ABSTRACT
La criptococosis es una de las infecciones oportunistas más frecuentes en pacientes con infección por HIV. La toxicidad de la anfotericina B y el aislamiento de un número creciente de cepas resistentes a fluconazol determinan la necesidad de tratamientos alternativos y estrategias novedosas. Este artículo presenta un paciente HIV positivo con criptococosis meníngea sin negativización de los aislamientos de Cryptococcus neoformans con el tratamiento convencional de inducción con anfotericina B más fluconazol, y respuesta favorable al sustituir este último antifúngico por voriconazol...
Cryptococcosis is one of the most common opportunistic infections in patientes with HIV infection. The toxicity of amphotericin B and isolation of an increasing number of strains resistant to fluconazole dictate the need for alternative treatments and novel strategies. This paper presents an HIV positive patient with cryptococcal meningitis without negativisation Cryptococcus neoformans isolates with conventional induction therapy with amphotericin B plus fluconazole, and favorable to the latter replaced by voriconazole antifungal response...
Subject(s)
Humans , Male , Adult , Amphotericin B/adverse effects , Amphotericin B/toxicity , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Cryptococcus neoformans/pathogenicity , Fluconazole/therapeutic use , Histoplasmosis/pathology , Meningitis, Cryptococcal/pathology , Pneumonia, Pneumocystis/pathology , HIV Seropositivity/pathologyABSTRACT
El paciente con enfermedades oncológicas tiene un alto riesgo para desarrollar infecciones respiratorias, y neumonía por Pneumocystis jirovecii. En Venezuela existen pocos estudios sobre la neumocistosis en pacientes oncológicos. El objetivo de este trabajo fue detectar la presencia de Pneumocystis jirovecii en pacientes oncológicos a través de la técnica de inmunofluorescencia directa. Se recibieron, durante 10 meses, 31 muestras respiratorias (lavado broncoalveolar, esputo espontáneo e inducido, aspirados traqueales), de ellas 8 (25,5 por ciento) resultaron positivas. La distribución por tipo de cáncer fue la siguiente: 18 tumores sólidos y 13 leucemias y linfomas. La positividad entre los grupos estudiados no fue estadísticamente significativa (P>0,05). Los exámenes de laboratorio complementarios, relacionados tampoco fueron estadísticamente significativos (P>0,05). Es necesario incluir este diagnóstico en estudio microbiológico diferencial de infecciones del tracto respiratorio inferior en pacientes con cáncer, estos pacientes cursan con una sintomatología general inespecífica y tendrán una alta posibilidad de desarrollar neumocistosis.
The patient with malignancy disease has a high risk to develop respiratory infections for Pneumocystis jirovecii pneumonia. Investigations about pneumocystosis in oncological patients in Venezuela are scarce. The objective of this work was to detect Pneumocystis jirovecii in oncological patients by the method of direct immunofluorescence technique. Thirty one respiratory specimens (bronchoalveolar lavage, spontaneous and induced sputum, and tracheal aspirates) received in 10 months, 8 specimens of them (25.5) were positive the distribution by malignancy disease was the following: 18 solid tumors, and 13 leukemias, and lymphomas. No statistically significant differences were found between the studied groups and positive results (P>0.05). The complementary laboratory tests, related to the presence of Pneumocystis, were not statistically significant either P>0.05). Is necessary to include this diagnosis in the microbiological differential study of low respiratory tract infections in oncological patients, since these patients show unspecific symptoms, and have a high possibility to develop pneumocystosis.
