularly among persons infected with human immunodeficiency virus (HIV). Liver involvement is an infrequently recognized complication of early syphilis, with no previous reports among HIV-infected patients. METHODS: We describe 7 cases of syphilitic hepatitis in HIV-positive individuals and review the literature. RESULTS: At our institutions, all patients presented with a rash consistent with secondary syphilis. Each case was characterized by a conspicuous increase in serum alkaline phosphatase level (mean level +/- standard deviation, 905 +/- 523.6 IU/L) and milder elevations in serum transaminase levels. The mean CD4+ absolute T cell count was 317 cells/mm3, and the median rapid plasma reagin (RPR) titer was 1 : 128. There was a significant correlation between higher CD4+ cell counts and the RPR titers (R=0.93; P=.002). Symptomatic resolution and biochemical improvement, particularly a significant decrease in serum alkaline phosphatase levels (P=.02), occurred following antibiotic therapy. CONCLUSIONS: Hepatic dysfunction is not uncommon in HIV-infected persons and is attributable to multiple causes. In the appropriate clinical setting, syphilitic hepatitis is an easily diagnosed and reversible etiology of liver dysfunction. The recognition of this entity will prevent unnecessary evaluation of abnormal liver enzyme levels in HIV-positive patients.


Assuntos
Infecções por HIV/complicações , Hepatite/complicações , Hepatite/microbiologia , Sífilis/complicações , Adulto , Humanos , Masculino
6.
Artigo em Inglês | MEDLINE | ID: mdl-2023100

RESUMO

Two cases of invasive aspergillosis in AIDS patients are reported and previously reported AIDS-related cases are reviewed. Only one-half of all cases were diagnosed antemortem. Outcome is poor despite antifungal and surgical therapy. Normal phagocytic function is important in host defense against Aspergillus species. HIV-infected patients may have impaired phagocytic function as a result of antiretroviral therapy or treatment of opportunistic infection, or due to HIV infection itself. As the lifespans of HIV-infected patients are extended by antiretroviral therapy, an increasing awareness of Aspergillus infection as an opportunistic pathogen will be necessary.


Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Aspergilose/complicações , Pneumopatias Fúngicas/complicações , Infecções Oportunistas/complicações , Adulto , Humanos , Masculino
7.
Artigo em Inglês | MEDLINE | ID: mdl-1691287

RESUMO

We evaluated the clinical, immunologic, and virologic effects of oral treatment with ribavirin and isoprinosine for up to 3 months in asymptomatic, HIV-culture-positive homosexual men. Fifteen consecutive men received isoprinosine 4 g/day (1 g q.i.d.), and 800 (9 men) or 1,200 mg/day (6 men) of ribavirin. Five men in each ribavirin dosage group completed at least 2 months of treatment. No unexpected toxicities were observed. Eight minor HIV-related events occurred in six men while on study. All men remained HIV-positive, and time to positive culture decreased by at least 4 days in three men from each treatment group. Serum p24 levels did not change in two men who were p24 antigenemic and received 800 mg/day of ribavirin. Treatment was associated with a generalized lymphopenia affecting all lymphocyte subsets including CD4, which was partially reversible 1 month after stopping treatment. Most of the men remained anergic on DTHS skin testing. No improvements were noted in in vitro lymphoproliferative responses to antigens or in NK cell activity (which decreased significantly in the 1,200 mg/day ribavirin group). Although well tolerated at the doses employed, the combination of ribavirin and isoprinosine produced an unexpected generalized lymphopenia and did not exhibit HIV-suppressive or immunorestorative effects.


