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Biomedical subjects

D Fertel

Publications and source records attributed to D Fertel.

8 recordsLinked to original sources
PubMed1992

Medical management of AIDS patients. Tuberculosis and nontuberculous mycobacterial disease.

AIDS has been responsible for a significant increase in mycobacterial disease, which in this setting is often extrapulmonary. In contrast to HIV-associated Mycobacterium avium complex disease, HIV-associated tuberculosis is normally transmissible between humans by the aerosol route, occurs earlier than most AIDS-related infections, and is readily treatable and preventable with conventional drugs.

HIV Infections↗
PubMed1989

Tuberculosis in acquired immune deficiency syndrome.

The acquired immune deficiency syndrome (AIDS) epidemic has resulted in a rising incidence of tuberculosis (TB) in the United States, especially in inner cities where AIDS is prevalent and among human immunodeficiency virus (HIV) infected subpopulations with a relatively high background prevalence of tuberculous infection (ie, intravenous drug abusers, Haitians, blacks). Because M tuberculosis is a relatively virulent organism among the AIDS related infections, TB occurs early (often as a sentinel disease) in the course of progressive HIV-induced immunosuppression. In this setting, TB commonly presents in a disseminated, extrapulmonary, or "unusual" form, and when pulmonary TB occurs, the chest radiographic picture is often atypical. Further, the tuberculin test is falsely negative in more than 50% of cases. A high index of suspicion and an aggressive diagnostic approach is required to avoid missing HIV-related tuberculous disease, which is communicable to the general population and is readily treatable with conventional anti-TB drugs. In order to control the rising incidence of AIDS-related TB, tuberculin skin testing must be performed early for all patients who are either HIV infected or are in high risk groups for HIV infection (while they can still react to tuberculin), and isoniazid prophylaxis carried out for those who are tuberculous infected.

Acquired Immunodeficiency Syndrome↗
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

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↗
PubMedDate not supplied

Acanthamoeba infection in lung transplantation: report of a case and review of the literature.

A 49-year-old woman underwent bilateral lung transplantation for advanced idiopathic pulmonary fibrosis. During the postoperative period she received immunosuppressive medications as well as corticosteroids. Aspergillus fumigatus grew from a sputum sample, and she was treated with nebulized amphotericin. She was discharged on tacrolimus and prednisone. After initially doing well, she required re-hospitalization for treatment of cytomegalovirus and Pseudomonas aeruginosa pneumonia. She was treated with ganciclovir and cefepime and, after a 2-week hospitalization, was discharged. Seven months after transplantation she developed progressive sinusitis, treated with antibiotics and sinus debridement surgery. Aspergillus organisms were recovered and, at the periphery of the tangled masses of Aspergillus hyphae, numerous amebic cysts were also identified, which were morphologically consistent with Acanthamoeba spp. Subsequent electron microscopy and immunofluorescent staining confirmed this impression. She was initially treated with intravenous amphotericin, later changed to voriconazole and caspofungin. Debridement of the sinuses 3 weeks later revealed fungal hyphae but no amebae. Infections with Acanthamoeba have rarely been reported in lung transplantation but have been recognized in bone-marrow and renal transplant patients, and have been lethal in many cases, particularly in patients with immunosuppression due to human immunodeficiency virus infection. More recently, aggressive antimicrobial therapy has resulted in successful outcomes, as discussed herein.

Acanthamoeba↗