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Biomedical subjects

A E Pitchenik

Publications and source records attributed to A E Pitchenik.

At least 37 records · Page 2Linked to original sources
PubMed1988

Mycobacterial disease: epidemiology, diagnosis, treatment, and prevention.

TB is common in the setting of HIV-induced immunosuppression, especially among demographic groups with a high background prevalence of tuberculous infection. It is often the first (sentinel) infectious disease to appear, extrapulmonary and disseminated disease is common, the chest x-ray picture is frequently atypical, and the tuberculin skin test is often falsely negative. It therefore requires a high index of suspicion and an aggressive diagnostic approach to avoid missing HIV-related tuberculous disease, which is communicable from man to man by the aerosol route and which appears to be highly treatable with conventional anti-TB drugs. Identification and INH prophylaxis of tuberculous-infected, HIV-seropositive persons is likely to be very important in the prevention of tuberculous disease. MAI is also a very common pathogen that frequently produces extrapulmonary and disseminated disease among patients with AIDS. In contrast to TB, AIDS-related MAI disease occurs more uniformly among the AIDS risk groups, occurs late among the HIV-related infections, and is not effectively treated with current drug regimens.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Cancer among Haitians in Florida.

Data on cancer rates from West Indian populations are scarce, and to the authors' knowledge there are no published data on cancer rates and distributions among Haitians. Proportional distributions of cancers among three groups of patients living in Florida were compared: Haitian born blacks, United States born blacks, and non-Haitian Caribbean born blacks. The incidence rate of cancer of the cervix among the Haitian and United States born black groups was also compared. Increased rates of certain malignancies associated with viral infection or immunodeficiency were found in the Haitian group. These tumors were hepatocellular carcinoma, nasopharyngeal carcinoma, reticulum cell sarcoma, Kaposi's sarcoma, and carcinoma of the uterine cervix. The age-adjusted incidence rate of carcinoma of the cervix was especially high among Haitian women even with a liberal estimate of the female Haitian population from whom the cases were drawn. Except for cancer of the cervix, the numbers of cancers of interest were small, and age-adjusted incidence rates were not calculated. Continued epidemiological study of larger numbers of patients is needed to evaluate these findings further.

Adult↗
PubMed1987

Detection of HTLV-III/LAV-specific IgG and antigen in bronchoalveolar lavage fluid from two patients with lymphocytic interstitial pneumonitis associated with AIDS-related complex.

Lymphocytic interstitial pneumonitis, a disorder of unknown cause, has been described in association with infection by the retrovirus human T lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV). This report describes the isolation of HTLV-III/LAV in bronchoalveolar lavage fluid and the quantitation of antibodies directed against HTLV-III/LAV in bronchoalveolar lavage fluid and peripheral blood of two patients with lymphocytic interstitial pneumonitis associated with acquired immune deficiency syndrome-related complex. The ratio of the concentrations of HTLV-III/LAV-specific IgG to total IgG in the bronchoalveolar lavage fluid of both patients was higher than that of the peripheral blood. These findings are consistent with the hypothesis that lymphocytic interstitial pneumonitis is sometimes associated with HTLV-III/LAV infection of pulmonary tissue that evokes a specific humoral immune response locally in the lung.

AIDS-Related Complex↗
PubMed1987

Lung natural killer and interleukin-2 activity in lung cancer. A pulmonary compartment of augmented natural killer activity occurs in patients with bronchogenic carcinoma.