Assuntos
Antivirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Inosina Pranobex/uso terapêutico , Inosina/análogos & derivados , Ribavirina/uso terapêutico , Ribonucleosídeos/uso terapêutico , Adulto , Linfócitos T CD4-Positivos , HIV/isolamento & purificação , Infecções por HIV/imunologia , Humanos , Células Matadoras Naturais/imunologia , Contagem de Leucócitos , Masculino , Linfócitos T Reguladores
8.
Artigo em Inglês | MEDLINE | ID: mdl-2975332

RESUMO

Ten homosexual men received oral lithium carbonate at doses that maintained their serum lithium concentrations between 0.5 and 1.5 mEq/L. Prior to treatment all patients had HIV isolated from PHA-activated peripheral blood lymphocytes (PBLs) using a quantitative antigen-capture enzyme-linked immunosorbent assay (ELISA) assay for detection, and had an absolute number of CD4 (helper) lymphocytes of less than 300/mm3. Eight of 10 patients developed symptoms of drug toxicity requiring discontinuation of the drug in 7 patients. Two patients completed only 4-5 weeks of lithium therapy, and 5 patients received 7-8 weeks. All patients remained culture positive for HIV during the trial, and viral titers as measured by the antigen capture assay were unchanged or increased. There were no significant changes in the absolute number of CD4 lymphocytes, CD4/CD8 ratio, or phytohemagglutinin (PHA) or tetanus toxoid induced proliferative responses. There was a significant decrease in mixed lymphocyte reaction (MLR). Lithium carbonate demonstrated no immunorestorative or antiviral activity when given in therapeutic doses. Drug toxicity limited therapy in the majority of patients.


Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Lítio/uso terapêutico , Síndrome da Imunodeficiência Adquirida/imunologia , Síndrome da Imunodeficiência Adquirida/microbiologia , Adulto , HIV/isolamento & purificação , Humanos , Interleucina-2/biossíntese , Lítio/efeitos adversos , Carbonato de Lítio , Ativação Linfocitária/efeitos dos fármacos , Teste de Cultura Mista de Linfócitos , Masculino , Pessoa de Meia-Idade , Linfócitos T Auxiliares-Indutores/imunologia
9.
Chest ; 103(1): 306-8, 1993 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-8417913

RESUMO

Extrapulmonary pneumocystosis recently has been reported in a number of tissues. Most cases occurred in patients receiving aerosolized pentamidine prophylaxis. We report a case of disseminated pneumocystosis presenting as a large pleural effusion without apparent lung involvement where Pneumocystis carinii was the only pathogen identified. The absence of parenchymal lesions on chest x-ray film, the lack of hypoxemia and the minimal uptake of gallium all argue against significant lung involvement. The patient was successfully treated with chest tube drainage, intravenous and inhaled pentamidine and orally administered dapsone and trimethoprim. The addition of inhaled pentamidine to intravenously administered pentamidine may have increased pleural fluid levels substantially and its use coincided with the patient's improvement.


Assuntos
Derrame Pleural/microbiologia , Infecções por Pneumocystis/patologia , Administração por Inalação , Adulto , Humanos , Injeções Intravenosas , Masculino , Pentamidina/administração & dosagem , Pentamidina/uso terapêutico , Derrame Pleural/tratamento farmacológico , Derrame Pleural/patologia , Infecções por Pneumocystis/tratamento farmacológico
10.
Obstet Gynecol ; 80(6): 985-8, 1992 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-1448269

RESUMO

OBJECTIVE: To determine attitudes and practices of obstetricians in maternal-fetal medicine fellowship programs regarding the management of human immunodeficiency virus (HIV) infection and the use of zidovudine during pregnancy. METHODS: We sent a questionnaire to the directors of all 78 approved maternal-fetal medicine fellowship programs. The responses, reflecting the consensus of the staffs of each program, were obtained and tabulated. RESULTS: Although their programs annually provide care for more than 2100 pregnant women infected with HIV, less than 25% of all maternal-fetal medicine fellowship directors reported that their patients participate in multicenter studies of HIV infection complicating pregnancy. Nearly two-thirds of the infected women are excluded from such multicenter studies. More than 70% of all program directors believe that zidovudine should be offered to symptomatic pregnant women infected with HIV; one-half question whether zidovudine poses short-term fetal risks. Nevertheless, nearly half of all HIV-infected pregnant women they manage are excluded from trials of zidovudine therapy during pregnancy. CONCLUSIONS: Many HIV-infected pregnant women who receive care in clinics of maternal-fetal medicine fellowship programs are excluded from multicenter studies. Consideration should be given to creating a national registry for this important, currently unreported, clinical resource.


