RESUMEN
Polymerase chain reaction (PCR) testing using up to four primer pairs and biotinylated probes was 97.9% sensitive (188 of 192 specimens positive) and 100% specific (267 of 267 specimens negative) for detecting the presence or absence of human immunodeficiency virus (HIV) DNA in peripheral blood mononuclear cells from pediatric patients whose HIV status has been confirmed. SK38/39 and SK145/150 were the most sensitive primer pairs, respectively detecting HIV DNA in 95.6 and 95.9% of peripheral blood mononuclear cell specimens from HIV-infected children and collectively detecting all adequately tested PCR-positive specimens. Primer pairs SK29/30 and SK68/69 respectively detected HIV DNA in only 76.4 and 76.6% of HIV-positive specimens. Among infants born to HIV-seropositive mothers, 30 who subsequently were confirmed to be infected were sampled when they were less than or equal to 6 months of age; in all but one infant, HIV DNA was found in the first specimen collected. Among the nine youngest infected infants tested, all were PCR positive by 38 days of age. PCR methods thus have reliably detected vertically transmitted HIV infection early in life.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Biotina , Reacción en Cadena de la Polimerasa , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/genética , Factores de Edad , Niño , Preescolar , Sondas de ADN , ADN Viral/análisis , Femenino , VIH-1/genética , Humanos , Lactante , Recién Nacido , Sensibilidad y EspecificidadRESUMEN
Bronchoalveolar lavage (BAL) by flexible fiberoptic bronchoscopy is useful in the diagnosis of Pneumocystis carinii pneumonia (PCP) in adults with acquired immunodeficiency syndrome. To evaluate the safety and efficacy of this procedure in children with human immunodeficiency virus in whom PCP was considered, we reviewed the records of 15 consecutive procedures performed on eight patients by a pediatric pulmonologist during a 19-month period. Pneumocystis carinii pneumonia was identified after five of 15 BAL procedures. Other pathogens or multiple pathogens were found in some cases. A specific infectious diagnosis was obtained in ten of 15 procedures. No patient required subsequent open lung biopsy. Follow-up for a minimum of 6 weeks and response to therapy did not suggest PCP in any case where BAL failed to establish its diagnosis. No major complication was attributed to BAL. We conclude that BAL is safe and effective in the diagnosis of PCP in children with HIV infection. Guidelines are suggested to optimize its safety and utility.
Asunto(s)
Bronquios , Infecciones por VIH/complicaciones , Neumonía por Pneumocystis/diagnóstico , Alveolos Pulmonares , Líquido del Lavado Bronquioalveolar , Broncoscopios , Niño , Preescolar , Femenino , Tecnología de Fibra Óptica , Humanos , Lactante , Masculino , Neumonía por Pneumocystis/complicaciones , Irrigación TerapéuticaAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Infecciones por Citomegalovirus/complicaciones , Obstrucción Intestinal/complicaciones , Infecciones por Citomegalovirus/diagnóstico por imagen , Infecciones por Citomegalovirus/patología , Femenino , Humanos , Lactante , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/patología , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/patología , RadiografíaRESUMEN
Primary varicella-zoster (VZ) infection in eight children with perinatally acquired human immunodeficiency virus infection tended to be severe, prolonged, complicated by bacterial infections and in one case fatal. Depletion of CD4-lymphocytes was associated with chronic and recurrent VZ infection. In some patients convalescent VZ antibody titers were low and did not correlate with recurrence of VZ lesions. Administration of acyclovir appeared to be beneficial in suppressing VZ in human immunodeficiency virus-infected children with primary or recurrent VZ infection.
Asunto(s)
Aciclovir/uso terapéutico , Varicela/complicaciones , Infecciones por VIH/complicaciones , Hepatitis Viral Humana/complicaciones , Neumonía Viral/complicaciones , Infecciones Bacterianas/complicaciones , Varicela/tratamiento farmacológico , Niño , Preescolar , Femenino , Hepatitis Viral Humana/tratamiento farmacológico , Humanos , Lactante , Masculino , Neumonía Viral/tratamiento farmacológico , RecurrenciaRESUMEN
Determination of the number of particles greater than 0.5, 1, 2, 5, and 10 microM in the air before, during, and after cleaning of carpeting disclosed larger numbers of airborne particles during cleaning with portable vacuum cleaners than with central vacuum cleaners, and more airborne particles during cleaning of shag carpeting than shorter pile carpeting.
Asunto(s)
Aire/análisis , Polvo/análisis , Análisis de Varianza , Pisos y Cubiertas de Piso , Humanos , Mantenimiento/métodosRESUMEN
This article reviews some concepts about the organization of the immune system and the immunopathologic mechanisms of hypersensitivity. This is followed by a discussion of the effect of excessive or inappropriate immunologic resources on the respiratory tract.
Asunto(s)
Enfermedades Pulmonares/inmunología , Animales , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/inmunología , Aspergilosis Broncopulmonar Alérgica/inmunología , Asma/inmunología , Linfocitos B/inmunología , Proteínas del Sistema Complemento/inmunología , Humanos , Hipersensibilidad/inmunología , Inmunoglobulinas/inmunología , Pulmón/inmunología , Fagocitos/inmunología , Neumonía/inmunología , Fibrosis Pulmonar/inmunología , Ratas , Sarcoidosis/inmunología , Linfocitos T/inmunologíaAsunto(s)
Enfermedad Granulomatosa Crónica/diagnóstico , Neumonía/diagnóstico , Grupo Citocromo b/deficiencia , Diagnóstico Diferencial , Enfermedad Granulomatosa Crónica/complicaciones , Enfermedad Granulomatosa Crónica/diagnóstico por imagen , Humanos , Lactante , Pulmón/diagnóstico por imagen , Masculino , NADH NADPH Oxidorreductasas/metabolismo , NADPH Oxidasas , Fagocitosis , Infecciones por Pseudomonas/complicaciones , RadiografíaAsunto(s)
Hipersensibilidad a las Drogas/etiología , Fenitoína/efectos adversos , Candida/inmunología , Niño , Concanavalina A/farmacología , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Activación de Linfocitos , Fenitoína/farmacología , Fenitoína/uso terapéutico , Fitohemaglutininas/farmacología , Mitógenos de Phytolacca americana/farmacología , Convulsiones/tratamiento farmacológicoRESUMEN
Earlier studies of serum immunoglobulin D concentrations were hampered by the insensitivity of single radial diffusion, since most normal individuals have IgD concentrations in a range below or near the limit of sensitivity of that method. Using a sensitive double-antibody radioimmunoassay, we measured serum IgD in normal individuals from 28 weeks' gestational age to 70 years of age and in several groups of diseased individuals, many of whom had elevated serum IgE concentrations. The group mean serum IgD concentration in children one to 20 years of age was 13.65 IU/ml. Premature and term neonates had levels that did not differ significantly from each other (0.22 and 0.14 IU/ml, respectively), but that were far lower than serum IgD concentrations in normal children one to 20 years of age (P = less than 10-9), indicating that mature levels of IgD are achieved sometime during the first year of life. Normal adults aged 21 to 70 years, atopic children with or without eczema, children with serum IgE values greater than 2,000 IU/ml, and children with cystic fibrosis all had group mean IgD concentrations that did not differ significantly from that of normal children. In contrast, 20 patients with the hyper IgE syndrome had a mean serum IgD concentration of 94.22 IU/ml, significantly higher than the normal or any other group mean (P = less than 10-5).