Studies were performed to determine if natural killer (NK) cell and interleukin-2 (IL-2) activities are increased in lungs that harbor malignancy. The NK activity (ability to lyse 51Cr-K562 cells) in bronchoalveolar lavage mononuclear cells (BAC) and washed whole blood cells (Blood) was measured in 8 patients with bronchogenic carcinoma and 8 healthy control subjects. The mean NK activity by BAC from the patients with bronchogenic carcinoma was 2.81 lytic units, and from the control subjects it was 0.19 lytic units (p less than 0.001). When the data were expressed as a ratio of NK activity for BAC/Blood, the mean ratio was 0.98 in patients with cancer compared with 0.12 in control subjects (p less than 0.003). IL-2 activity was bioassayed in recovered bronchoalveolar lavage fluid (BAL) using 3H-thymidine uptake by IL-2-dependent T-cells. The concentration of IL-2 was expressed as units per microgram albumin and also as units multiplied by a dilution factor. The median concentration of IL-2 in BAL from the patients with bronchogenic carcinoma was 10.5 units x 10(-3)/micrograms albumin (range, 3.7 to 229), and from the healthy control subjects it was 0.37 units x 10(-3)/micrograms albumin (range 0.26 to 0.70) (p less than 0.001). When IL-2 activity was expressed as total number of IL-2 units in recovered lavage fluid times a dilution factor (volume of saline used for lavage/volume of lavage fluid recovered), the median number of IL-2 units was 4.7 for the patients with bronchogenic carcinoma and 0.085 for the control subjects (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchoalveolar Lavage Fluid↗
PubMed1987

Value of repeat fiberoptic bronchoscopies and significance of nondiagnostic bronchoscopic results in patients with the acquired immunodeficiency syndrome.

Out of 286 patients with the acquired immunodeficiency syndrome (AIDS) who had fiberoptic bronchoscopies performed for the diagnosis of pulmonary disease, 21 (7.3%) patients (Group I) had repeat procedures after 1 to 30 days (mean, 14.8 days) because of persistent pulmonary infiltrates despite therapy, and 46 (15.9%) patients (Group II) had repeat procedures after 2 to 32 months (mean, 7.5 months) because of recurrent pulmonary infiltrates after initial clinical and radiographic improvement. Pneumocystis carinii pneumonia was the most common diagnosis in both groups on initial evaluation, being found in 55% of the patients. Repeat bronchoscopy yielded a new treatable diagnosis in 1 (5%) of 21 patients in Group I and in 27 (59%) of 46 patients in group II. Sixty-two percent of patients in Group I died within 1 month. It appears that in patients with AIDS who have persistent or worsening pulmonary infiltrates despite therapy, repeat bronchoscopy after a short interval (i.e., less than 1 month) is unlikely to have therapeutic implications. In contrast, those patients whose pulmonary involvement resolves initially may benefit from an aggressive diagnostic approach if new pulmonary infiltrates appear. In both groups, nondiagnostic bronchoscopies were common (29% overall). The most commonly missed bronchoscopic diagnoses (proved by open lung biopsy) were cytomegalovirus pneumonia and Kaposi's sarcoma, and neither had much therapeutic implication. Further, 12 patients in Group II with nondiagnostic bronchoscopies improved both radiographically and clinically even though no treatment was given.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Human T-cell lymphotropic virus-III (HTLV-III) seropositivity and related disease among 71 consecutive patients in whom tuberculosis was diagnosed. A prospective study.

The incidence of tuberculosis has recently risen in Southeast Florida. In order to determine the number and proportion of tuberculosis cases and the characteristics of tuberculosis that might be related to human T-cell lymphotrophic virus-III (HTLV-III) infection, all patients seen by the Dade County Florida Public Health Department-Tuberculosis Clinic during a 6-month period were medically evaluated and screened for HTLV-III antibody by an enzyme-linked immunosorbent assay. Of 71 consecutive patients confirmed to have tuberculosis (70 by culture) during the study period, 22 (31%) were seropositive and 49 (69%) were seronegative for HTLV-III antibody. The seropositive group had a significantly higher proportion of patients who were black, Haitian, and within the age group of 25 to 44 yr. The seropositive group also had a significantly higher rate of mild-to-moderate serum aspartate transaminase elevations (less than or equal to 5 times normal), tuberculin skin test false negativity, extrapulmonary tuberculosis (especially lymphatic), and pulmonary tuberculosis with an atypical radiographic picture. The seropositive group had a significantly lower proportion of patients with sputum cultures positive for M. tuberculosis. There was no significant difference between the groups with respect to the proportion of patients with positive sputum smears when sputum cultures were positive, serious antituberculosis drug reactions (requiring discontinuation of therapy), or percent of home contacts who were tuberculin skin tested and found to be positive. At the time of the diagnosis of tuberculosis, only 6 (27%) of the seropositive patients with tuberculosis had clinical evidence of AIDS or AIDS-related complex (unexplained thrush).(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1986

ICU survival of patients with the acquired immunodeficiency syndrome.