Assuntos
Bolsas de Estudo , Infecções por HIV/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Obstetrícia , Complicações Infecciosas na Gravidez/tratamento farmacológico , Zidovudina/uso terapêutico , Ensaios Clínicos como Assunto/estatística & dados numéricos , Feminino , Humanos , Obstetrícia/educação , Perinatologia/educação , Gravidez , Conselhos de Especialidade Profissional , Estados Unidos
11.
Pancreas ; 13(4): 356-71, 1996 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-8899796

RESUMO

A wide variety of infectious agents has been associated with acute pancreatitis. Strict diagnostic criteria were developed to assess with relationship between individual microorganisms and acute pancreatitis. Pathologic or radiologic evidence of pancreatitis associated with well-documented infection was noted with viruses (mumps, coxsackie, hepatitis B, cytomegalovirus, varicella-zoster virus, herpes simplex virus), bacteria (Mycoplasma, Legionella, Leptospira, Salmonella), fungi (Aspergillus), and parasites (Toxoplasma, Cryptosporidium, Ascaris). Clues to the infectious nature of pancreatitis lay in the characteristic signs and symptoms associated with the particular infectious agent. How often these agents are responsible for idiopathic pancreatitis is unclear.


Assuntos
Infecções Bacterianas , Pancreatite/microbiologia , Pancreatite/parasitologia , Doenças Parasitárias , Viroses , Humanos , Micoses , Pancreatite/virologia
12.
Med Clin North Am ; 76(6): 1449-61, 1992 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-1405828

RESUMO

Sexually active travelers are at risk for a variety of STDs, including traditional venereal infections such as gonorrhea, chlamydial urethritis, syphilis, chancroid, and herpes simplex infection. More recently, hepatitis B, hepatitis C, and HIV-1 have also been described. Risk varies depending on the geographic area of travel and the type of sexual contact. Physicians should be aware of the prevalence of antimicrobial resistance of N. gonorrhoeae and H. ducreyi because this will affect empiric antibiotic therapy. Prevention should focus on proper and consistent usage of barrier contraceptives.


Assuntos
Infecções Sexualmente Transmissíveis , Viagem , Humanos , Fatores de Risco , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/terapia
14.
J Endocrinol Invest ; 28(3): RC1-3, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15952401

RESUMO

Leptin, the protein product of the obese gene (ob), is secreted by adipocytes. Circulating leptin levels correlate with fat mass in humans, including individuals infected with HIV. Leptin serves as an adipostatic hormone, a permissive factor for reproduction and a modulator of immune function. Leptin is a cytokine, and has been demonstrated to enhance CD4 cell proliferation and IL-2 secretion from CD4 cells in vitro. The role of leptin in HIV-positive patients treated with highly active antiretroviral therapy (HAART) has not been well defined. We haveevaluated leptin levels in HIV-infected individualsduringthe early phase of HAART. We measured plasma leptin levels in 15 antiretroviral-naive HIV positive patients at baseline and after 1 and 4 weeks of HAART. After the first week of therapy, mean leptin level and CD4 count were increased compared to baseline, 6.0 vs 7.2 ng/ml (p = 0.004) and 377 vs 432 cells/ul (p = 0.014), respectively. In contrast, mean body mass index (BMI) remained unchanged 27.0 vs 26.8 kg/m2 (p < 0.08). After four weeks of therapy, leptin and BMI values were unchanged compared to baseline, 6.0 vs 5.9 (p < 0.4) and 27.0 vs 26.9 (p < 0.5), respectively, whereas CD4 count continued to increase to 491 cells/ul (p < 0.012 compared to baseline). These data demonstrate an early transient increase in plasma leptin levels in HIV positive patients initiated on HAART, despite a lack of change in BMI. It is unclear if the transient increase in leptin is related to its role as a cytokine, a metabolic regulator, or reproductive factor.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Peso Corporal/fisiologia , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Leptina/sangue , Índice de Massa Corporal , Contagem de Linfócito CD4 , Soropositividade para HIV , Humanos
15.
J Infect Dis ; 160(6): 1076-80, 1989 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-2584755

