[Pulmonary complications during HIV infection in children].
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Pulmonary complications occur in over half of patients with AIDS at some point in their illness. A chest X-ray is a valuable first-line investigation. The plain film and computed tomographic features of these complications are described and several examples illustrated. The role of computed tomography, including high resolution scanning techniques in further investigation and management, is discussed.
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The gross and histological appearance of pulmonary mycotic disease is rarely pathognomonic for a particular entity. Tissue obtained through an invasive procedure is usually necessary for a specific diagnosis. Pathological diagnosis is directed by the pattern of inflammation and based on the morphological identification of fungi. The interventional radiologist plays a critical role in the diagnosis of pulmonary mycoses by obtaining additional material for culture. An open and inquisitive collaboration between the radiologist and pathologist can improve diagnostic accuracy for both specialists.
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The treatment of the major systemic fungi encountered in the United States--Histoplasma capsulatum, Blastomyces dermatitides, and Coccidioides immitis--depends on an understanding of the natural history of disease. Clinical manifestations of these infections can range from an asymptomatic disease that requires no therapy to an illness that is incurable and requires long-term suppression with antifungal agents to produce a balanced host-to-parasite relationship. This article discusses the natural history of disease caused by H. capsulatum, B. dermatitides, and C. immitis and various clinical situations that require antifungal chemotherapy.
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