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Biomedical subjects

H D Pohle

Publications and source records attributed to H D Pohle.

At least 73 records · Page 4Linked to original sources
PubMed1989

Mycobacteremia in AIDS patients. Results of a prospective study.

The importance of blood cultures in diagnosing disseminated mycobacteriosis in AIDS patients was evaluated. Blood samples were screened for mycobacteria by culture and microscopic techniques. Mycobacteremia was proven in 20/136 (14.7%) AIDS patients, the agent being M. avium-M. intracellulare (MAI) in 16 cases and M. tuberculosis in four cases. The rate of cases with positive blood samples in disseminated MAI infection was 59.3% (16/27 cases) and in disseminated tuberculosis 57.1% (4/7 cases). To detect mycobacteria buffy-coat was slightly superior to lysated cell pellets, obtained by a lysis-centrifugation technique. In 4/16 cases with MAI bacteremia, the agent was proven by positive blood smears for acid-fast bacilli only; in these four patients MAI was demonstrated at other body sites. These results illustrate the diagnostic role of blood culture and its use in early diagnosis of disseminated mycobacteriosis, with microscopic examination of blood smears being an important adjunct.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Cryptococcosis in AIDS patients: observations concerning CNS involvement.

The clinical course and response to therapy of seven patients with cryptococcosis and AIDS were reviewed. One patient was still in the primary stage of cryptococcosis in AIDS, i.e. the stage that is characterized by the sole cultural detection of Cryptococcus neoformans in the respiratory tract. The other six patients were in the secondary stage, where C. neoformans can be detected from the cerebrospinal fluid (CSF), blood, urine, faeces and other body sites. The main presenting features (headache, fever, nausea) were due to central nervous system involvement, although meningism and mental changes were rarely present, and CSF changes were very subtle. Treatment with amphotericin B and flucytosine was very effective, there being no more growth of fungi in cultures in most cases. Adverse reactions to the drugs used occurred frequently and consisted mainly of anaemia, hepatosis and fever. Diagnosis in the primary stage of cryptococcosis may improve the prognosis.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Analysis of oligoclonal antibody bands against individual HIV structural proteins in the CSF of patients infected with HIV.

Intrathecal antibody responses to HIV were investigated by a highly sensitive immunoblot assay. Serum and CSF specimens were tested for reactivity with the recombinant HIV gag proteins p15, p17 and p24 and with the recombinant transmembrane protein p41. Autochthonous production of virus-specific IgG to one or more HIV structural proteins was seen in 8 of 10 asymptomatic seropositive subjects, in 3 of 4 men with AIDS-related complex, and in 9 of 13 patients with AIDS. These results were consonant with an elevated CSF/serum antibody ratio to total HIV antigen. The high frequency of local HIV-specific antibody synthesis in seropositive individuals without related clinical symptoms indicates an early involvement of the CNS in HIV infections.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The incidence of legionella pneumonia: a 1-year prospective study in a large community hospital.

In a 1-year prospective study, 28 of 476 pneumonia patients (5.9%) were diagnosed as having legionella pneumonia. Legionella pneumonia was diagnosed in 12 (5%) of 240 community-acquired pneumonias and in 16 (6.8%) of 236 nosocomial pneumonias. Four methods of establishing diagnosis were used: serum antibody detection, direct proof of legionellae by immunofluorescence, culture, and legionella antigen detection in urine. The latter method proved to be clearly advantageous to all other methods in establishing the diagnosis. Twelve of the 28 patients (42.8%) died; all of them had severe underlying diseases. The fatality rate in patients treated with erythromycin was 18.8% (3/16 cases) and 75% (9/12 cases) in patients treated with antibiotics other than erythromycin. In 57.1% (16/28 patients) legionella pneumonia was acquired nosocomially. The results of our study underscore the need to use a broad spectrum of legionella diagnostic methods routinely and to administer antibiotics effective against legionellae in cases of pneumonia of unknown cause.

Adult↗
PubMed1989

Oral hyperpigmentation in HIV-infected patients.

