No abstract

Because cytomegalovirus (CMV) can be isolated from pulmonary secretions of human immunodeficiency virus (HIV)-infected patients without causing disease, its clinical significance as a cause of pneumonia in this patient population is frequently questioned. In a 22-month period, CMV pneumonia was diagnosed in 17 (8%) of 210 HIV-infected patients who underwent lung biopsy on the basis of microbiological and histologic criteria. The clinical presentations of these patients were nonspecific, including fever (100% of patients), shortness of breath (71%), cough (76%), and Pao2 of < 75 mm Hg (88%). A high correlation in the degree of viral burden in lung biopsy specimens was demonstrated by histologic examination, immunohistochemical analysis, and in situ hybridization. No other pulmonary pathogens were identified for nine patients, whereas other possible causes of pneumonia were present in eight: 11 patients had evidence of extrapulmonary CMV disease at presentation. Most patients initially responded to specific anti-CMV therapy; the overall mean survival +/- SD was 3.1 +/- 2.5 months. CMV should be considered as a possible cause of pneumonia in patients with advanced AIDS especially if CMV infection is documented at other sites.

The effect and tolerance of long-term oral administration of small doses of neomycin as a serum cholesterol reducing agent has been investigated. Sixteen patients were given neomycin sulfate orally for periods varying from 12 to 40.1 months, following control periods of 2.6 to 14.6 months. After an initial daily dose of 2 g of neomycin, the daily dose was varied between 0.5 and 2 g according to response. Average total serum cholesterol concentrations decreased in each of the 16 patients by 15 to 32%; the average decrease for the group was 22%. The difference was statistically significant in each patient at the 0.1% level. Serum cholesterol concentrations were maintained at the lower plateau as long as the drug was given. In an additional patient, after administration of neomycin for 2 months there was no change in serum cholesterol concentrations and the study was discontinued. Another developed severe diarrhea, nausea, and abdominal cramps during the first week of the study, so that medication was interrupted. No other serious side effects occurred. During the first 2 weeks of medication eight of the 16 patients experienced mild diarrhea or abdominal cramps or both which subsided spontaneously during continued medication. Physical examinations were carried out, kidney and liver functions remained normal, and pathogens were not grown from stool cultures.