The ICU records of 31 patients with the acquired immunodeficiency syndrome were reviewed. Of 23 (74%) patients admitted for respiratory failure requiring intubation and mechanical ventilation, 20 (87%) patients had Pneumocystis carinii and/or cytomegalovirus pneumonia. Of the eight patients admitted without respiratory failure, five (63%) were monitored after brain biopsy. Respiratory failure patients remained in the ICU for 10 +/- 1 days, compared to 5 +/- 1 days for those without respiratory failure (p less than .05). Overall mortality was 24 patients (77%); 21 (91%) of 23 respiratory failure patients died, compared to three (38%) of the eight without respiratory failure (p less than .01). All seven ICU survivors lived to hospital discharge.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Sputum examination for the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome.

The diagnostic utility of sputum examination in patients with Pneumocystis carinii pneumonia secondary to the acquired immunodeficiency syndrome (AIDS) has so far not been determined. Sputum was induced in 43 patients with AIDS or suspected AIDS just prior to fiberoptic bronchoscopy, scheduled because of an unexplained pulmonary infiltrate on a chest radiograph. Pneumocystis carinii pneumonia was diagnosed by sputum examination and/or by a bronchoscopic procedure in 20 patients. Of these, sputum samples were positive for Pneumocystis organisms in 11 (55%) of 20 patients tested, bronchial washings were positive in 11 (79%) of 14 patients tested, brush biopsies were positive in 9 (53%) of 17 patients tested, and transbronchial lung biopsies were positive in 18 (90%) of 20 patients tested. The presence of P. carinii cysts in sputum did not correlate with the presence of alveolar macrophages in sputum nor with the volume of sputum. Sputum examination for P. carinii organisms, employed as a first diagnostic step in patients with AIDS with pulmonary infiltrates, may frequently obviate the need for bronchoscopy.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Pneumocystis carinii pneumonia presenting as cavitating and noncavitating solitary pulmonary nodules in patients with the acquired immunodeficiency syndrome.

Among 150 cases of microscopically proved Pneumocystis carinii pneumonia secondary to the acquired immunodeficiency syndrome (AIDS) seen by our pulmonary service from January 1982 to January 1986, P. carinii presented roentgenographically as a solitary pulmonary nodule in 2 patients (1.3%). It was the sole cause of the nodules as determined by clinical and roentgenographic response to specific drug therapy, examination of specimens obtained at fiberoptic bronchoscopy, and examination of lung specimens obtained at autopsy. In one of the patients, the nodule appeared to develop a large central cavity, which was confirmed at autopsy. In patients with AIDS, a solitary pulmonary nodule with or without cavitation may rarely represent P. carinii pneumonia.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Pulmonary nocardiosis in the acquired immunodeficiency syndrome. Diagnosis with bronchoalveolar lavage and treatment with non-sulphur containing drugs.

A patient with the acquired immunodeficiency syndrome (AIDS) presented with Pneumocystis carinii pneumonia and pulmonary nocardiosis. The nocardial lesions appeared small and localized on chest radiograph. On two separate occasions, nocardial organisms were absent in transbronchial lung biopsy specimens, but were identified in bronchoalveolar lavage fluid probably because the latter specimen sampled a larger area of lung. The patient was initially treated with trimethoprim-sulfamethoxazole (TMP/SMX) for both infections. When TMP/SMX was discontinued because of an adverse reaction, the nocardiosis promptly exacerbated but was then easily controlled with minocycline and amikacin followed by minocycline and cycloserine. Among patients with AIDS who have sulfamethoxazole hypersensitivity during treatment for nocardiosis, alternative drugs may be efficacious and may be particularly important in this setting because they have a lower incidence of toxicity.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Salmonella bacteremia as manifestation of acquired immunodeficiency syndrome.

