Cardiac dysfunction associated with the acquired immunodeficiency syndrome (AIDS)

Five patients with acquired immune deficiency syndrome (AIDS) developed clinical evidence of mild to severe cardiac dysfunction confirmed by nuclear angiography and echocardiography. In 4 patients who were studied postmortem there was no evidence of myocarditis, valvular, or ischemic heart disease. Cardiac involvement in patients with AIDS may include pericardial and myocardial involvement by opportunistic pathogens or Kaposi's sarcoma, subclinical myocardial dysfunction, or an as-yet unexplained cardiomyopathy.     

The acquired immunodeficiency syndrome (AIDS) dementia complex

The acquired immunodeficiency syndrome (AIDS) dementia complex is a frequent and devastating complication of infection with human immunodeficiency virus-type 1 (HIV-1). Features of the AIDS dementia complex include decreased memory, the inability to concentrate, apathy, and psychomotor retardation. Typical neuropathologic findings include gliosis, focal necrosis of neurons, perivascular inflammation, formation of microglial nodules, multinucleated giant cells, and demyelination. That HIV-1 is the direct cause of this neurologic syndrome is strongly supported by the available evidence. In addition, several studies have identified the monocyte-macrophage as the predominant cell type in the brain infected with HIV-1. However, the mechanisms by which the infected monocytes-macrophages mediate neurologic dysfunction and destruction have not been elucidated.     

High-dose IgG for neutropenic patients with acquired immunodeficiency syndrome (AIDS)

Summary Leukocytopenia and bacterial infections are common and serious complications in patients with AIDS. We report here on three such patients in whom the administration of high IgG doses led to gradual (two patients) or prompt (one patient) increases in circulating leukocyte counts (from 200–600 to 2500–5900/1), inducing definite improvement in two patients; one patient died fromPneumocystis carinii pneumonia. Although the rise in leukocyte counts lasted for only approximately 3 weeks, high-dose IgG might be a useful therapeutic adjunct in such patients.This work was supported by theDeutsche Forschungsgemeinschaft (Sa 405/1-3)     

Azidothymidine associated with bone marrow failure in the acquired immunodeficiency syndrome (AIDS)

Four patients with the acquired immunodeficiency syndrome, and a history of Pneumocystis carinii pneumonia developed severe pancytopenia (hemoglobin, less than 85 g/L; granulocytes, less than or equal to 0.5 X 10(9)/L; platelets, less than or equal to 30 X 10(9)/L) 12 to 17 weeks after the initiation of azidothymidine (AZT) therapy. The bone marrow was markedly hypocellular in three patients and moderately hypocellular in the fourth. Partial bone marrow recovery was documented within 4 to 5 weeks in three patients, but no marrow recovery has yet occurred in one patient during the more than 6 months since AZT treatment was discontinued. Azidothymidine should be used cautiously, with close monitoring of blood values.     

Positive direct antiglobulin test associated with hyperglobulinemia in acquired immunodeficiency syndrome (AIDS)

This study determined the prevalence and clinical significance of a positive direct antiglobulin test (DAT) observed in pretransfusion tests on red cells from patients with acquired immunodeficiency syndrome (AIDS). Transfusion service records showed that prevalence of a positive DAT on red cells was 18% (10/55) in AIDS patients compared to 0.6% in general hospital patients during a 2-year period (1981-1983). A similar rate of 18% (8/45) was observed in other hyperglobulinemic patients. Of the 10 AIDS patients whose red cells were DAT positive, four had IgG and complement, four had IgG, and two had complement alone on their red cells. The eluates were not reactive with normal red cells nor with penicillin or cephalothin-coated red cells. Clinically, no hemolysis was observed. In this series a positive DAT in AIDS patients appeared not to be associated with autoimmune hemolytic anemia. The positive DAT in AIDS patients may be due to the hyperglobulinemic state.     

Intestinal infections in patients with the acquired immunodeficiency syndrome (AIDS). Etiology and response to therapy