Six cases of oral hyperpigmentation in HIV-infected patients are reported. While in two patients the lesions could be related to systemic clofazimine or ketoconazole therapy, in the other patients the cause remained unknown. Clinically, the pigmentations were characterized by a sudden onset and the appearance of well-defined, brown-black macules in the buccal mucosa, the gingiva, the hard palate, or the lateral borders of the tongue. In one patient, longitudinal hyperpigmented striae were observed on all fingernails and toenails. Histologically, hyperpigmentations associated with systemic medication revealed accumulation of melanin in phagocytes and extracellularly within the connective tissue. In those lesions with unknown cause, melanin was restricted to keratinocytes of the basal cell layer or to extracellular foci in the lamina propria. The clinical and histologic findings, as well as differential diagnosis, are discussed.

Adult↗
PubMed1989

Immunosuppression and mycobacteria other than Mycobacterium tuberculosis: results from patients with and without HIV infection.

Infections caused by mycobacteria other than Mycobacterium tuberculosis (MOTT) have often been described as common in AIDS patients. To evaluate whether infections with MOTT are specific for HIV related immunosuppression or are also frequent in patients with immunosuppression of different aetiology, data on the frequency of isolation from immunosuppressed patients with HIV infection are important. Blood, stool and urine specimens from 134 patients with non-HIV related immunosuppression, and from 55 immunocompetent subjects were examined for mycobacteria. MOTT have been isolated from one immunocompetent person but from none of the immunosuppressed patients. Since in AIDS patients an initial colonization of the gastrointestinal tract (GI-tract) with MOTT is common, GI-tract biopsy specimens from an additional 80 patients were examined microscopically and histologically for mycobacteria. Mycobacteria were not isolated from these specimens. In the same period of time 72 AIDS patients have been examined; 7 (10%) had infections with M. tuberculosis whereas MOTT have been isolated from 16 (22%) of these patients. Mycobacteria have been found only rarely in immunocompetent patients and have not been isolated from patients with non-HIV related immunosuppression. The isolation of MOTT is highly correlated with an HIV-related immunosuppression.

Adult↗
PubMed1989

Regression of oral Kaposi's sarcoma in a case of AIDS on zidovudine (AZT).

A case with oral Kaposi's sarcoma (KS) is reported that regressed during therapy with Zidovudine (AZT) which was started 5 months after the first dermal and oral tumours were noted. After 6 months of treatment the absolute number of T-helper cells had increased from 54/microliters to 232/microliters and the ratio of T-helper to T-suppressor cells from 0.15 to 0.3. During the same time the lesions of KS on the gingiva, uvula and the body as well as the face disappeared. The lesion of KS on the hard palate regressed.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Oral hairy leukoplakia: observations in 95 cases and review of the literature.

Oral hairy leukoplakia (HL) was observed in 25.4% of 373 HIV-seropositive patients (n = 95). 87 were men of an average age of 37.1 yr, 8 were women (30.3 yr). 71.6% of the patients were male homosexuals. At initial diagnosis of HL the majority of cases was classified as CDC IVc1 (45.3%) and CDC II (22.1%). Average CD4/CD8 ratio (n = 19) was 0.24 with a range of 0.04-1.0. Thirty biopsies of HL revealed some of the histologic features thought to be characteristic. In only 20 of 30 biopsies EB-virus-specific-capsid antigen was detected. The problems of clinical and histological diagnosis of HL are discussed. Further strict criteria are necessary in order to define HL more distinctly.

Adult↗
PubMed1989

[Polygraphic sleep data in AIDS patients].

Somnopolygraphic recordings were registered from 29 patients with AIDS, their age ranged from 20 to 55 years (mean: 40.9; median: 44). The patients represent the full range of cerebral disintegration representing the picture of a progressing destruction of physiological sleep organization. Some disturbances begin quite early and progress successively, such as the reduction of REM- and delta-sleep as well as the reduction of sleep spindle- and K-complex-densities. Other changes are not manifest until intellectual capabilities break down; they occur massively such as the shortening of real sleep time and the reduction of sleep stage 2 with a simultaneous increase in waking time. It is remarkable that despite the enormous REM reduction there is no suppression of REM periods corresponding to "REM sine REM". REM periods become very short at an early stage; this is not only because the patients awake more frequently and earlier from their dream periods.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Incidence and clinical features of community-acquired legionellosis in hospitalized patients.