Multiple opportunistic infections are characteristic of the acquired immunodeficiency syndrome (AIDS). Although bacterial pathogens have presented few problems, we have noted an emerging problem with salmonellal infection among patients with AIDS. A review of all stool and blood cultures from adults between January 1982 and July 1984 showed that 80 stool cultures were positive for Salmonella species; serogroup B was the most common isolated. Eight (10%) were isolated from patients with AIDS. Nineteen blood cultures were positive for Salmonella species. Six (32%) were isolated from patients with AIDS: three were positive for Salmonella serogroup B; two yielded Salmonella choleraesuis; and one yielded Salmonella serogroup D. In three (50%), Salmonella bacteremia was a presenting manifestation of AIDS. Bacteremias were recurrent in five patients. Thus, it appears that AIDS not only predisposes patients to serious salmonellal infections but also compromises their ability to eradicate these bacteria.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Evaluation of patients with the acquired immunodeficiency syndrome (AIDS) by fiberoptic bronchoscopy.

Hospital records were reviewed on 78 consecutive patients (33 homosexuals, 37 Haitians and 8 IV drug abusers) who had AIDS and who underwent fiberoptic bronchoscopy over a two year period. Pneumocystis carinii pneumonia (PCP) was the most common bronchoscopic finding (53.8% of patients) followed by tuberculosis (14.1%), cytomegalovirus infection (12.8%) and atypical mycobacteriosis (3.8%). In 15.4% of patients multiple organisms were found. Twenty-seven percent of patients had non-diagnostic bronchoscopies. In 8 patients with non-diagnostic bronchoscopies, open-lung biopsy or autopsy revealed PCP (2 patients), Kaposi's sarcoma (3 patients) and non-specific lymphocytic-plasmacytic infiltrates (3 patients). Histologic studies of transbronchial biopsy specimens were more sensitive for the diagnosis of PCP than touch imprints. PCP was diagnosed in 15 patients who had received trimethoprim-sulfamethoxazole for up to 4 days. Mean duration of respiratory symptoms prior to bronchoscopy was 4.2 weeks in patients with PCP and was not significantly different in patients with other bronchoscopic diagnoses. Historical, laboratory and chest radiographic parameters were not helpful in establishing a diagnosis or assessing prognosis in these AIDS patients with pulmonary infiltrates. Fiberoptic bronchoscopy with transbronchial biopsy is safe (only one of the patients had a self limited hemorrhagic episode) and sensitive for the diagnosis of pulmonary infiltrates in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1985

The radiographic appearance of tuberculosis in patients with the acquired immune deficiency syndrome (AIDS) and pre-AIDS.

We reviewed the medical records and chest radiographs of 23 adult patients with culture-proved tuberculosis and verified acquired immune deficiency syndrome. Seventeen patients, including 8 with disseminated tuberculosis, had positive sputum or bronchial washing cultures for Mycobacterium tuberculosis. Their initial pretreatment radiographs revealed hilar and/or mediastinal adenopathy in 10 patients (59%), localized pulmonary infiltrates limited to the middle or lower lung fields in 5 patients (29%), localized pulmonary infiltrates involving an upper lobe in 3 patients (18%), diffuse miliary or interstitial infiltrates in 3 patients (18%), no pulmonary infiltrates in 6 patients (35%), and no abnormalities in 2 patients (12%). Pulmonary cavitation was not seen. Only 1 patient (6%) had a chest radiograph typical of adult onset reactivation tuberculosis (i.e., localized pulmonary infiltrate involving the upper lung fields without hilar or mediastinal adenopathy). Six patients (35%) had pulmonary infiltrates that may have been caused by concomitant nontuberculous infection. Six patients had positive cultures for M. tuberculosis from extrapulmonary sites only. Three (50%) of these patients had hilar and/or mediastinal adenopathy. None of them had pulmonary infiltrates on their initial chest radiograph.

Acquired Immunodeficiency Syndrome↗