Showing papers by "Henry Masur published in 1992"
TL;DR: The number of cases of Pneumocystis carinii pneumonia recognized per year in the United States has increased dramatically, from about 65 in 1967 through 1970 to an estimated 20,000 to 60,000 in the late 1980s and early 1990s, largely due to the epidemic of the acquired immunodeficiency syndrome (AIDS).
Abstract: THE number of cases of Pneumocystis carinii pneumonia (PCP) recognized per year in the United States has increased dramatically, from about 65 in 1967 through 1970 to an estimated 20,000 to 60,000 in the late 1980s and early 1990s.1 , 2 This increase is largely due to the epidemic of the acquired immunodeficiency syndrome (AIDS); other contributing factors include increasing numbers of organ-transplant recipients, the use of more aggressive chemotherapy for malignant tumors and various other inflammatory or immunologic diseases, and improved diagnostic techniques.3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 The number of cases occurring annually in the United States may decline to some extent in the 1990s . . .
188 citations
TL;DR: As the largest lymphoid organ in the body, the gastrointestinal tract is a potential reservoir for human Immunodeficiency virus (HIV), the causative agent of the acquired immunodeficienc...
Abstract: ▪ As the largest lymphoid organ in the body, the gastrointestinal tract is a potential reservoir for human immunodeficiency virus (HIV), the causative agent of the acquired immunodeficienc...
182 citations
TL;DR: Pulmonary complications, both infectious and non-infectious, are an important cause of morbidity in patients with various types of immunosuppression and the appropriate response to these complications is needed.
Abstract: Pulmonary complications, both infectious and noninfectious, are an important cause of morbidity in patients with various types of immunosuppression. The appropriate response to these clinical problems requires an understanding of pulmonary host defense and of the various types of systemic immunosuppression. Infectious and noninfectious pulmonary complications may vary according to the type of immunosuppression as well as to the degree and duration of immunosuppression. Appropriate clinical management also requires an understanding of the clinical problems commonly seen in specific groups of immunosuppressed patients and an understanding of the sensitivity, specificity, and potential complications associated with the available diagnostic approaches to those patients. Because respiratory disease in these patient groups may progress rapidly to respiratory failure, an expeditious evaluation based on the knowledge of likely causes of respiratory disease and prompt specific or empiric therapy are indicated. Specific sets of algorithms for the evaluation of both focal and diffuse pulmonary disease may facilitate such an evaluation. In addition, an aggressive approach to the prevention of pulmonary disease including immunization, prophylaxis, and immunomodulation (for example, colony stimulating factors) may be warranted in specific subgroups at risk.
77 citations
TL;DR: A marked diminution in surfactant glycerophospholipid in patients with AIDS and PC pneumonia is demonstrated and a potential role for surfactants abnormality in the pathophysiology of this disease is suggested.
61 citations
TL;DR: This study assessed whether the yield of a single middle or lower lobe BAL could be increased by the utilization of two techniques: indirect immunofluorescent staining with a combination of two murine monoclonal anti-Pneumocystis antibodies in addition to routine toluidine blue O and cytopathologic staining and multiple lobe, site-directed BAL.
Abstract: The yields of both induced sputum examination and bronchoalveolar lavage (BAL) have been reported to be decreased for breakthrough episodes of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients receiving aerosolized pentamidine chemoprophylaxis. This study assessed whether the yield of a single middle or lower lobe BAL could be increased by the utilization of two techniques: (1) indirect immunofluorescent staining with a combination of two murine monoclonal anti-Pneumocystis antibodies in addition to routine toluidine blue O and cytopathologic staining, and (2) the performance of multiple lobe, site-directed BAL (I.e., both upper lobe and middle or lower lobe lavage, including the lobe with the greatest radiographic abnormality). Results of 252 fiberoptic bronchoscoples performed at the National institutes of Health and the Los Angeles County-University of Southern California Medical Center were analyzed. P. carinii pneumonia was documented in 21 episodes in patients who did ...
49 citations
TL;DR: This AIDS Commentary updates prophylaxis for P. carinii pneumonia in patients infected with the human immunodeficiency virus for the AIDS Commentary, placing currently available information into concise clinical perspective and detailing a rational plan for the clinician to follow based on results of recent studies.
Abstract: Following the initial observation by Dr. Margaret Fischl that trimethoprim-sulfamethoxazole can prevent Pneumocystis carinii infection in patients with Kaposi's sarcoma, initiating prophylaxis for pneumocystic infection in all patients with less than 200 CD4+ cells/mm3 has become accepted practice. This prophylactic intervention has been found not only to reduce the development of pneumonia due to P. carinii but also to prolong life. Drs. Henry Masur and Joseph A. Kovacs first reviewed prophylaxis for P. carinii pneumonia in patients infected with the human immunodeficiency virus for the AIDS Commentary 3 years ago. They have updated that initial review for this AIDS Commentary, placing currently available information into concise clinical perspective and detailing a rational plan for the clinician to follow based on results of recent studies.
33 citations
27 citations
TL;DR: Polymerase chain reaction analysis is clearly of value in providing confirmation of the low probability of infection in this group, although in patients who do become infected, detection by this test may not always precede diagnosis by serologic methods.
Abstract: Our objective was to map serial patterns of Western blot reactivity over time of a cohort of initially ELISA-negative, Western blot-indeterminate individuals from a high-risk group and to determine if these individuals were at increased risk of harboring occult HIV-1 infection. A 2-year prospective study used serial ELISA, two types of Western blot, immunologic profiles, HIV-1 culture, and analysis by polymerase chain reaction. Subjects were 20 ELISA-negative, Western blot indeterminate homosexual volunteers and 20 matched seronegative controls. Results showed that 19 of 20 study subjects completed a mean of 17.0 months of clinical and laboratory follow-up. Reactivities with p24 and/or with p55 were the two most commonly observed Western blot patterns, occurring in 70% of individuals. Specific Western blot reactivity was dependent upon the particular immunoblot preparation being used and varied considerably on a longitudinal basis. No individual pattern appeared predictive of an increased likelihood of subsequent seroconversion to HIV-1 relative to controls. By all other criteria including polymerase chain reaction analysis, samples from 17 of 19 individuals remained negative for HIV-1 at each time point. Two individuals evolved from an indeterminate to a positive Western blot and, simultaneously, from a negative to a positive polymerase chain reaction analysis, during follow-up. Our conclusions were as follows. ELISA-negative, Western blot-indeterminate individuals from a high-risk group show marked variability in immunoblot findings over time, and these patterns do not appear predictive of an increased likelihood of infection. Polymerase chain reaction analysis is clearly of value in providing confirmation of the low probability of infection in this group, although in patients who do become infected, detection by this test may not always precede diagnosis by serologic methods.
14 citations
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TL;DR: Patients at greatest risk of pneumonia are those whose CD4 positive lymphocyte counts are less than 200/mm3 or less than 20% of the total T-lymphocyte countl and those who have had previous episodes of pneumocystis pneumonia.
Abstract: Piieiii7iocystis carillii pneumonia ultimately affects 80% of patients with AIDS in North America who are not receiving antipneumocystis prophylaxis. The patients at greatest risk are those whose CD4 positive lymphocyte counts are less than 200/mm3 or less than 20% of the total T-lymphocyte countl and those who have had previous episodes of pneumocystis pneumonia. Interstitial pneumonitis is the most com-