Subject(s)
Humans , Male , Female , Middle Aged , Leukemia/pathology , Lymphoma/pathology , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/etiology , Pneumonia, Pneumocystis/pathology , Respiratory System/pathology , Fluorescent Antibody Technique, Direct/methods , Sputum/virology , Bacterial Infections/complications , Bronchoalveolar Lavage/methodsABSTRACT
Acute HIV infection is rarely recognized as the signs and symptoms are normally unspecific and can persist for days or weeks. The normal HIV course is characterized by a progressive loss of CD4+ cells, which normally leads to severe immunodeficiency after a variable time interval. The mean time from initial infection to development of clinical AIDS is approximately 8-10 years, but it is variable among individuals and depends on a complex interaction between virus and host. Here we describe an extraordinary case of a man who developed Pneumocisits jiroveci pneumonia within one month after sexual exposure to HIV-1, and then presented with 3 consecutive CD4 counts bellow 200 cells/mm³ within 3 months, with no other opportunistic disease. Although antiretroviral therapy (AZT+3TC+ATZ/r) was started, with full adherence of the patient, and genotyping indicating no primary antiretroviral resistance mutations, he required more than six months to have a CD4 restoration to levels above 200 cells/mm³ and 10 months to HIV-RNA to become undetectable.
Subject(s)
Adult , Humans , Male , AIDS-Related Opportunistic Infections/pathology , Anti-HIV Agents/therapeutic use , Disease Progression , Pneumocystis carinii , Pneumonia, Pneumocystis/pathology , Acute Disease , AIDS-Related Opportunistic Infections/drug therapy , HIV Infections/drug therapy , HIV Infections/pathology , Viral LoadABSTRACT
Se presentan los resultados de la evaluación de 980 pacientes utilizando Tomografía Computada con alta resolución (TCAR), demostrando que los cortes obtenidos son equivalentes a la superficie de corte macroscópica de la anatomía patológica. Se realizan como mínimo 3 cortes fijos en los exámenes de rutina. Se hace una revisión y puesta al día de la patología observada manteniendo la división técnica en patrones pulmonares, correlacionándolos con la histopatología. Se presenta un nuevo enfoque en la interpretación del criterio de los tumores. Se propone la utilización sistemática de esta metodología en todos los procesos pulmonares focales y difusos
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Lung , Pulmonary Emphysema/pathology , Pulmonary Fibrosis/classification , Tomography, X-Ray Computed/methods , Cytomegalovirus Infections/diagnosis , Pneumonia, Mycoplasma/diagnosis , Pneumonia, Mycoplasma/pathology , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/pathology , Lung/anatomy & histology , Lung/pathology , Pulmonary Fibrosis , Pulmonary Fibrosis/etiologyABSTRACT
Se reportan 3 casos de pacientes que presentaron por Pneumocystis carinii, resaltándose el hecho de que se puede realizar un diagnóstico parasitológico rápido utilizando las coloraciones de Giemsa y Azul de toluidina al cabo de una hora de obtenida la muestra. Propugnamos que sospechándose clínicamente esta entidad, en casos de neumonías severas, especialmente en inmunocomprometidos, se puede diagnosticar precozmente la presencia del parásito en tejido pulmonar o lavado bronquioalveolar para beneficio del paciente crítico
Subject(s)
Humans , Male , Pneumonia, Pneumocystis/pathology , Pneumocystis carinii/isolation & purification , Pneumocystis carinii/pathogenicitySubject(s)
Humans , Communicable Diseases/pathology , Histocytological Preparation Techniques , Diagnostic Techniques, Surgical , Leukoencephalopathy, Progressive Multifocal/pathology , Opportunistic Infections/pathology , Papillomaviridae , Pathology, Surgical/methods , Pneumocystis carinii/pathogenicity , Pneumonia, Pneumocystis/pathology , Staining and LabelingABSTRACT
O caso de um homem de 46 anos, que desenvolveu uma pneumonia pneumocística fatal, sem associaçäo a outra doença reconhecida ou ao uso de terapêutica imunodepressora, é apresentado e comparado a outros semelhantes da literatura. O paciente evidenciava ainda uma proliferaçäo imunoblástica exuberante do tecido linfóide do baço, a qual näo está descrita associada com a infecçäo pneumocística, mas é de avaliaçäo dificil, a face à sua inespecificidade. Desde que se admite que o pneumocystis carinii é um germe estritamente oportunista, cuja açäo patogênica depende basicamente de baixa da resistência do portador, deve-se supor que estes casos inusitados, aparentemente "primários", podem depender de efeitos sutis nos mecanismos de defesa do hospedeiro, suficientes para permitir a pneumonia grave difusa