Aspectos tomográficos da tuberculose pulmonar em pacientes adultos com AIDS / Computed tomography findings of pulmonary tuberculosis in adult AIDS patients

OBJETIVO: Este trabalho tem como finalidade descrever os achados tomográficos da tuberculose pulmonar em pacientes adultos com AIDS atendidos no serviço de radiologia de um hospital de referência em doenças infecciosas, procurar associações desses achados e a contagem de CD4. MATERIAIS E MÉTODOS: Foram estudados 45 pacientes por meio de tomografia computadorizada de tórax durante quatro anos. RESULTADOS: Foram encontrados linfonodomegalia mediastinal e/ou hilar em 31 (68,8 por cento) dos casos, derrame pleural em 29 (64,4 por cento), nódulos centrolobulares de distribuição segmentar em 26 (57,7 por cento), consolidação em 24 (53,3 por cento), confluência de micronódulos em 17 (37,7 por cento), nódulos mal definidos com distribuição centrolobular em 16 (35,5 por cento), padrão de "árvore em brotamento" em 13 (28,9 por cento), espessamento de parede brônquica em 12 (26,6 por cento), cavidade de parede espessa em 10 (22,2 por cento), nódulos miliares em 9 (20 por cento) e bronquiectasias cilíndricas em 6 (13,3 por cento). Dos 45 pacientes, 35 (77,8 por cento) apresentaram CD4 < 200 cel/mm³ e 10 (22,2 por cento) apresentaram CD4 > 200 cel/mm³. CONCLUSÃO: Concluímos que neste estudo, diversamente do descrito na literatura, linfonodomegalia mediastinal e/ou hilar e consolidação foram significativamente mais frequentes em pacientes com CD4 > 200 cel/mm³. No entanto, linfonodos com centro hipodenso foram mais frequentemente observados em pacientes com severa imunodepressão, ou seja, CD4 < 200 cel/mm³.

OBJECTIVE: The present study is aimed at describing computed tomography findings pulmonary tuberculosis in adult AIDS patients assisted at a radiology unit of a reference infectious diseases hospital, in an attempt to establish the association between such findings and CD4 count. MATERIALS AND METHODS: Forty-five patients were evaluated by chest computed tomography over a four-year period. RESULTS: Mediastinal and/or hilar lymph node enlargement was found in 31 (68.8 percent) cases, pleural effusion in 29 (64.4 percent), centrilobular nodules with segmental distribution in 26 (57.7 percent), consolidation in 24 (53.3 percent), confluent micronodules in 17 (37.7 percent), poorly defined nodules with centrilobular distribution in 16 (35.5 percent), tree-in-bud pattern in 13 (28.9 percent), bronchial wall thickening in 12 (26.6 percent), thick-walled cavity in 10 (22.2 percent), miliary nodules in 9 (20 percent), and cylindrical bronchiectasis in 6 (13.3 percent). Among the 45 patients, 35 (77.8 percent) presented CD4 count < 200 cel/mm³ and 10 (22.2 percent) presented CD4 count > 200 cel/mm³. CONCLUSION: Differently from reports in the literature, the authors conclude that mediastinal and/or hilar lymph node enlargement and consolidation were significantly most frequent in patients with CD4 count > 200 cel/mm³. However, lymph nodes with hypodense center were most often observed in severely immunosuppressed patients with CD4 count < 200 cel/mm³.

Clinicopathologic correlation between CD4-positive T lymphocyte counts and superficial lymphadenopathy in HIV-positive/AIDS patients / 中华病理学杂志

