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Biomedical subjects

D L Cohn

Publications and source records attributed to D L Cohn.

At least 73 records · Page 4Linked to original sources
PubMed1991

Pneumothorax with Pneumocystis carinii pneumonia in AIDS. Incidence and clinical characteristics.

A retrospective review of the charts of patients with the acquired immunodeficiency syndrome (AIDS) was performed at three university-affiliated teaching hospitals in Denver between May 1982 and April 1987. Patients were evaluated for the presence or absence of Pneumocystis carinii pneumonia (PCP) and for the occurrence of pneumothorax at any time during their clinical course. The incidence of pneumothorax in AIDS patients with PCP was 9.0 percent (8/89), compared with 0 percent (0/45) in AIDS patients without PCP (p less than 0.03). All of the pneumothoraces resolved, most without chest tube placement. This study suggests that in patients with AIDS, PCP is associated with an increased incidence of pneumothorax, while AIDS patients without PCP are not at increased risk for the development of pneumothorax.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Bacterial pneumonia in the HIV-infected patient.

The incidence of bacterial pneumonia is increased in human immunodeficiency virus (HIV) infection, and bacteremia and recurrences occur frequently. Streptococcus pneumoniae and Haemophilus influenzae are the most common pathogens, but several other organisms have now been identified as etiologies. Several abnormalities in B-cells and humoral immunity, and possibly neutropenia and white blood cell dysfunction, predispose to bacterial pneumonia. Despite the severity of pneumonia in HIV infection, most patients respond well to specific antimicrobial chemotherapy. Potential preventive measures include vaccines, immunoglobulin therapy, and antimicrobial prophylaxis.

Bacterial Infections↗
PubMed1991

Marked elevations of serum alkaline phosphatase in patients with AIDS.

We have observed many patients with AIDS who have unexplained marked elevations in serum alkaline phosphatase. To determine the frequency of alkaline phosphatase elevations in patients with AIDS, and to identify diagnoses, medications, and demographic factors associated with such elevations, we conducted a retrospective study of the first 90 consecutive AIDS cases in hospitals affiliated with the University of Colorado Health Sciences Center in Denver, Colorado. We found elevations of alkaline phosphatase in excess of 1,000 IU/L in 17% of consecutive patients with AIDS. This level of elevation was less frequent in patients with Kaposi's sarcoma but there was otherwise no significant association with diagnoses or medications, or transmission categories for AIDS. The majority of the patients with elevations to this level did not have documented opportunistic infections or biliary tract dilatation previously described in the "cholangitis" syndrome in AIDS patients. Other explanations for these elevations for this common laboratory finding may exist.

Acquired Immunodeficiency Syndrome↗
PubMed1990

A 62-dose, 6-month therapy for pulmonary and extrapulmonary tuberculosis. A twice-weekly, directly observed, and cost-effective regimen.

STUDY OBJECTIVE: To evaluate the efficacy and toxicity of a 62-dose, four-drug, 6-month, and directly observed regimen for treatment of pulmonary and extrapulmonary tuberculosis. DESIGN: An open, nonblinded clinical trial, with intended follow-up of patients for 36 months after the completion of therapy. SETTING: A metropolitan tuberculosis clinic in a public health department. PATIENTS: From March 1981 through April 1989, we enrolled 160 patients with suspected or known tuberculosis; 35 of these patients were excluded from the analysis. INTERVENTIONS: Isoniazid, rifampin, pyrazinamide, and streptomycin were administered daily for 2 weeks; these drugs were then given in higher doses twice weekly for 6 weeks, followed by isoniazid and rifampin twice weekly for 6 weeks, followed by isoniazid and rifampin twice weekly for 18 weeks. A total of 62 doses were administered, and all therapy was directly observed by a nurse or an outreach worker. MEASUREMENTS AND MAIN RESULTS: Of the 125 evaluable patients, 101 (81%) had pulmonary tuberculosis, 7 (6%) had both pulmonary and extrapulmonary involvement, and 17 (13%) had extrapulmonary disease only. Seventy-one (57%) patients had a history of recent alcoholism. There were two relapses (1.6% +/- 2.2%), occurring 6 and 56 months after the completion of therapy. The time at which sputum samples became culture negative in pulmonary patients ranged from 1 to 19 weeks (median, 4.6 weeks); 40% +/- 9.6% of patients were culture-negative after 4 weeks of therapy, 75% +/- 8.5% after 8 weeks, 94% +/- 4.7% after 12 weeks, 97% +/- 3.3% after 16 weeks, and 100% after 20 weeks. Adverse drug reactions included hyperuricemia (greater than 178 mumol/L [3 mg/dL] above normal) secondary to pyrazinamide in 80 patients (64%), twofold or greater elevations of aspartate aminotransferase in 21 patients (17%), 1.5-fold or greater elevations of alkaline phosphatase in 33 patients (27%), cutaneous abnormalities in 8 patients (6%), nausea in five patients (4%), and dizziness in 1 patient (1%). CONCLUSIONS: This 62-dose, largely twice-weekly tuberculosis treatment regimen is efficacious and relatively nontoxic and is especially useful for patients in whom directly observed therapy is indicated.

