Clinical and pathological findings of Rhodococcus equi infection in foals / Achados clínicos e patológicos da infecção por Rhodococcus equi em potros

Infection by Rhodococcus equi is considered one of the major health concerns for foals worldwide. In order to better understand the disease's clinical and pathological features, we studied twenty cases of natural infection by R. equi in foals. These cases are characterized according to their clinical and pathological findings and immunohistochemical aspects. Necropsy, histologic examination, bacterial culture, R. equi and Pneumocystis spp. immunohistochemistry were performed. The foals had a mean age of 60 days and presented respiratory signs (11/20), hyperthermia (10/20), articular swelling (6/20), prostration (4/20), locomotor impairment (3/20) and diarrhea (3/20), among others. The main lesions were of pyogranulomatous pneumonia, seen in 19 foals, accompanied or not by pyogranulomatous lymphadenitis (10/20) and pyogranulomatous and ulcerative enterocolitis (5/20). Pyogranulomatous osteomyelitis was seen in 3 foals, one of which did not have pulmonary involvement. There was lymphoplasmacytic (4/20), lymphoplasmacytic and neutrophilic (1/20) or pyogranulomatous arthritis (1/20), affecting multiple or singular joints. Immunohistochemistry revealed to be a valuable tool for the detection of R. equi, confirming the diagnosis in all cases. Furthermore, pulmonary immunostaining for Pneumocystis spp. demonstrates that a coinfection with R. equi and this fungal agent is a common event in foals, seen in 13 cases.(AU)

Infecção por Rhodococcus equi é considerado um dos maiores problemas sanitários para potros em todo o mundo. Para melhor compreender a apresentação clínica e patológica da enfermidade, foram avaliados vinte casos de infecção natural por R. equi em potros. Os casos são caracterizados de acordo com seus achados clínicos e patológicos e aspectos imuno-histoquímicos. Foram realizados exames de necropsia, histologia, bacteriologia e imuno-histoquímica para R. equi e Pneumocystis spp. Os potros tinham idade media de 60 dias e apresentaram sinais respiratórios (11/20), hipertermia (10/20), aumento de volume articular (6/20), prostração (4/20), distúrbios locomotores (3/20) e diarreia (3/20), entre outros. As lesões mais importantes eram pneumonia piogranulomatosa, vista em 19 potros, acompanhada ou não por linfadenite piogranulomatosa (10/20) e enterocolite ulcerativa (5/20). Osteomielite piogranulomatosa foi constatada em três potros, um dos quais não apresentava envolvimento pulmonar. Artrites afetando uma ou múltiplas articulações eram caracterizadas por infiltrado linfoplasmocítico (4/20), linfoplasmocítico e neutrofílico (1/20) e piogranulomatoso (1/20). A imuno-histoquímica demonstrou ser uma ferramenta valiosa na detecção de R. equi, permitindo confirmar o diagnóstico em todos os casos avaliados. Além disso, a imuno-histoquímica para Pneumocystis spp. demonstra que a coinfecção por R. equi e o agente fúngico é um evento frequente em potros, constatado em 13 casos.(AU)

Detección y genotipificación de Pneumocystis jirovecii en muestras de pacientes mexicanos VIH positivos y negativos / Detection and genotyping of Pneumocystis jirovecii in samples from HIV positive and negative Mexican patients

Resumen Introducción: Pneumocystis jirovecii es un hongo atípico detectado particularmente en pacientes VIH-positivos o con trasplante. Objetivo: Detectar y genotipificar Pneumocystis jirovecii en muestras de pacientes de dos hospitales de la ciudad de México. Método: Fueron procesadas 89 muestras respiratorias, correspondientes a 53 pacientes (30 VIH positivos y 23 VIH negativos) con sintomatología respiratoria y 11 personas sanas incluidas como control negativo. El DNA fue extraído y amplificado por PCR anidada de la región del espaciador transcrito interno, obteniendo un fragmento en cada ronda (de 693 y 550 pb). Los genotipos y su relación filogenética fueron determinados por secuenciación del fragmento de 550 pb. Resultados: Cuarenta y ocho muestras de 30 pacientes VIH-positivos provenían de un solo hospital, de las cuales 11 (36.6 %) fueron positivas a Pneumocystis jirovecii. Ninguna fue positiva en pacientes VIH-negativos o personas sanas. Los haplotipos detectados con mayor frecuencia fueron Eg y Em. Conclusiones: La frecuencia de infección por Pneumocystis jirovecii fue alta en la población mexicana estudiada. El genotipo más frecuente fue diferente a los reportados en otros países. Es necesario encauzar este problema de salud hacia la detección temprana de esta infección.