<p><b>OBJECTIVE</b>To explore the clinicopathological correlation between CD4(+) T lymphocyte count and superficial lymphadenopathy HIV/AIDS patients.</p><p><b>METHODS</b>A total of 1066 HIV/AIDS patients were included in this study. The incidence of superficial lymphadenopathy, peripheral blood CD4(+) T lymphocyte counts and histological features of superficial lymphadenopathy were analyzed.</p><p><b>RESULTS</b>Among 1066 patients, 126 cases (11.8%) presented with superficial lymphadenopathy. Of the 126 cases, there were 69 cases with CD4(+) T lymphocyte counts < 100/µl and clinical diagnoses including tuberculosis (37 cases), reactive hyperplasia (8 cases), AIDS-related lymphadenopathy (18 cases), penicillium diseases (12 cases), fungal infection (5 cases) and non-tuberculous mycobacterial infection (1 case). Twenty-six cases had CD4(+) T lymphocyte counts between 100/µl to 200/µl and clinical diagnosis including tuberculosis (12 cases), reactive hyperplasia (8 cases), AIDS-related lymphadenopathy(6 cases), penicillium disease (2 cases) and non-Hodgkin lymphoma (1 case). Twenty-nine cases had CD4(+) T lymphocyte counts > 200/µl and clinical diagnoses including tuberculosis (11 cases), reactive hyperplasia (12 cases), AIDS-related lymphadenopathy (3 cases), Penicillium diseases (1 case) and non-Hodgkin lymphoma (4 cases). The CD4(+) T lymphocyte counts among patients with tuberculosis, AIDS-related lymphadenopathy and Penicillium diseases were significantly different (χ(2) = 8.861, P = 0.012). A significant correlation between the incidence of superficial lymphadenopathy and CD4(+) T lymphocyte counts was found (χ(2) = 375.41, P = 0.000).</p><p><b>CONCLUSIONS</b>The most common cause of superficial lymphadenopathy in HIV/AIDS patients is tuberculosis, followed by lymph node reactive hyperplasia, AIDS-related lymphadenopathy and Penicillium disease. Low CD4(+) T lymphocyte count correlates with an increased incidence of superficial lymphadenopathy and the risk of opportunity infection. Therefore, determination of peripheral blood CD4(+) T lymphocyte count should become an integral marker for the early diagnosis and treatment of superficial lymphadenopathy in HIV/AIDS patients.</p>

Human immunodeficiency virus and the central nervous system

The pandemic of HIV/AIDS continues to grow daily. Incident cases among women, intravenous drug users and ethnic minorities comprise the fastest growing segment of the HIV-infected population, and the number of HIV-infected individuals over the age of 50 is growing rapidly. Today, the central nervous system and the immune system are seen as main targets of HIV infection. Significant progress in the knowledge and treatment of AIDS has been obtained in recent years. The neurological manifestations directly related to HIV are acute viral meningitis, chronic meningitis, HIV-associated dementia (HAD), vacuolar myelopathy, and involvement of the peripheral nervous system.

Bone marrow abnormalities in HIV disease.

Bone marrow abnormalities are frequently observed in HIV infected individuals at all stages of the disease. The most common abnormal finding is dysplasia affecting one or more cell lines. Erythroid dysplasia is the most common type of dysplasia and is recognized in over 50% of HIV infected patients, abnormal granulocytic and megakaryocytic development is encountered in one-third of patients. Plasma cells are strikingly increased in bone marrow of HIV infected patients. It may represent a physiological response to antigenic stimulation by viruses, other infective agents or secondary to dysregulated B-cell proliferation due to HIV. Herein we present a review discussing the various bone marrow abnormalities associated with the HIV disease.

Study of bone marrow abnormalities in patients with HIV disease.

AIM: Present work was carried out to study the bone marrow abnormalities in patients with HIV/AIDS and to find their association with peripheral hematological abnormalities. METHODS: Seventy four patients of HIV/AIDS were included in the study. The patients had anemia, leucopenia, thrombocytopenia or pyrexia of unknown origin (PUO) as indications for bone marrow examination. A complete blood count, relevant biochemical investigations, HIV RNA load and CD4 positive lymphocyte counts were done, besides a thorough history and clinical examination. HIV positive patients were classified as those having AIDS and those without AIDS according to NACO criteria. RESULTS: Majority of patients (72.9%) had AIDS. Bone marrow was normocellular in 78.95% of non-AIDS and 74.55% of AIDS, hypocellular in 5.26% of non-AIDS and 7.27% of AIDS, hypercellular in 15.79% of non-AIDS and 18.18 % of AIDS patients. Myelodysplasia was present in 21.05% of non AIDS and 36.46% of AIDS and the most common series affected was granulocytic (15.79% of total in non-AIDS and 30.9% in AIDS). Dysplasia was statistically significantly associated with lower CD4 count (p = 0.031) and anemia (p = 0.013). Myelodysplasia was apparent even before patients developed anemia (16.67%). Increased plasma cells in bone marrow were observed in 57.89% of non-AIDS and 65.45% of AIDS, whereas decreased lymphoid cells were seen in 36.84% of non AIDS and 60.00% of AIDS patients. CONCLUSIONS: Myelodysplasia is found in 32.43% of cases of HIV/AIDS and is more common in AIDS than in non AIDS patients. Granulocytic series is most commonly associated with evidence of dysplasia. Myelodysplasia is more common in patients with CD4 count < 200/microl and in patients with anemia. 54.05% of patients had decreased lymphoid cells in bone marrow and it was more commonly seen in AIDS than in non AIDS.