In a two-year prospective study of patients hospitalized because of community-acquired pneumonia, the incidence of legionellosis was found to be 3.8% (17/442 cases). After S. pneumoniae, M. pneumoniae and influenzae viruses, legionellae were the fourth most frequently identified pneumonia agents. We evaluated the clinical data from 41 cases with legionellosis, 17 diagnosed in this prospective study and 24 prior to the study. The age range of all patients (22 women, 19 men) was 24-78 yrs (median 61.3 yrs), 14 of 41 cases (34.1%) had extrapulmonary organ involvement. Twelve patients (29.3%) died. The fatality rate was 4.5% (1/22 cases) in patients treated with erythromycin, and 57.9% (11/19 cases) in patients treated with other antibiotics. Antibiotics effective in legionellosis should be added to the routine therapy of community-acquired pneumonia when this aetiology can not be excluded.

Adult↗
PubMed1988

[Side effects of trimethoprim-sulfamethoxazole in patients with AIDS].

Forty-nine episodes of Pneumocystis carinii pneumonia, treated with trimethoprim-sulfamethoxazole among 46 patients with AIDS were analysed retrospectively for any side effects. For only two were there insufficient data. There were 39 toxic reactions, 15 of them serious: leukopenia (n = 23), abnormal liver functions (n = 14), skin changes (n = 12), gastrointestinal complaints (n = 10) and thrombocytopenia (n = 9). In nine patients the treatment had to be discontinued, in six of them so early that a switch to pentamidine was necessary. Gastrointestinal symptoms occurred as early as the sixth day of treatment, while leukopenia and thrombocytopenia were first observed after 12-13 days. Despite the high rate of side effects trimethoprim-sulfamethoxazole remains the drugs of choice, other regimens not having been found to be any better.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Chronic HIV encephalitis--I. Cerebrospinal fluid diagnosis.

To establish a reliable procedure for the early detection of central nervous system involvement in HIV infection, paired cerebrospinal fluid and serum samples of 59 patients were analysed. Fifteen were HIV antibody positive without clinical symptoms (stage I), 12 had lymphadenopathy syndrome or AIDS-related complex (stage II), and 32 had AIDS (stage III). Intrathecal synthesis of HIV antibodies was determined by a modified ELISA. Antibodies in CSF and serum were evaluated at identical immunoglobulin G levels to correct for the actual blood-CSF-barrier permeability. A CSF/serum quotient above 1.5 is indicative of intrathecal antibody synthesis, which was found in 47% of the patients in stage I, 67% in stage II, and 84% in stage III. These findings indicate an early and frequent invasion of the CNS.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Chronic HIV encephalitis--II. Clinical aspects.

Combined medical, neurological, and serological investigations were carried out in 59 patients infected with human immunodeficiency virus (HIV). In stage I clinical and neuropsychiatric testing did not reveal evidence for HIV encephalitis as diagnosed by local antibody production in CSF. Neuropsychiatric abnormalities, brain atrophy, memory and cognitive impairment reliably indicated HIV encephalitis in later stages. The commonest symptoms were cerebellar and brainstem signs, followed by dementia. Epileptic fits and hemiparesis always were associated with cerebral toxoplasmosis. A polyneuropathy was frequently found but other causes have to be considered.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Fatal Legionnaires' pneumonia: frequency of legionellosis in autopsied patients with pneumonia from 1969 to 1985.

In 89 of 3027 (2.9 per cent) patients in whom pneumonia was found at autopsy during the period from 1969 to 1985, legionella pneumonia was diagnosed. Legionellae were demonstrated through the direct fluorescent antibody test by screening lung tissue sections. All 89 cases were caused by Legionella pneumophila. Suspicious typical rod-shaped organisms were demonstrated in all cases by the modified Dieterle stain whereas conventional histological stains failed to detect causative bacteria. The frequency per year of legionellosis in patients with pneumonia at autopsy ranged from 1.4 per cent (3/212 cases) to 6.8 per cent (12/177 cases). In patients who have died of unexplained pneumonia, examinations for the demonstration of legionellae should be carried out.

Adult↗