STUDY OBJECTIVE: To determine the frequency of pathogenic gastrointestinal microorganisms in patients with the acquired immunodeficiency syndrome (AIDS) and diarrhea, and to determine if treatment for identifiable microorganisms improves symptoms. DESIGN: Prospective, consecutive sample study. Setting: Referral-based clinic and wards, National Institutes of Health. PATIENTS: Twenty of twenty-two consecutive homosexual males with AIDS and diarrhea, and 10 homosexual males with AIDS without diarrhea. INTERVENTIONS: All patients had a complete physical examination; serial stool examinations for viral, bacterial, fungal, and protozoan pathogens; and esophagogastroduodenoscopy and colonoscopy to obtain duodenal fluid and mucosal tissue to analyze for enteric pathogens or histopathology. Patients with diarrhea had a malabsorption evaluation. Patients with treatable pathogenic microorganisms received standard antimicrobial therapy. MEASUREMENTS and MAIN RESULTS: The 20 patients with AIDS and diarrhea had greater weight loss, lower mean numbers of helper-inducer (OKT4) lymphocytes, and a higher incidence of extraintestinal opportunistic infections than the 10 patients without diarrhea. One or more enteric pathogen was identified in 17 of 20 patients (85%; 95% confidence interval [CI], 65% to 96%) with diarrhea. Only 1 patient without diarrhea was infected with an enteric pathogen. Nineteen of twenty patients with diarrhea and all 10 patients without diarrhea had chronic inflammatory changes in their intestinal biopsy specimens. Sixteen patients with identifiable enteric pathogens and diarrhea were treated; 11 (69%; 95% CI, 43% to 87%) showed microbiologic, histologic, or clinical improvement. CONCLUSIONS: Thorough diagnostic evaluation can lead to the identification of enteric pathogens in a high percentage of patients with AIDS and diarrhea. Specific therapy can lead to symptomatic improvement.     

Fine-needle aspiration biopsy of patients with acquired immunodeficiency syndrome (AIDS): experience in an outpatient clinic

One hundred twenty-one fine-needle aspiration biopsies of lymph nodes were done on 113 men followed in the AIDS (acquired immunodeficiency syndrome) Outpatient Clinic of the San Francisco General Hospital. The cytologic diagnoses on these 121 biopsies included 60 (50%) hyperplasias, 24 (20%) non-Hodgkin lymphomas, 21 (17%) mycobacterial infections, 12 (10%) cases of Kaposi sarcoma, and 1 each of Hodgkin disease, giant cell carcinoma, nasopharyngeal carcinoma, and squamous cell carcinoma. No false-positive results occurred in this series, but five false-negative results were seen in the 10 patients with hyperplasia on fine-needle aspiration biopsy specimens who subsequently had open surgical biopsy. From our experience, we believe fine-needle aspiration biopsy is a useful, cost-effective initial method to evaluate lymphadenopathy in patients seen at an AIDS outpatient clinic.     

An update on the acquired immunodeficiency syndrome (AIDS)

The pandemic, acquired immunodeficiency syndrome (AIDS) has been described in 40 nations throughout the world. This paper describes the wide spectrum of gastrointestinal tract manifestations seen in this syndrome, with particular attention to the epidemiology, etiology, and measurement of these problems. Discussion of candidiasis, herpes simplex, “hairy” leukoplakia, Kaposi's sarcoma, cytomegalovirus, anal warts and carcinoma, chlamydial proctitis (LGV), coccidiosis, and mycobacterial diarrhea, as well as “gay bowel syndrome,” demonstrates the complex management problems associated with this condition.     

艾滋病患者肺部感染的临床分析

目的提高对艾滋病机会性感染尤其是肺部感染临床表现的认识。方法对作者在坦桑尼亚多多马省地区医院经治的３２例艾滋病患者进行临床综合分析。结果３２例艾滋病患者肺部感染临床表现的共同特征为：发热，乏力，消瘦，盗汗，咳嗽，吐痰，全身疼痛等。其中结核病患者２４例，占总数的７８％。其余为肺部感染和卡氏肺囊虫病。这些患者同时伴有皮肤感染和心、肝、肾等多系统损害。结论肺部感染是艾滋病患者晚期的主要机会性感染，其中结核感染最多见，并且可伴有机体多系统损害，治疗困难。     

A case of acquired immunodeficiency syndrome (AIDS) with histoplasmosis

Fungal infection is a major opportunistic infection in AIDS. Histoplasmosis is often seen in American AIDS, but only one case has been reported in Japan. We report a AIDS case of with histoplasmosis in Japan. The patient was a forty year old male living in the U.S from 1987 to 1990. He was diagnosed as candidial esophagitis in July, 1994, and human immunodeficiency virus type 1 (HIV) antibody positive led to a diagnosis of AIDS. He was admitted to our hospital with fever and lymphadenopathy (neck, abdomen) in August. The therapy for candidial esophagitis was successful and he was recovering, but he was newly diagnosed as atypical mycobacteriosis and Kaposi's sarcoma. Though the fever was slight, it persisted. He was discharged from our hospital in October. He was readmitted for a high fever and dehydration in December, but died after a week from disseminated intravascular coagulation (DIC). Histoplasma capsulatum was found by blood and ascites cultures on second admission. Many yeast like histoplasma cells in granuloma of the liver were found at autopsy. For moderate or severe histoplasmosis, amphotericin B is generally used as the first induction therapy. Fluconazole (FLCZ) is used as a maintenance therapy. We did not use amphotericin B, but used FLCZ because we did not diagnose histoplasmosis before death, and his general condition became worse. The effect of FLCZ therapy was unclear in our case because he had other infections. We expect that AIDS with histoplasimosis will increase in Japan through HIV infected patients infected in the U.S.A.