Pathology of AIDS-related lymphadenopathy: a study of 18 biopsy cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features of acquired immunodeficiency syndrome (AIDS)-related lymphadenopathy and to elucidate the salient features helpful in achieving a correct pathologic differentiated diagnosis.</p><p><b>METHODS</b>Eighteen cases of AIDS-related lymphadenopathy were retrieved from the files of the First Affiliated Hospital of Guangxi Medical University from 2001 to 2004. Histochemical stains, including periodic acid-Schiff, acid-fast, Giemsa, Grocott stains and immunohistochemistry (EnVision method), were used to detect the presence of pathogens in tissue sections and classify them.</p><p><b>RESULTS</b>Fifteen of the 18 cases (83%) were stage 4 (i.e. follicular and lymphocytic depletion). Twelve cases were co-infected with Penicillium marneffei and 4 other cases with Mycobacterium, and no pathogen was found in 1. The remaining patient was complicated with diffuse large B-cell lymphoma.</p><p><b>CONCLUSIONS</b>When presented in early stages, AIDS-related lymphadenopathy may be overlooked, especially in routine pathology practice. Awareness of the entity in patients with persistent fever and generalized lymphadenopathy is thus crucial. Florid infection with Penicillium marneffei is also considered as an important predictor for underlying AIDS. Thorough understanding of morphologic features of AIDS-related lymphadenopathy, including possible co-infection, is essential in arriving at the correct diagnosis.</p>

Llamado para la acción: nuevas perspectivas en la lucha contra el VIH/SIDA en Nicaragua / Call for the action: news perspectives in the fight against the VIH in Nicaragua

El documento presenta una propuesta concreta del grupo temático ONUSIDA en apoyo a tareas prioritarias contenidas en el plan estratégico nacional, como una expresión de la preocupación del sistema de las naciones unidas (SNU) por el impacto de la epidemia en el desarrollo social, económico y cultural del país. Así mismo el documento proporciona nuevos ambitos de acción para asegurar una percepción real de la dimensión de la epidemia en Nicaragua y de la vulnerabilidad de ciertos sectores de la población, para identificar nuevos actores que deben integrarse a la respuesta expandida. Esta respuesta deberá constituirse en un proceso sistemático, participativo, basado en el reconocimiento de roles y responsabilidades bien definidas y respetadas

Risk Factors for tuberculosis among human immunodeficiency virus-infected persons. A case-control study in Belo Horizonte, Minas Gerais, Brazil (1985-1996)

The objective of this study was to identify tuberculosis risk factors and possible surrogate markers among human immunodeficiency virus (HIV)-infected persons. A retrospective case-control study was carried out at the HIV outpatient clinic of the Universidade Federal de Minas Gerais in Belo Horizonte. We reviewed the demographic, social-economical and medical data of 477 HIV-infected individuals evaluated from 1985 to 1996. The variables were submitted to an univariate and stratified analysis. Aids related complex (ARC), past history of pneumonia, past history of hospitalization, CD4 count and no antiretroviral use were identified as possible effect modifiers and confounding variables, and were submitted to logistic regression analysis by the stepwise method. ARC had an odds ratio (OR) of 3.5 (CI 95 per cent - 1.2-10.8) for tuberculosis development. Past history of pneumonia (OR 1.7 - CI 95 0.6-5.2) and the CD4 count (OR 0.4 - CI 0.2-1.2) had no statistical significance. These results show that ARC is an important clinical surrogate for tuberculosis in HIV-infected patients. Despite the need of confirmation in future studies, these results suggest that the ideal moment for tuberculosis chemoprophylaxis could be previous to the introduction of antiretroviral treatment or even just after the diagnosis of HIV infection.

Ética: entre a cruz e a espada / Ethics: between the cross and the sword

Discriminação pode levar pacientes a omitir informações valiosas e comprometer todo o trabalho do CD. Relacionamento entre as duas partes é fator importante para o equacionamento da questão, principalmente em casos de HIV soropositivos

Stuctured AIDS Education Inspires Self-Expression of Needs and Beneficial Changes

The accuracy with which the real needs of the people are met; in the prevention and control of AIDS; will determine the success with which the disease is controlled. A structured AIDS education that integrates with formal and continuing education is proposed as away of bringing about long term and lasting behaviour changes. The programme described here has five subjects; namely demystifying the AIDS epidemic; adolescent development and courtship values and ethics; marriage; family/population development and the future with AIDS. These topics integrate well with similar topics in the subject of Social Education and Ethics syllabus which is taught in secondary schools in Kenya. The AIDS education programme is being administered in weekly features articles in one of Kenya's dailies. It is read by about 3 million people some of whom write to the author to express their needs and the beneficial changes that they have experienced as a result of reading the articles. These needs have been grouped into 8 categories and have been responded to in writing

Nível de informaçäo e comportamento dos dentistas brasileiros em relaçäo à AIDS e à infecçäo pelo HIV / Information level and behavior of brazilian dentists relating to AIDS and HIV infection

