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Biomedical subjects

S Ewig

Publications and source records attributed to S Ewig.

140 records · Page 8Linked to original sources
PubMed1993

Pneumocystis carinii pneumonia presenting as an upper lobe cavity after aerosolized pentamidine prophylaxis in an HIV-infected patient.

We describe an atypical diagnostic feature of a breakthrough Pneumocystis carinii pneumonia (PCP) during primary prophylaxis with aerosolized pentamidine. Our case disclosed infiltrates restricted to the left upper lobe. After 2 weeks a solitary cavity developed. Diagnosis was easily established by bronchoalveolar lavage when performed in the affected segment bronchus. Cavitation clearly demonstrated localized infection, with tissue destruction as one main pathogenetic pattern of a breakthrough PCP during aerosolized pentamidine prophylaxis.

Adult↗
PubMed1991

[Progressive cytomegalovirus encephalitis in successful ganciclovir therapy of cytomegalovirus retinitis in an AIDS patient].

We describe a case of an HIV-infected intravenous drug-abuser who died of progressive cytomegalovirus encephalitis despite successful treatment of cytomegalovirus retinitis with ganciclovir. On autopsy, complete remission of retinitis and widespread cytomegalovirus-encephalitis could be demonstrated. Therapeutic failure therefore seems attributable to insufficient CNS-distribution of ganciclovir rather than to ganciclovir-resistant cytomegalovirus strains.

AIDS Dementia Complex↗
PubMed1991

[Course and diagnosis of pulmonary Kaposi sarcoma in patients with AIDS].

Diagnosis of pulmonary Kaposi's sarcoma can be difficult. Clinical findings and chest X-rays are non-specific and endobronchial diagnostic in about 50% of cases. Additional concomitant infectious complications are frequent. Symptomatic pulmonary Kaposi's sarcoma most oftenly is progressive and has a poor prognosis. Preliminary data suggest effective palliation with radio- and chemotherapy and an improved survival time in selected cases. We present six cases of proven pulmonary Kaposi's sarcoma and discuss clinical course and diagnostic difficulties. Based on this view we propose a diagnostic approach to warrant therapeutic success.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[A case of AIDS-associated histoplasmosis in Germany].

In a thirty-year-old patient with AIDS the diagnosis of disseminated histoplasmosis was established via biopsy and culture. The patient had grown up in Argentina, where histoplasmosis is endemic. He had not been in an endemic region during the last two years anteceding the manifestation of systemic histoplasmosis. Accordingly, in patients with a progressive immunodeficiency syndrome, reactivation of a former (possibly inapparent) infection with Histoplasma capsulatum must be considered. Therapy with Amphotericin B lead to a remarkable improvement of clinical, laboratory and sonographic findings. Due to the fact that total eradication of H. capsulatum from the infected host cannot be achieved with any known drug regimen, a life-long follow-up therapy was begun. The patient showed no signs of relapse after a follow-up of 7 months.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Chronic fatigue syndrome].

Reports on conditions of chronic fatigue associated with other somatopsychic symptoms after acute viral infections have led to the hypothesis of a "chronic fatigue syndrome" (CFS). Historical disease descriptions, like e.g. "myalgic encephalomyelitits", were updated by means of modern virological diagnostic techniques and data analysis. Several viral agents like enteroviruses, Epstein-Barr virus, Human-Herpesvirus 6 and other herpesviruses have been implicated for possible underlying infections. A preliminary disease definition by the Center for Disease Control (CDC) seeks to provide a rational basis for further etiological studies. In fact, there is growing consensus that the syndrome comprises various separate disease entities and causative agents. Today we can tentatively differentiate a "chronic mononucleosis" after infection with Epstein-Barr virus, an etiologically undetermined "postviral fatigue syndrome" and a fatigue syndrome of the myalgic type after Coxsackie-B virus infection. Furthermore, a valid diagnosis of CFS must be based on the exclusion of defined other diseases and the awareness of dealing with a hypothetical concept. As a result, current knowledge does not yet allow specific therapeutic recommendations.

Diagnosis, Differential↗
PubMed1990

[Tuberculosis and atypical mycobacterioses in HIV infection. Results from the Bonn Center 1985 to 1989].

485 HIV-positive patients have been treated at our institution in Bonn during 1985 to 1989. Mycobacterial infections occurred in twelve (2.5%) HIV-positive patients. Of 166 AIDS-manifestations according to CDC, eleven (6.6%) were mycobacterial infections. There occurred one case of miliary tuberculosis, six cases of extrapulmonary, one of disseminated tuberculosis and four cases of atypical mycobacteriosis. Mycobacteriosis other than tuberculosis (MOTT) were caused three times by Mycobacterium kansasii and once by Mycobacterium scrofulaceum. Tuberculosis was seen less often in haemophiliacs. Disseminated tuberculosis and atypical mycobacteriosis developed in late stages of HIV-infection with underlying severe immunodeficiency. The lung was the main target organ of tuberculosis. MOTT most often affected the gastrointestinal tract additionally. Noninvasive materials, first of all sputum and gastric acid, were reliably diagnostic but available with delay in particular cases. In those cases histologic studies proved helpful. Application of five-fold regimen (INH, RMP, EMB, PZA and SM) always succeeded in negative cultures in a mean of 15 days in all cases of tuberculosis. Two cases of atypical mycobacteriosis with Mycobacterium kansasii were treated with a five-fold regimen (one case with ciprofloxacin additionally) and culture-negative after six resp. 28 weeks of therapy.