Adolescent↗
PubMed1989

Clinical and immunologic significance of cholera-like toxin and cytotoxin production by Campylobacter species in patients with acute inflammatory diarrhea in the USA.

The humoral immune response to both Campylobacter jejuni cell surface antigens and to potential toxins of the organism was studied in 64 adults with inflammatory diarrhea. In an enzyme-linked immunosorbent assay (ELISA) for surface antigens, 17 (71%) of 24 persons with Campylobacter enteritis showed seroconversion in more than one immunoglobulin class, versus only 2 (5%) of 40 patients with non-Campylobacter enteritis. In a GM1, ganglioside-based ELISA for detecting serum IgG to cholera-like enterotoxin, only one patient studied showed seroconversion to the enterotoxin. Of 22 Campylobacter isolates studied for production of cholera-like toxin, none of the supernatants from the Campylobacter strains were positive. Supernatants were also tested for enterotoxin and cytotoxic activity on Chinese hamster ovary cells; all isolates were negative for enterotoxin activity. In contrast, cytotoxin was produced by 7 (32%) isolates but was usually low-level and was not neutralized by patient's serum. These findings indicate that production of cholera-like toxin and cytotoxin by Campylobacter strains in the United States occurs in few strains and that host immune response is absent; their biologic significance in the pathogenesis of Campylobacter infections remains unclear.

Acute Disease↗
PubMed1989

Defects in sera from acquired immunodeficiency syndrome (AIDS) patients and from non-AIDS patients with Mycobacterium avium infection which decrease macrophage resistance to M. avium.

Some characteristics of the sera and macrophages (MP) of human immunodeficiency virus (HIV)-infected patients which might contribute to their unusual susceptibility to Mycobacterium avium infection were studied. Cultures of patient peripheral blood MP in medium supplemented with their sera or normal subject sera were infected with M. avium and compared with similar cultures of normal MP. Intracellular mycobacterial replication was measured in the infected MP by CFU counts of the bacteria made from lysed samples of the MP at 0, 4, and 7 days after MP infection. Sera from patients with chronic granulomatous infection with M. avium, but no HIV infection, also were studied. The sera from all of the patients with chronic granulomatous infection and from several HIV-infected patients were deficient or lacking in an inhibitor that in normal serum acts within normal MP to suppress intracellular growth of M. avium. Most of the HIV-infected patients also had MP that were abnormally permissive for M. avium because they responded poorly to the serum inhibitor. Elucidation of these associated defects in native defenses against M. avium may result in better prevention and therapy of M. avium infections.

AIDS-Related Complex↗
PubMed1989

Diagnosis of Pneumocystis carinii pneumonia by induced sputum in a city with moderate incidence of AIDS.

Examination of induced sputum from AIDS patients has been reported to provide the noninvasive diagnosis of PCP in 10 to 76 percent of cases. Since previous studies were done in centers with a high incidence of AIDS, we asked whether this test could be implemented successfully in a center with a lower incidence of AIDS. Over a 13-month period 25 of 38 (66 percent) AIDS patients with PCP had positive Giemsa (Diff-Quik) stains of induced sputum. We were unable to predict before sputum induction which patients would be positive based on clinical severity (increased A-a gradient or serum LDH levels). We confirmed prior observations that a normal serum LDH level was found in only 5 percent of documented PCP cases. This noninvasive technique significantly decreased the number of bronchoscopies performed and led to a considerable cost savings.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Serosanguineous pleural effusions in AIDS-associated Kaposi's sarcoma.

