Black hairy tongue.

Black hairy tongue is a benign disorder characterized by hypertrophy of the filiform papillae of the tongue. A brownish-black discoloration of the papillae occurs. The etiology is unclear, but the disorder has been associated with numerous predisposing conditions. Although black hairy tongue is usually cured by removal of these factors, a variety of measures, particularly brushing of the tongue, may aid in resolution.

Asymptomatic patients with HIV infection. Keeping them well.

Primary care physicians need to be prepared to counsel and manage patients with human immunodeficiency virus (HIV) infection. Asymptomatic seropositive patients should be seen quarterly, and T4 lymphocyte counts should be followed. Other serologic markers that may detect disease progression are p24 antigen and beta 2 microglobulin. Abnormalities in the levels of these markers may influence the decision to initiate early antiretroviral therapy. Therapeutic regimens are now available for delaying progression of HIV disease and for preventing Pneumocystis carinii pneumonia, the most common opportunistic infection to develop in patients with HIV infection. Whether antiretroviral therapy should be initiated in all asymptomatic HIV-positive patients remains to be seen. Physicians can do their part by educating themselves about HIV infection so they can provide competent, nonjudgmental care to patients and by supporting legislation to protect the rights of HIV-infected persons.

Aerosolized pentamidine in HIV. Promising new treatment for Pneumocystis carinii pneumonia.

Pneumocystis carinii pneumonia is the most common life-threatening disease diagnosed in patients infected with the human immunodeficiency virus (HIV). Patients treated for their initial episode are at risk for recurrence of the disease. HIV-positive patients with low T4 lymphocyte counts are also at risk. Conventional treatment regimens with parenteral pentamidine isethionate (Pentam 300) or trimethoprim-sulfamethoxazole have a 50% to 60% incidence of serious adverse effects and a 20% to 40% rate of failure. Aerosolized pentamidine represents a promising new therapy for HIV-infected patients. Major adverse reactions have not been reported with its use. The Food and Drug Administration's (FDA's) recent approval of aerosolized pentamidine may also have a positive effect on healthcare costs by preventing episodes of P carinii pneumonia. In addition, FDA approval may result in reimbursement of patients for this new therapy by more insurance companies.

Klebsiella pneumoniae bacteremia in the community hospital.

The purpose of this study was to elicit the circumstances of occurrence and organism sensitivities of Klebsiella pneumoniae bacteremia in the community hospital, since data on this illness from the community hospital are rare. All records of documented Klebsiella pneumoniae bacteremia (46 cases) at Alachua General Hospital, Gainesville, Florida, over the period July 14, 1982, through July 27, 1985, were reviewed in detail. Fifty-nine percent (27 organisms) were nosocomial, whereas 41% (19 organisms) were community acquired. The most common predisposing disorders in these patients were, in decreasing order, malignancy; following gastrointestinal or biliary surgery; biliary tract obstruction; diabetes; and unknown. Twenty-two percent (10) of the patients died from bacteremia. The majority of organisms tested were sensitive to mezlocillin, cephalothin, cefoxitin, tetracycline, tobramycin, gentamicin, co-trimoxazole and ceftizoxime. Therapy was considered to be appropriate in 89% (41) of the patients and inappropriate in 10.9% (5) of the patients. Contrary to previous thought, Klebsiella pneumoniae bacteremia is a relatively common problem in the community hospital and may be community acquired as well as nosocomial. There are many characteristics of this disease in the community that are different from those reported in studies on Klebsiella pneumoniae bacteremia from large referral centers.