A prática odontológica é uma atividade que apresenta elevado risco de contaminaçäo para várias doenças infecto-contagiosas. O objetivo do presente estudo foi determinar, pela aplicaçäo de um questionário específico, o nível de informaçäo e o comportamento de dentistas brasileiros em relaçäo a pacientes HIV e com AIDS. Duzentos e noventa e cinco dentistas brasileiros foram entrevistados a respeito de aspectos básicos da AIDS e da infecçäo pelo HIV, durante o Congresso Paulista de Odontologia. As respostas revelaram que há despreparo, preconceito e medo relacionados ao tratamento de pacientes HIV. Contudo, esse problema näo ocorre somente no Brasil, mas em muitos outros países nos quais estudos semelhantes foram desenvolvidos. Nossos resultados, assim como os de outros estudos, mostraram a necessidade da implantaçäo de programas sistemáticos de esclarecimento aos dentistas

Evolução da síndrome de imunodeficiência adquirida (AIDS - SIDA) na clínica odontológica. O papel do cirurgião-dentista / The evolution of the acquired immunodeficiency syndrome in dental clinc and the dental team role

Evolução da infecção pelo HIV na clínica odontológica, mostrando a sua transmissão e seus diferentes estágios. A epidemiologia no mundo e Brasil, em especial, na clínica odontológica, o papel do cirurgião-dentista, discutindo os seus procedimentos, diante dos pacientes e suas manifestações bucais como a sua própria biossegurança durante o trabalho

Infecçöes emergentes e síndrome de imunodeficiência adquirida: aspectos morfológicos da linfadenopatia pelo VIH, malacoplaquia (Rhodococcus equi) e microsporidiose intestinal / Emergent Infections and syndrome of acquired imunodeficiência: morphologic aspects of the linfadenopatia for VIH, malacoplaquia (Rhodococcus equi) and intestinal microsporidiose

Enfoca-se três patologias distintas. Inicialmente, foram estudados 31 linfonodos de pacientes infectados pelo vírus da imunodeficiência humana (VIH+), com ou sem síndrome de imunodeficiência adquirida (SIDA), por técnicas histológicas convencionais e imuno-histoquímicas. Hiperplasia folicular foi o padräo mais comum em pacientes soropositivos, enquanto involuçäo folicular e padräo difuso foram observados nos pacientes com SIDA. No segundo trabalho, foram descritos dois casos de malacoplaquia em pacientes com SIDA. Estudos em microscopias óptica, confocal de varredura a laser e eletrônica de transmissäo demonstraram corpos de Michaelis-Gutmann e bactérias, livres ou citoplasma de células de von Hansemann. Rhodococcus equi (cocobacilos Gram positivos), coraram-se muito bem pela prata metenamina de Grocott, em secçöes de tecido. Quando examinados, por microscopia confocal de varredura a laser, demonstraram brilho intenso, permitindo o estudo tridimensional da célula de von Hansemann. No terceiro trabalho, foram estudadas biópsias intestinais de 39 pacientes com SIDA e diarréia crônica, nove delas positivas para microsporídios. Os esporos, melhor observados em microscopia convencional pela coloraçäo de Brown-Brenn, quando analisados por microscopia confocal de varredura a laser, apresentaram intenso brilho à luz refletida, facilitando a sua visualizaçäo. O estudo em microscopia eletrônica, em material desparafinado e pós-fixado em glutaraldeído, permitiu a observaçäo de, praticamente, todas as formas de desenvolvimento do Encephalitozoon bieneusi. Os resultados dos trabalhos demonstram a utilidade de estudo ultraestrutural e por microscopia de varredura confocal a laser na identificaçäo de agentes infecciosos, principalmente quando material a fresco näo está disponível

A Case of Proximal Subungual Onychomycosis in a Patient with Rheumatoid arthritis / 대한피부과학회지

Proximal subungual onychomycosis (PSO) is the rarest form of onychomycosis and most commonly due to Trichophyton rubrum, The fungus initially penetrates the horny layer of the proximal nail fold and subsequently invades the under-surface of the nail plate. PSO has been mainly reported in patients with AIDS and AIDS related complex and may serve as an early clue for the presence of imrnunodeficiency. We report a case of PSO in a 45-year-old woman with reumatoid arthritis who received oral steroid.

Linfoma primario de intestino delgado relacionado al SIDA: informe de un caso / Primary lymphoma of the bowel related to AIDS: a case report

El linforma no Hodgkin es una neoplasia relacionada con el SIDA, cuya incidencia se incrementa a mayor duración de la infección por el VIH. Se presenta el caso de un hombre de 21 años de edad con diagnóstico de linfoma no Hodgkin inmunoblástico de células grandes, primario del yeyuno