trimethoprim--sulfamethoxazole-drug-combination and Airway-Obstruction

A multivariate analysis using a logistic regression model evaluated odds ratio (OR) and 95% confidence limits (95% CL) of pediatrician-diagnosed wheezing respiratory illness in 75 infants with perinatal human immunodeficiency virus-type 1 (HIV-1) infection, 205 uninfected infants of HIV-1 infected mothers, and 1780 infants of HIV-1 uninfected mothers. Infants were prospectively followed-up for the first 2 years of life. Covariates were risk factors for wheezing respiratory illness (preterm delivery, low birth weight, maternal smoking, formula feeding, and neonatal respiratory disorders). Maternal use of illicit drugs in pregnancy, antiretroviral treatment in pregnancy, maternal HIV-1-related clinical condition at the time of delivery were also included in the models when infants of HIV-1 infected mothers were taken into account. Although the frequency of risk factors for wheezing respiratory illness was higher in infants of HIV-1 infected than in those of uninfected mothers, HIV-1 infection emerged as a protective factor [OR: 0.001 (95% CL: 0.0001-0.01); p < 0.001]. The frequency of risk factors was similarly high among infants of infected mothers, but OR was lower in HIV-1 infected than in uninfected infants of infected mothers (0.005; 95% CL: 0.0004-0.06; p < 0.001). Finally, OR was higher in uninfected infants of HIV-1 infected mothers (who evidenced a higher frequency of risk factors) than in infants of HIV-1 uninfected mothers (9.97; 95% CL: 4.87-20.40; p < 0.001). Understanding the reason why HIV-1 protects against wheezing respiratory illness could shed light on the immunologic and inflammatory mechanisms of airway obstruction.

Topics: Adult; Airway Obstruction; Anti-Infective Agents; Antiretroviral Therapy, Highly Active; Chemoprevention; Female; Follow-Up Studies; HIV Infections; HIV-1; Humans; Infant Welfare; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Male; Maternal Welfare; Mother-Child Relations; Pneumonia, Pneumocystis; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Protease Inhibitors; Respiratory Sounds; Reverse Transcriptase Inhibitors; Risk Factors; Severity of Illness Index; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Rhinoscleroma is a very rare cause of upper airway obstruction with only isolated reports in the literature of rhinoscleroma with isolated tracheal obstruction. The course is usually chronic with the presentation most often being non-specific. We report a 54-year-old woman with progressive shortness of breath and wheezing over 7 years' duration. She was diagnosed and treated as bronchial asthma without improvement in her symptoms. At the time of referral to our institution, her flow-volume loop revealed fixed upper airway obstruction. Her chest radiography and other laboratory tests were normal. Bronchoscopy revealed a 70-80% irregular concentric stenosis of the trachea beginning immediately below the vocal cords and extending 4 cm distally. Biopsy showed characteristic Mikulicz histiocytes containing numerous gram-negative intracellular coccobacilli consistent with a diagnosis of rhinoscleroma. The patient was treated with laser resection of the stenosis followed by a course of ciprofloxcin and trimethoprim-sulfamethoxazole. She has remained asymptomatic over a year follow-up period and repeated biopsies have shown no evidence of recurrence.

Topics: Airway Obstruction; Anti-Infective Agents; Bronchoscopy; Ciprofloxacin; Dyspnea; Female; Gram-Negative Bacterial Infections; Humans; Laser Therapy; Middle Aged; Radiography, Thoracic; Respiratory Sounds; Rhinoscleroma; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Airway Obstruction; Biopsy; Diagnosis, Differential; Hoarseness; Humans; Laryngoscopy; Male; Rhinoscleroma; Tracheostomy; Trimethoprim, Sulfamethoxazole Drug Combination