Infection and disease due to human immunodeficiency virus and the acquired immunodeficiency syndrome.
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Biomedical subjects
Publications and source records attributed to B Postic.
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We have described the case of a patient with AIDS in whom a chylothorax developed, probably as a result of lymphatic obstruction from KS. This case emphasizes that the loss of proteins, fats, and lymphocytes into chylous pleural effusions can be particularly devastating in AIDS patients, who have profound nutritional problems and a marked depletion in the level of helper T-lymphocytes.
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.
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The failure of the 1982-1983 influenza vaccine to protect elderly NHCU residents from clinical infection with influenza A/Philippines/2/82 resulted primarily from antigenic drift of the epidemic strain, inasmuch as the attack rates in the vaccinated and nonvaccinated patients were not significantly different. This experience supports the decision to replace A/Bangkok/1/79 with A/Philippines/2/82 virus antigen in the 1983-1984 influenza vaccine.
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Vancomycin pharmacokinetics were studied in four patients with peritonitis undergoing chronic intermittent peritoneal dialysis. Serum levels exceeding 4.0 micrograms/ml were maintained for 8 and 13 days after a single 1-g intravenous dose. Vancomycin serum concentrations measured before, during, and upon completion of dialysis revealed no appreciable decline. Peritoneal fluid concentrations in two patients exceeded 4.0 micrograms/ml for more than 12 days.
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The unsuspected introduction of a carrier of hepatitis B virus into a hepatitis-free hemodialysis unit coincided with a routine serologic survey in early April 1976. Thus the prevalence of hepatitis B surface antigen and its antibody was known for the 42 patients and 23 personnel at risk. Control consisted of isolating the patient identified as a carrier seven days after admission. Immune globulin was not given to potentially exposed persons. During a 15-month period, only one case of icteric hepatitis B occurred, in a nurse who was probably infected through defective gloves while attending the carrier in isolation. Monthy serologic tests showed that none of the other personnel and patients became infected with hepatitis B virus. This limited spread of hepatitis B indicated that isolation of the carrier was an effective preventive measure in given setting.
A heroin addict with asymmetric septal hypertrophy and persistent fungemia with Candida parapsilosis was treated with amphotericin B and flucytosine (5-fluorocytosine). The diagnosis of endocarditis was based on the subsequent development of a murmur of mitral regurgitation and echocardiographic evidence of prolapse of the posterior leaflet of the mitral valve. Cure was effected with antifungal therapy alone. Thus, when the diagnosis of fungal endocarditis is made early in its course, open-heart surgery may not be needed. To investigate the relative frequency of isolation of C parapsilosis from particular sites, a mycologic survey was conducted in our hospital. Among the isolates of yeasts, C parapsilosis represented 8.0, 17.1, and 26.7 percent of those from all cultured sites, from contaminated intravenous catheters, and from cultures of blood, respectively. Since this trend to cluster in cases of fungemia was not seen with other yeasts, C parapsilosis appears to be more invasive than other species of Candida.
The incidence of infections due to Serratia marcescens increased steadily at the Veterans Administration Hospital in Pittsburgh, Pennsylvania from 1970 to mid 1975 followed by a decline extending into 1977. One hundred eighty-four Serratia marcescens isolates were collected from 123 patients over a 4-month period in 1975 and were characterized by stereotype and antibiotic sensitivity. Three-fourths of the isolates were clinically significant. Among 24 stereotypes O-:H2 predominated in the urinary tract and O-H12 in respiratory secretions. Clusters of serotypes were on occasion identified in the GU Surgery Ward and the Intensive Care Unit. Uninary isolates showed remarkable resistance to antibiotics; only two thirds were susceptible to amikacin, the most effective agent in vitro. The patients from whom Serratia was isolated were older than the general hospital population (60 vs. 53.6 years of age), were hospitalized longer than the age-corrected controls (62 vs. 34.5 days) and two-thirds of thirds of them acquired the infection in the hospital. Uninary catheterization and prior antibiotic therapy were significant risk factors for urinary infections, and prior surgery contributed to recovery of Serratia from the respiratory tract. Serotype and antibiotype differences between isolates from the urinary and those from the respiratory tract suggest that strains evolved a site specificity.
Human cell culture-derived interferon was shown to inhibit human cytomegalovirus in vitro. A prototype strain, Davis, and six clinical isolates of cytomegalovirus were tested. All six isolates showed uniform susceptibility to interferon, exceeding that of the Davis strain by two- to fourfold. The latter virus was found to be 32 to 4 times less susceptible than the sensitive indicator, vesicular stomatitis virus. However, the laboratory finding of susceptibility to an antiviral material may not relate to its clinical effectiveness.
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