Adult↗
PubMedDate not supplied

Male-to-female transmission of HIV in a cohort of hemophiliacs--frequency, risk factors and effect of sexual counseling.

The incidence of male-to-female transmission of HIV infection was studied in a population of 198 sexual partners of hemophiliacs who tested HIV positive since 1984. The follow-up observation period was 1987-1992. Transmission occurred in 20 (10%) cases. The analysis of risk factors for transmission was performed in a subgroup of 57 hemophiliacs with seronegative sexual partners as compared to eight transmitters. Transmitters showed a significantly more advanced immune depletion at enrollment as well as at the end of the observation period. Furthermore, transmitters had a more advanced disease at the end of the study (75% vs. 29% CDC IV; p < 0.01). Also virus cultures were more frequently positive in the transmitters than in the non-transmitters (71% vs. 42%). Regular sexual counseling was offered to all couples. After 1987, no new seroconversions were detected. However, two seroconversions in female partners of hemophiliacs outside the initial study population were observed. Both transmissions occurred during a period of severe clinical and immunological deterioration. This study shows that sexual partners of HIV-infected hemophiliacs with more advanced disease are at higher risk of infection with HIV. The frequency of male-to-female transmission of HIV in long-term monogamous sexual relationships practicing safer sex is low. Overall, disease awareness and counseling for safer sex seem to be effective in reducing transmission rates.

Adult↗
PubMedDate not supplied

Predicting in-hospital outcome in HIV-associated Pneumocystis carinii pneumonia.

Pneumocystis carinii pneumonia (PCP) in HIV-infected patients remains a life-threatening complication in the course of HIV infection. Despite effective treatment, mortality may still be as high as 10%. The identification of risk factors associated with a lethal outcome might be helpful as a guide to therapy for patients at risk and in the evaluation of new drugs with anti-pneumocystic activity. In a retrospective study 58 first episodes of HIV-associated PCP without prophylaxis were analyzed. Variables associated univariately with higher mortality were identified. A prognostic rule was established in a multivariate approach using canonical discriminant analysis. Cut-off values for parameters included were determined in order to allow a clinically applicable estimate of the individual risk. Variables associated with early mortality were hemoglobin, hematocrit, platelet count, albumin, total protein, gamma-globulins, and AaDO2. LDH values, percentage of neutrophils in the BAL, as well as the cellular immunologic state as indicated by CD4-cell count were not significantly associated with the outcome. The discriminant function yielded the best classification results with the inclusion of hemoglobin, albumin, and gamma-globulins (overall accuracy 86%). Two or more of the following parameters were associated with a 14-fold increased risk of in-hospital mortality: hemoglobin less than 10 g/dl, albumin less than 3 g/dl, and gamma-globulins less than 1.2 g/dl. This prognostic rule was 80% sensitive and 94% specific with a negative predictive value of 94%, yielding an overall accuracy of 91%. Patients with HIV-associated PCP with a positive prognostic rule have a 14-fold increased risk for in-hospital lethal outcome. This discriminant rule may be helpful in identifying patients at risk.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Pneumocystis carinii pleuropneumonia after aerosolized pentamidine prophylaxis.

We observed an atypical Pneumocystis infection with spontaneous pneumothorax, bronchopleural fistulae, an apical cyst and Pneumocystis pleuritis after aerosolized pentamidine prophylaxis in an AIDS patient. These findings suggest a failure of pentamidine aerosol in controlling active Pneumocystis infection in peripheral pulmonary areas. A relapse of Pneumocystis carinii pneumonia (PCP) must be suspected when pneumothorax occurs during secondary prophylaxis with aerosolized pentamidine. It should always be confirmed by bronchoalveolar lavage or transbronchial or open biopsy. Cases presenting as atypical Pneumocystis pneumonia may additionally reveal extrapulmonary dissemination of Pneumocystis infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Heart rate variability in patients with sleep-related breathing disorders.

The increased mortality among patients with obstructive sleep apnea syndrome has been explained in part by the increased incidence of arterial and pulmonary hypertension. A decreased heart rate variability (HRV) has been shown to be associated with an increased mortality as well. We investigated 53 patients, admitted to the hospital for chest pain for sleep-related breathing disorders (SRBD) with an ambulatory screening device (MESAM-IV). HRV was recorded simultaneously. All patients received coronary artery catheterization and 36 had significant coronary artery disease (CAD; 67.9%). Standard time domain parameters were compared by a 4-way Anova for patients with an oxygen desaturation index of more and less than 5/hour and the factors CAD, diabetes and beta-blocker use. The percentage of differences between RR intervals that differ more than 50 ms (pNN > 50: 9.0 +/- 11.1 vs. 19.2 +/- 22.2%: p < 0.05) as well as the root mean square of these differences (38.0 +/- 29.0 vs. 59.2 +/- 51.5 ms; p < 0.05) were significantly decreased in patients with SRBD. In an hourly breakdown the number of desaturations was not correlated with a change in HRV. Mean oxygen saturation was significantly decreased in patients with SRBD (95.2 +/- 1.8 vs. 96.2 +/- 1.42%, p < 0.05), and positively correlated with the pNN > 50 (r = 0.34, p < 0.01). This correlation might suggest a more profound pathophysiological interaction between HRV and SRBD than short-term vagal activation alone. The results favor HRV for inclusion in future risk stratification models in patients with sleep apnea syndrome.

Cardiac Catheterization↗