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Biomedical subjects

D Mildvan

Publications and source records attributed to D Mildvan.

At least 73 records · Page 4Linked to original sources
PubMed1985

The bone marrow in AIDS. A histologic, hematologic, and microbiologic study.

During one year, 55 bone marrow biopsies from 49 patients with CDC-defined acquired immune deficiency syndrome (AIDS) were studied. Eighty-three percent were normocellular or hypercellular; 17% were hypocellular. Marrow plasma cells were increased in 83% of patients, most showing polyclonal hypergammaglobulinemia. Forty percent of patients showed peripheral neutropenia, 29% thrombocytopenia, and 79% lymphopenia with markedly reduced T4+ lymphocytes. Eighty-five percent of patients were anemic, with iron studies showing a pattern consistent with the anemia of chronic disease. Mycobacterium avium-intracellulare (MAI) grew from ten (20%) biopsies, four with granuloma and six without granuloma (five of these six also showed marrow hypocellularity). Small poorly formed granuloma (70-150 micron) were seen in eight (16%) patients (four AFB-culture positive, 4 negative). Three of four granuloma-positive, culture-negative cases eventually grew MAI from autopsy material. Five (10%) patients had lymphoplasmacytic aggregates; later, one developed lymphoma, another, markedly atypical lymphoid hyperplasia. Two additional patients showed marrow B-cell lymphomas. Of these findings, only marrow MAI meets the CDC definition of AIDS. However, in this series, small ill-defined granulomas, lymphoplasmacytic aggregates, and B-cell lymphomas also were found. The authors conclude that these latter findings, when seen in high-risk patients, particularly those with lymphopenia, anemia, and/or hypergammaglobulinemia, also strongly suggest the diagnosis of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Salmonella bacteremia associated with the acquired immunodeficiency syndrome (AIDS).

Six cases of bacteremia due to serotypes of Salmonella enteritidis are described in patients with the acquired immunodeficiency syndrome (AIDS). In four instances the bacteremia was recurrent despite appropriate antimicrobial treatment. Neither a gastrointestinal tract source nor any other focus of infection could be identified in four of the six patients. In one patient an unusual Salmonella infection, ie, pyelonephritis, was noted. The discovery of Salmonella sepsis led in four cases to the initial diagnostic consideration of AIDS, which was ultimately confirmed. When unexplained Salmonella bacteremia occurs in populations known to be at high risk for the development of AIDS, a thorough evaluation for this disorder should be undertaken.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Longitudinal study of persistent generalised lymphadenopathy in homosexual men: relation to acquired immunodeficiency syndrome.

42 homosexual or bisexual men with persistent generalised lymphadenopathy not attributable to an identifiable cause have been followed longitudinally since February, 1981. Lymphadenopathy was accompanied by fatigue, low-grade fever and/or night sweats (57%), splenomegaly (29%), leucopenia (40%), hypergamma - globulinaemia (76%), and diminished proportion and absolute numbers of helper T cells (95%). Of the 26 patients who had lymph node biopsy, all showed benign reactive hyperplasia. After 15-30 (median 22) months, 8 patients have met criteria for the diagnosis of acquired immunodeficiency syndrome (AIDS). This outcome was associated with previous heavy nitrite inhalant use, with the presence of night sweats, with leucopenia, and with the triad of constitutional symptoms, splenomegaly, and leucopenia. In addition, a lower mean absolute helper T cell count and an increased frequency of anergy to mumps intradermal antigen and of herpes simplex virus isolation distinguished these patients from those remaining in the cohort, who seem to be stable and in some cases to have improved.

Acquired Immunodeficiency Syndrome↗
PubMed1984

The syndrome of unexplained generalized lymphadenopathy in young men in New York City. Is it related to the acquired immune deficiency syndrome?

To establish whether the syndrome of unexplained generalized lymphadenopathy in homosexual men was new and related epidemiologically to the acquired immune deficiency syndrome (AIDS), we reviewed 3,139 pathology reports of lymph node biopsies performed at seven hospitals in New York City during the years 1977 through 1981. Three hundred twenty-nine patients (10%) were categorized as having unexplained lymph node hyperplasia; a detailed medical record review of 30% of these patients revealed three, two, six, eight, and 16 cases of unexplained generalized lymphadenopathy in the five years studied, respectively. Of these 35 cases, 26 (74%) occurred in males aged 16 to 44. A record review of 68 additional male patients aged 16 to 44 years with unexplained lymph node hyperplasia in two of the hospitals showed a similar increase in cases of unexplained generalized lymphadenopathy during the five-year period. Twenty-one of 25 cases in males with known sexual orientation were homosexual or bisexual. The increase in the syndrome of unexplained generalized lymphadenopathy from 1978 to 1981 and the characteristics of the population affected are similar to those observed for AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Central-nervous-system toxoplasmosis in homosexual men and parenteral drug abusers.