We describe the clinical course and pleural fluid findings in patients with AIDS-associated pleural KS and survival analysis of cases from the Colorado registry with and without pleuropulmonary KS. Twenty-one of 105 (20 percent) of AIDS cases with KS had pleuropulmonary involvement with KS and 13 (62 percent) had pleural effusions. All cases were homosexual males with cutaneous lesions of KS that antedated pleural involvement by several months. Clinical presentation and physical examination findings were nonspecific. Chest roentgenograms generally showed nonloculated bilateral pleural effusions; concurrent parenchymal infiltrates were present in 90 percent. Pleural fluid analysis showed that most effusions were serosanguineous, mononuclear cell-predominant exudates. Pleural fluid was visibly blood-tinged in nine of ten cases, with median RBC counts of 52,000/microliters (range 16,000 to 803,000/microliters). Cytologic examination of pleural fluid or needle biopsy of the parietal pleura failed to establish the diagnosis. In two cases the effusions were chylous. Postmortem examination of the lungs typically showed multiple cherry red to purple lesions on the visceral but not parietal pleural surface. In half the cases progressive pleural effusions led to significant morbidity or mortality. Systemic chemotherapy for disseminated KS was minimally effective; chest tube thoracostomy with attempted tetracycline sclerosis was unsuccessful in controlling pleural effusions in three cases. Median survival from diagnosis of KS to death was 205 and 338 days, respectively, for patients with and without pleuropulmonary KS (p less than 0.01). Pleural effusions are common in AIDS-associated pleuropulmonary KS, and finding a serosanguineous exudative effusion in an AIDS patient with cutaneous KS is highly suggestive of the diagnosis of pleural KS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Pulmonary non-Hodgkin's lymphoma in AIDS.

Whereas extralymphatic involvement is common in lymphomas associated with HIV infection, there have been few reports of pulmonary lymphoma. In 648 cases of AIDS reported in Colorado, 40 have had non-Hodgkin's lymphoma. Of these, four have had documented pulmonary involvement and are reported in detail. Clinical manifestations were nonspecific and included fever, weight loss, generalized lymphadenopathy, dyspnea, chest pain and cough. Chest roentgenograms revealed multiple nodules or interstitial infiltrates. Transbronchial biopsy failed to establish the diagnosis in all cases. Three of four patients died four to five months after appearance of pulmonary nodules; one patient with stage IE disease showed slow radiographic progression over 16 months following radiation and chemotherapy and died 18 months after appearance of pulmonary nodules. Pulmonary involvement with lymphoma should be considered in patients with HIV infection, especially if multiple nodules are seen on chest roentgenograms.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Cytomegalovirus vasculitis and colon perforation in a patient with the acquired immunodeficiency syndrome.

We describe a patient with the acquired immunodeficiency syndrome who suffered a colon perforation which we believe was directly attributable to disseminated cytomegalovirus (CMV) infection. Thrombosed vessels within the submucosa and muscle wall contained evidence of CMV vasculitis, while adjacent vessels without viral inclusions were fully patent. This report supports other evidence that CMV may act as a primary etiologic agent of gastrointestinal disease, particularly in the immunocompromised host. The increased recognition of CMV as a cause of significant morbidity in certain gastrointestinal lesions becomes especially important with the advent of newer antiviral therapy specifically directed against CMV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Comparison of AIDS and HIV antibody surveillance data in Colorado.

We compared cumulative surveillance data for AIDS (May 1982-December 1986) and persons with positive HIV antibody tests (July 1985-December 1986) to examine the adequacy of each surveillance system in directing public health disease control activities. Neither AIDS nor HIV antibody surveillance data alone described the total extent of HIV infection. The geographic distribution of persons with positive HIV antibody tests was more widespread than the distribution of AIDS cases for all demographic and transmission categories. Ideally, preventive efforts should be based on a comprehensive surveillance system that indicates all persons who are infectious with HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Transmission of human immunodeficiency virus (HIV) by blood transfusions screened as negative for HIV antibody.

