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cific Furthermore, the severity of symptoms ranges from fever and no respiratory symptoms through mild cough or dyspnea to frank respiratory distress Hypoxemia may be severe, with a PO2 less than 60 mm Hg The cornerstone of diagnosis is the chest radiograph Diffuse or perihilar infiltrates are most characteristic, but only twothirds of patients with Pneumocystis pneumonia have this finding Normal chest radiographs are seen in 5 10% of patients with Pneumocystis pneumonia, while the remainder have atypical infiltrates Apical infiltrates are commonly seen among patients with Pneumocystis pneumonia who have been receiving aerosolized pentamidine prophylaxis Large pleural effusions are uncommon with Pneumocystis pneumonia; their presence suggests bacterial pneumonia, other infections such as tuberculosis, or pleural Kaposi s sarcoma Definitive diagnosis can be obtained in 50 80% of cases by Wright-Giemsa stain or direct fluorescence antibody (DFA) test of induced sputum Sputum induction is performed by having patients inhale an aerosolized solution of 3% saline produced by an ultrasonic nebulizer Patients should not eat for at least 8 hours and should not use toothpaste or mouthwash prior to the procedure since they can interfere with test interpretation The next step for patients with negative sputum examinations in whom Pneumocystis pneumonia is still suspected should be bronchoalveolar lavage This technique establishes the diagnosis in over 95% of cases In patients with symptoms suggestive of Pneumocystis pneumonia but with negative or atypical chest radiographs and negative sputum examinations, other diagnostic tests may provide additional information in deciding whether to proceed to bronchoalveolar lavage Elevation of serum lactate dehydrogenase occurs in 95% of cases of Pneumocystis pneumonia, but the specificity of this finding is at best 75% Either a normal diffusing capacity of carbon monoxide (DLCO) or a high-resolution CT scan of the chest that demonstrates no interstitial lung disease makes the diagnosis of Pneumocystis pneumonia very unlikely In addition, a CD4 count above 250 cells/mcL within 2 months prior to evaluation of respiratory symptoms makes a diagnosis of Pneumocystis pneumonia unlikely; only 1 5% of cases occur above this CD4 count level (Figure 31 1) This is true even if the patient previously had a CD4 count lower than 200 cells/mcL but has had an increase with antiretroviral therapy Pneumothoraces can be seen in HIV-infected patients with a history of Pneumocystis pneumonia, especially if they have received aerosolized pentamidine treatment b Other infectious pulmonary diseases Other infectious causes of pulmonary disease in AIDS patients include bacterial, mycobacterial, and viral pneumonias Communityacquired pneumonia is the most common cause of pulmonary disease in HIV-infected persons An increased incidence of pneumococcal pneumonia with septicemia and Haemophilus influenzae pneumonia has been reported Pseudomonas aeruginosa is an important respiratory pathogen in advanced disease The incidence of infection with Mycobacterium tuberculosis has markedly increased in metropolitan areas because of HIV infection as well as homelessness Tuberculosis occurs in an estimated 4% of persons in the United States who have AIDS Apical infiltrates and disseminated disease occur more.

In patients with limited disease, skin and mucous membrane lesions should be treated with topical corticosteroids Complicating infection requires appropriate systemic and local antibiotic therapy

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The Convert class can convert to a number of classes, including ToInt32 (and various other types of int), ToDouble, ToBoolean, ToChar, and ToString. However, there are some limitations, most of which are easy to predict. You can convert a char to a string easily (you get a string with just one character), but you can t convert a string to a char if it s more than one character long. You can t convert a char to a double, no matter what you do, because the two types are incompatible. This means that if your code requires a conversion, you should include some error-checking code to ensure that your program doesn t crash if the user enters bad data for example, if the user enters Q in the age-checking code we just showed you. We ll get to that in 16; for the time being, we ll assume that you have perfect users who always do just what they re told, and never enter bad data. (When you re done with them, can you send them over our way We d love to meet them.)

The course tends to be chronic in most patients, though about one-third appear to experience remission Infection is the most frequent cause of death, usually from S aureus septicemia

Ahmed AR et al Treatment of pemphigus vulgaris with rituximab and intravenous immune globulin N Engl J Med 2006 Oct 26;355(17):1772 9 [PMID: 17065638] Bystryn JC et al Pemphigus Lancet 2005 Jul 2 8;366(9479):61 73 [PMID: 15993235] Stanley JR et al Pemphigus, bullous impetigo, and the staphylococcal scalded-skin syndrome N Engl J Med 2006 Oct 26;355(17):1800 10 [PMID: 17065642]

Verrucous papules anywhere on the skin or mucous membranes, usually no larger than 1 cm in diameter Prolonged incubation period (average 2 18 months) Spontaneous cures are frequent (50% at 2 years for common warts) Recurrences (new lesions) are frequent

Many other skin disorders are characterized by formation of bullae, or blisters These include bullous pemphigoid, cicatricial pemphigoid, dermatitis herpetiformis, and pemphigoid gestationis Bullous pemphigoid is a relatively benign pruritic disease characterized by tense blisters in flexural areas, usually remitting in 5 or 6 years, with a course characterized by exacerbations and remissions Most affected persons are over the age of 60 (often in their 70s or 80s), and men are affected twice as frequently as women The appearance of blisters may be preceded by urticarial or edematous lesions for months Oral lesions are present in about one-third of affected persons The disease may occur in various forms, including localized, vesicular, vegetating, erythematous,

There are many situations in which you will want to do the same thing again and again, perhaps slightly changing a value each time you repeat the action. This is called iteration, or looping. Typically, you ll iterate (or loop) over a set of items, taking the same action on each item in the collection. This is the programming equivalent of an assembly line. On an assembly line, you might take 100 car bodies and put a windshield on each one as it comes by. In an iterative program, you might work your way through a collection of text boxes on a form, retrieving the value from each in turn and using those values to update a database. C# provides an extensive suite of iteration statements, including for and while, and also do...while and foreach loops. You can also create a loop by using the goto statement. In the remainder of this chapter, we ll consider the use of goto, for, while, and do...while. However, we ll postpone coverage of foreach until 10, until after we ve introduced you to arrays.

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