Central-nervous-system toxoplasmosis developed in 7 of 269 patients with the acquired immunodeficiency syndrome reported to the New York City Health Department through July 1982. Focal neurologic abnormalities, mass lesions on computed-tomographic brain scans, lymphocytic cerebrospinal fluid pleocytosis, and detectable IgG antibody to Toxoplasma gondii were common; but IgG titers of 1:1024 or more, IgM antibody to T. gondii, and positive open brain biopsies were uncommon. Serologic findings suggested that the disease resulted from recrudescent rather than primary infection. Four of five patients improved when treated with sulfonamides and pyrimethamine, but 2 had relapses. An aggressive diagnostic approach and sometimes even empiric therapy are warranted when central-nervous-system toxoplasmosis is suspected in a seropositive patient with the acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Mycotic aortic aneurysm. A complication of Campylobacter fetus septicemia.

The first surviving case, to our knowledge, of a Campylobacter fetus mycotic aortic aneurysm is reported. Bacteremia and an ileofemoral thrombophlebitis preceded the development of the infected aneurysm, reconfirming the vascular tropism of this organism. The clinical similarity with infections caused by Salmonella choleraesuis is illustrated by this case. The full recovery of our patient attests to the efficacy of extralanatomic bypass combined with long-term antibiotic therapy in the treatment of aortic mycotic aneurysm. Because of frequent changes in nomenclature and insufficient emphasis on speciation of the various campylobacters, pathogenesis and optimal antimicrobial therapy for systemic C fetus infections have not yet been adequately defined.

Aged↗
PubMed1983

Cytomegalovirus retinitis: a manifestation of the acquired immune deficiency syndrome (AIDS).

Two homosexual males with the "gay bowel syndrome' experienced an acute unilateral loss of vision. Both patients had white intraretinal lesions, which became confluent. One of the cases had a depressed cell-mediated immunity; both patients ultimately died after a prolonged illness. In one patient cytomegalovirus was cultured from a vitreous biopsy. Autopsy revealed disseminated cytomegalovirus in both patients. Widespread retinal necrosis was evident, with typical nuclear and cytoplasmic inclusions of cytomegalovirus. Electron microscopy showed herpes virus, while immunoperoxidase techniques showed cytomegalovirus. The altered cell-mediated response present in homosexual patients may be responsible for the clinical syndromes of Kaposi's sarcoma and opportunistic infection by Pneumocystis carinii, herpes simplex, or cytomegalovirus.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Virus-associated colitis in homosexual men: two case reports.

Two homosexual men with colitis are described. In each case there was evidence of viral infection of the colon. One patient developed toxic megacolon that responded to conservative therapy. The other patient had proctosigmoiditis and opportunistic infections that eventually led to his death. An intensive search for viruses should be made in all homosexual men with proctitis and/or colitis.

Adult↗
PubMed1982

Opportunistic infections and immune deficiency in homosexual men.

A syndrome of opportunistic infections and acquired immune deficiency occurred among four previously healthy homosexual men. Fever, leukopenia, and diminished delayed hypersensitivity were accompanied by various degrees of proctitis, perianal ulcerations, and lymphadenopathy. The infectious agents included Pneumocystis carinii, Cryptococcus neoformans, Candida albicans, herpes simplex virus, and cytomegalovirus. The immune deficiency was characterized as a persistent and profound selective decrease in the function as well as number of T lymphocytes of the helper/inducer subset and a possible activation of the suppressor/cytotoxic subset. Three patients died despite aggressive anti-infective therapy.

Adult↗
PubMed1981

Sexual transmission of enteric protozoa and helminths in a venereal-disease-clinic population.

We examined the prevalence of enteric protozoan and helminthic infections and the associations between infection and gender, sexual preference, and sexual practices in 180 consecutive patients at a venereal-disease clinic. Of 163 men, 29 were infected with one or more enteric parasites. None of the 17 women had an enteric infection. The prevalence of infections with Entamoeba histolytica or Giardia lamblia (or both) was 21.5 per cent in homosexual men, 6.2 per cent in bisexual men, and 0 in heterosexual men. There were significant associations between oral-anal sex and infection with E. histolytica (P less than 0.01) or with helminths (P less than 0.05). Homosexuality and oral-anal sex were the most important risk factors in E. histolytica, G. lamblia, and helminthic infections. We conclude the "hyperendemic" enteric protozoan infection rates in homosexual men are related to three factors: the original endemic level in the general population; the prevalence of sexual acts that facilitate transmission; and the frequency of exposure to an infected person.

Entamoebiasis↗