Since early 1985, blood donations in the United States have been screened for antibody to human immunodeficiency virus (HIV). To identify instances of HIV transmission by antibody-negative donations, we investigated 13 persons seropositive for HIV who had received blood from 7 donors who were screened as negative for HIV antibody at the time of donation. Twelve of the 13 recipients had no identifiable risk factors for HIV infection other than the transfusions they had received. On evaluation 8 to 20 months after transfusion, HIV-related illnesses had developed in three recipients, and the acquired immunodeficiency syndrome had developed in one. All seven donors were found to be infected with HIV. On interview, six reported a risk factor for HIV infection, and five had engaged in high-risk activities or had had an illness suggestive of acute retroviral syndrome within the four months preceding their HIV-seronegative donation. Thus, these donors had apparently been infected only recently, and so were negative at the time of blood donation according to available antibody tests. We conclude that there is a small but identifiable risk of HIV infection for recipients of screened blood. To minimize this risk, the reasons for deferral of donation need to be communicated more effectively to blood donors who are at high risk of HIV infection, and new assays that detect HIV infection earlier should be evaluated for their effectiveness in screening donated blood.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Class-specific antibody response to pneumococcal capsular polysaccharides in men infected with human immunodeficiency virus type 1.

We characterized the effect of infection with human immunodeficiency virus type 1 (HIV) on levels of total immunoglobulins and pneumococcal vaccine-specific immunoglobulins in 28 heterosexual and 25 homosexual men seronegative for HIV; 27 asymptomatic, seropositive homosexual men; and 21 patients with AIDS. Total serum IgG levels were increased in both HIV-seropositive groups compared with the HIV-seronegative men (P less than .001). Total IgM levels, however, were elevated only in the asymptomatic, HIV-seropositive men (P less than .08); total IgA levels were elevated only in the patients with AIDS (P less than .05). Vaccine-specific serum IgG, IgM, and IgA significantly increased over baseline three and six weeks after immunization in all groups (P less than .05). Responses to vaccine among the HIV-seronegative groups were similar but were greater for all antibody classes than were responses among the HIV-seropositive groups (P less than .05).

Acquired Immunodeficiency Syndrome↗
PubMed1988

Persistent Campylobacter jejuni infections in patients infected with the human immunodeficiency virus (HIV).

We identified Campylobacter jejuni infections in four patients infected with the human immunodeficiency virus (HIV); three had persistent and severe C. jejuni infections. Multiple isolates obtained from each patient had the same biochemical and serotypic characteristics, indicating recurrent infection rather than reinfection with unrelated strains. Serum antibody responses to C. jejuni group antigens by enzyme-linked immunosorbent assay were markedly impaired in the three patients with persistent infection compared with forty-two immunocompetent C. jejuni-infected controls and with the HIV-infected patient who readily cleared the organism. One patient was bacteremic; his blood isolate was killed by normal serum but was resistant to his own serum, whereas a simultaneous stool isolate of a different serotype was sensitive. Failure of two patients to eradicate the organism and long-term administration of erythromycin therapy led to the in-vivo development of resistance to this antibiotic, which is most frequently used to treat C. jejuni infections.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Hepatic inflammation, hepatitis B replication, and cellular immune function in homosexual males with chronic hepatitis B and antibody to human immunodeficiency virus.

We measured serum aspartate transaminase (AST) concentration and serum hepatitis B virus (HBV) DNA concentration in homosexual men with chronic HBV infection and a spectrum of immune deficiency as a result of exposure to human immunodeficiency virus (HIV). Serum AST and HBV DNA concentrations were similar in patients with varying immune function as indicated by in vivo criteria (diagnosis and skin tests reactivity) and in vitro criteria (lymphocyte transformation responses to mitogens and Candida and tetanus antigens) and were unrelated to the number of circulating T cells, suppressor/cytotoxic cells, helper cells, natural killer cells, and the helper:suppressor ratio. Serum AST concentration and indices of cellular immune function were similar in patients with varying HBV replicative activity (high and low HBV DNA concentrations). The observed lack of relationship between serum AST concentration and indices of cellular immune function and HBV replication suggests either that other factors determine the severity of hepatic inflammation in chronic HBV infection, or that currently available tests of cellular immune function and HBV replicative activity do not accurately reflect processes in the liver.

Adult↗