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Revista do Instituto de Medicina Tropical de São Paulo

On-line version ISSN 1678-9946

Rev. Inst. Med. trop. S. Paulo vol.35 no.2 São Paulo Mar./Apr. 1993

http://dx.doi.org/10.1590/S0036-46651993000200004 

ORIGINAL ARTICLES

 

Respiratory complications in Brazilian patients infected with human immunodeficiency virus

 

Complicações respiratórias em pacientes brasileiros infectados pelo vírus da imunodeficiência humana

 

 

Adriana WeinbergI; Maria Irma Seixas DuarteII

IDepartment of Infectious Diseases of the "Hospital das Clínicas" of the University of São Paulo School of Medicine and Laboratory of Virology, Institute of Tropical Medicine, São Paulo, Brazil
IIDepartment of Pathology of the University of São Paulo School of Medicine. São Paulo, Brazil

Address for correspondence

 

 


SUMMARY

PURPOSE: To determine how often and by what means an indentifiable pulmonary pathogen can be recognized in human immunodeficiency virus (HIV) infected patients with respiratory disorders in Brazil, which are the most frequently observed microorganisms and what impact specific therapy has on these agents.
PATIENTS AND METHODS: Thirty-five HIV seroposiüve subjects with respiratory complaints were studied. All patients had a complete history, physical examination and blood counts.
The pulmonary assessment included chest radiograms; sputum examination for bacterial and fungal pathogens; bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. Patients with treatable complications received standard antimicrobial therapy.
RESULTS: One or more microorganisms were found in 24 subjects and another 3 individuals showed nonspecific interstitial pneumonitis. The sputum examination identified the pulmonary pathogens in 7 cases. The bronchoalveolar lavage and the histopathologic examination were diagnostic in 14% and 83%, respectively, of the 28 individuals that were submitted to bronchoscopy. The most frequently identified microorganism was P. carinii (55%), followed by M. tuberculosis (41%) and cytomegalovirus (8%). The clinical, laboratory and radiographic findings failed to distinguish the specific pulmonary pathogens. Twenty-three individuals with P. carinii pneumonitis and/or tuberculosis received specific therapy; among the evaluable patients the therapeutic response rates were 79% for PCP and 100% for TB.
CONCLUSIONS: We have determined that tuberculosis, P. carinii and cytomegalovirus pneumonitis are the most common respiratory opportunistic diseases in Brazilian patients infected with HIV. The histologic evaluation was crucial in order to identify the pulmonary pathogens. Tuberculosis in AIDS individuals displayed clinical and radiographic findings atypical for reactivation disease. However, most of the features observed in HIV infected patients had been previously described in infection of the normal host. Furthermore, the AIDS subjects showed a good therapeutic response to anti-tuberculous drugs.

Key words: AIDS; HIV infection; Respiratory disorders; Tuberculosis; Pneumocystis carinii pneumonia; CMV pneumonitis; Nonspecific interstitial pneumonitis.


RESUMO

OBJETIVO: Determinar a frequência e os meios pelos quais é possível identificar um agente patogênico respiratório em pacientes brasileiros infectados pelo vírus da imunodeficiência humana (HIV); quais são os microorganismos mais comuns; e qual é o impacto da terapêutica específica.
PACIENTES E MÉTODOS: Trinta e cinco pacientes HIV positivos, com queixas respiratórias foram estudados. Todos os pacientes tiveram história, exame físico e testes hematólogicos. A avaliação da patologia respiratória incluiu radiografia pulmonar, exame do escarro para bactérias e fungos, broncoscopia com lavagem bronquiolo-alveolar e biopsia transbronquica. Pacientes com patologias tratáveis receberam a terapêutica indicada.
RESULTADOS: Um ou mais organismos foram encontrados em 24 pacientes, e outros 3 pacientes mostraram pneumonite intersticial inespecífica. O exame de escarro identificou o agente patogênico pulmonar em 7 casos. O lavado bronquiolo-alveo-lar e o exame histopatológico definiram o diagnóstico em 14% e 83%, respectivamente, entre os 28 pacientes que foram submetidos à broncoscopia. O organismo mais comun foi P.carinii (55%), seguido por M.tuberculosis (41%), e citomegalovírus (8%). Os achados clínicos, laboratoriais e radioló-gicos não discriminaram os agentes patogênicos. Vinte e três pacientes com PCP ou tuberculose receberam terapêutica específica; entre os pacientes que puderam ser avaliados o tratamento foi bem sucedido em 79% dos episódios de PCP e 100% em TB.
CONCLUSÕES: Determinamos que TB, PCP e CMV são as causas mais frequentes de infecções respiratórias em pacientes brasileiros infectados pelo HIV. O exame histológico foi essencial para firmar o diagnóstico etiológico. A TB em pacientes aidéticos assumiu formas semelhantes à TB primária em pacientes imunocompetentes e apresentou boa resposta terapêutica.


 

 

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Address for correspondence:
Adriana Weinberg, M.D.
University Hospital School of Medicine
Campus Box C227
4200 East Ninth Avenue
Denver, Colorado 80262,U.S.A.

Recebido para publicação em 05/05/1992
Aceito para publicação em 11/01/1993

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