RESUMO

Sonicated preparations of Giardia lamblia hydrolyze a variety of protein substrates including human immunoglobulin. Activity is increased by thiol-activating agents and inhibited by thiol proteinase inhibitors. About 55% of activity remains in the soluble fraction after high-speed centrifugation, and pretreatment with a nonionic detergent results in increased soluble activity. This suggests that the enzyme is membrane bound or associated with subcellular particles. Activity elutes as a major peak at 38,000 molecular weight by calibrated sieve chromatography. The favored sites of enzymatic cleavage of IgA1 are between the CH2 and CH3 domain and near the hinge region of the heavy chain. Similar cleavage patterns were identified using sonicated preparations of Entamoeba histolytica and Trichomonas vaginalis.


Assuntos
Cisteína Endopeptidases/metabolismo , Giardia/enzimologia , Animais , Cromatografia em Gel , Ativação Enzimática , Hemoglobinas/metabolismo , Imunoglobulina A/metabolismo , Imunoglobulinas/metabolismo , Peso Molecular , Inibidores de Proteases/farmacologia , Sonicação
16.
J Infect Dis ; 151(1): 140-7, 1985 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-3965585

RESUMO

Retrospective review of isolates of Capnocytophaga, a genus of capnophilic gram-negative bacilli, referred to the Massachusetts State Laboratory Institute in Boston revealed 31 patients with infection due to Capnocytophaga, 16 in nonimmunocompromised hosts. These infections included empyema (three patients), lung abscess (one), sinusitis (one), conjunctivitis (three), subphrenic abscess (one), wound (three), osteomyelitis (one), and bacteremia (three). Two of the wound infections were closed-fist injuries involving bone or soft tissue. Capnocytophaga was frequently isolated as part of a polymicrobial infection with other oral flora. There was only one death in the nonimmunocompromised group. In contrast, of 15 immunocompromised patients with 16 episodes of bacteremia due to Capnocytophaga, 87% had leukopenia and 73% had significant oral pathology such as gingivitis, mucositis, or ulceration. Five immunocompromised patients died. Thus, Capnocytophaga species may cause disease in both nonimmunocompromised and immunocompromised hosts. Isolation of this organism should suggest an oral source for infection.


Assuntos
Capnocytophaga/isolamento & purificação , Cytophagaceae/isolamento & purificação , Síndromes de Imunodeficiência/microbiologia , Abscesso/microbiologia , Adolescente , Adulto , Fatores Etários , Idoso , Capnocytophaga/patogenicidade , Oftalmopatias/microbiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/microbiologia , Sepse/microbiologia , Fatores Sexuais
17.
J Infect Dis ; 163(6): 1326-35, 1991 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-2037799

RESUMO

Note from Dr. Merle A. Sande--The role of Mycobacterium avium as a pathogen in the human immunodeficiency virus-infected population has been confusing and controversial to clinicians who care for AIDS patients. The organism is commonly isolated from respiratory secretions of patients with other infections and often seems part of the resident flora; even when isolated from the bone marrow or bloodstream, its impact on the course of AIDS and contribution to systemic diseases are unknown. However, an increasing subset of patients without other documented opportunistic infections or malignancies has symptoms that respond to therapy directed against M. avium. Studies are in progress to evaluate chemotherapeutic agents. Accordingly, the subject is here reviewed and guidelines offered to infectious disease clinicians by one with a long-standing interest in mycobacterial disease who has made numerous contributions to the field.


Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Complexo Mycobacterium avium/efeitos dos fármacos , Infecção por Mycobacterium avium-intracellulare/complicações , Humanos , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico
18.
Infect Agents Dis ; 4(2): 76-94, 1995 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-7613731

RESUMO

Wasting syndrome is a common complication of HIV infection and is marked by progressive weight loss and weakness, often associated with fever and diarrhea. The pathophysiologic mechanisms responsible for this syndrome are not well defined, but it is clear that this is a multifactorial process in which the relative contribution of individual etiologic factors vary among patients. Considerations include inadequate diet, malabsorptive phenomena, metabolic derangements, and cytokine activity. The onset of opportunistic infections is often accompanied by a hypermetabolic state characterized by progressive weight loss. Potential cytokines that may promote weight loss in AIDS patients include tumor necrosis factor, interleukin-1, interleukin-6, and alpha-interferon. At present there is no effective treatment. Multiple therapeutic methods, including enteral and parenteral alimentation, appetite stimulants, recombinant growth hormone, and cytokine modulators, are currently being explored.


Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Caquexia/etiologia , Infecções Oportunistas Relacionadas com a AIDS/metabolismo , Infecções Oportunistas Relacionadas com a AIDS/fisiopatologia , Acetilcisteína/uso terapêutico , Síndrome da Imunodeficiência Adquirida/fisiopatologia , Composição Corporal , Caquexia/fisiopatologia , Caquexia/terapia , Citocinas/metabolismo , Ácidos Graxos Ômega-3/uso terapêutico , Humanos , Hiperlipidemias/metabolismo , Talidomida/uso terapêutico , Redução de Peso
19.
Am J Public Health ; 77(12): 1542-3, 1987 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-3674256

RESUMO

The health status of 239 Ethiopian refugees in the United States was evaluated. Over 70 per cent were males 15-30 years old. Positive PPDs (purified protein derivative of tuberculin) were observed in 72 per cent and 3.4 per cent had abnormal chest x-rays. One patient had active tuberculosis. Other laboratory abnormalities included: intestinal parasites (36.7 per cent), anemia (14.9 per cent), eosinophilia (14 per cent), positive syphilis serology (7.5 per cent), and hepatitis B surface antigenemia (9.4 per cent). The most prevalent intestinal parasites were Giardia lamblia, Trichuris trichiura, and Schistosoma mansoni.


Assuntos
Nível de Saúde , Saúde , Refugiados , Adolescente , Adulto , Animais , Criança , Pré-Escolar , District of Columbia , Etiópia/etnologia , Feminino , Giardíase/epidemiologia , Humanos , Lactente , Recém-Nascido , Enteropatias Parasitárias/epidemiologia , Masculino , Massachusetts , Estudos Retrospectivos , Fatores Sexuais , Teste Tuberculínico , Estados Unidos
20.
Infect Dis Obstet Gynecol ; 9(2): 81-7, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11495558

RESUMO

OBJECTIVE: To survey the evolution over the past decade of attitudes and practices of obstetricians in maternal-fetal medicine fellowship programs regarding the management of human immunodeficiency virus (HIV)-infected pregnant women. METHODS: Directors of all 65 approved maternal-fetal medicine training programs were sent questionnaires, responses to which were to reflect the consensus among members of their faculties. Programs were stratified based upon the number of HIV-infected pregnant patients cared for in the previous year. RESULTS: Responses reflect experience with over 1000 infected pregnant women per year, nearly one-quarter with advanced disease. Combination antiretroviral therapy was prescribed by all respondents, universally in the 2nd and 3rd trimesters. A three-drug regimen (often containing a protease inhibitor) was used more often by those who treated at least 20 HIV-infected pregnant patients per year than by those programs seeing a lower number of patients (80 vs 59%). Despite the known and unknown risks of the use of antiretrovirals during pregnancy, only half of all responding programs report adverse events to the Antiretroviral Pregnancy Registry; reporting was more common among the institutions seeing a higher number of patients (61 vs 45%). Seventy-eight percent of higher volume programs enroll their patients in clinical studies, usually multicenter, versus 35% of lower volume programs. CONCLUSIONS: Care for HIV+ pregnant women has dramatically changed over the past decade. Antiretroviral therapy is now universally prescribed by physicians involved in maternal-fetal medicine training programs. Given limited experience with these agents in the setting of pregnancy, it is essential for maternal-fetal medicine practitioners to actively report on adverse events and participate in clinical trials.


Assuntos
Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Atitude do Pessoal de Saúde , Bolsas de Estudo/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Serviços de Saúde Materna , Padrões de Prática Médica/estatística & dados numéricos , Complicações Infecciosas na Gravidez/tratamento farmacológico , Aleitamento Materno , Coleta de Dados , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez
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