Abstract Introduction: Pneumocystis jirovecii is an atypical fungus particularly detected in HIV-positive or transplant patients. Objective: To detect and genotype Pneumocystis jirovecii in patient samples from two hospitals in Mexico City. Method: Eighty-nine respiratory tract samples, corresponding to 53 patients (30 HIV-positive and 23 HIV-negative) with respiratory symptoms and to 11 healthy individuals included as negative control, were processed. DNA was extracted from the ITS region and amplified by nested polymerase chain reaction from the internal transcribed spacer, with one fragment being obtained at each round (693 and 550 bp). Genotypes and their phylogenetic relationship were determined by sequencing the 550 bp fragment. Results: Forty-eight samples from 30 HIV-positive patients were received from a single hospital, out of which 11 (36.6 %) were positive for Pneumocystis jirovecii. No sample was positive in HIV-negative patients or healthy subjects. The most frequently detected haplotypes were Eg and Em. Conclusions: The frequency of Pneumocystis jirovecii infection was high in the studied Mexican population. The most common genotype was different from those reported in other countries. It is necessary to address this health problem through early detection of this infection.

Trends in overall opportunistic illnesses, Pneumocystis carinii pneumonia, cerebral toxoplasmosis andMycobacterium avium complex incidence rates over the 30 years of the HIV epidemic: a systematic review

BACKGROUND: The natural history of HIV infection has changed dramatically after the introduction of highly active antiretroviral therapy. Currently, opportunistic illnesses still represent a major cause of death and hospitalization in this population. In this study, we review the trends in opportunistic illnesses incidence rates and compare the results observed in high-income settings with that for low/middle-income settings, with special attention given to studies from Brazil. METHODS: We systematically searched Pubmed, Web of Science, Lilacs and Google scholar for publications on HIV associated opportunistic illness. Studies reporting rates based on person-time for all opportunistic illnesses and/or the three opportunistic infections of interest, namely,Pneumocystis carinii pneumonia, cerebral toxoplasmosis, and Mycobacterium avium complex were included. RESULTS: Significant reductions in the incidence rates were demonstrated for opportunistic illnesses overall and also for the specific opportunistic infections included in the present study, both in high and low/middle-income settings. Out of the 37 studies included in the present review, almost 70% were from high-income settings. All the studies conducted in low/middle-income settings were single center studies and four were from Brazil. We found no study from Brazil reporting annual incidence rates of opportunistic illnesses. CONCLUSIONS: Opportunistic illnesses remain an important public health problem. To better guide health policies in low/middle-income settings, multicenter cohort studies should be encouraged. Studies from Brazil are urgently needed to assess the current burden of opportunistic illnesses in our population and to support the planning of HIV/AIDS health care services organization. .

Profilaxis de neumonía por Pneumocystis jiroveci en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos / Prophylaxis against Pneumocystis pneumonia in pediatric and adult patients undergoing solid organ or hematopoietic stem cells transplantation

Pneumocystis jiroveci is an important pathogen in patients undergoing SOT and HSCT. Universal prophylaxis is recommended for all adults and children with SOT and HSCT, considering that its use significantly reduces the occurrence and mortality associated with pneumonia by this agent. The drug of choice is cotrimoxazole (A1) three times a week, low-dose scheme, that has proved equally effective and better tolerated than the daily regimen and/or at high doses. Prophylaxis starts 7 to 14 days post transplant in SOT recipients and post-implant in HSCT, with an average duration of 6 months except in liver and lung transplant as in HSCT with significant degree of immunosuppression, that lasts for 1 year. Alternatives for prophylaxis are dapsone (B2), aerosolized pentamidine (B2) and atovaquone (C2).

Pneumocystis jiroveci es un patógeno importante en pacientes sometidos a TOS y TPH. Se recomienda proilaxis universal a todos los pacientes adultos y niños sometidos a TOS o TPH porque su uso reduce signiicati-vamente la ocurrencia y mortalidad asociada a neumonía por este agente. El medicamento de elección es cotrimoxa-zol (A1) tres veces por semana, en dosis bajas, esquema que ha demostrado igual eicacia y mejor tolerancia que el esquema diario y/o con dosis altas. La proilaxis se inicia 7 a 14 días post trasplante en TOS y posterior al implante en TPH, con una duración promedio de 6 meses salvo en trasplante de hígado y pulmón en que se prolonga por 1 año, al igual que en TPH con grado importante de inmunosupresión. Son alternativas de profilaxis dapsona (B2), pentamidina aerosolizada (B2) y atavacuona (C2).

Neumotórax en pacientes con SIDA: Actualización sobre el tema / Pneumothorax in patients with AIDS: Update on the theme

La aparición de neumotórax como complicación de la neumonía por Pneumocistis carinii (PCP) en pacientes con SIDA, es muy frecuente desde los inicios de la pandemia en 1982, y comporta gran mortalidad. En este trabajo se reporta una serie de 25 pacientes con neumotórax como complicación de la Pneumocistis carinii en pacientes con SIDA, tratado por los autores durante cinco a ños de trabajo discontinuos en el cono sur africano: tres en Sudáfrica y dos en Zimbabwe. Se reportan los datos demográficos y el estado de los mismos al llegar a la sala de cirugía y su evolución después de tratados quirúrgicamente. La toracotomía fue necesaria en ocho pacientes (32 por ciento), diez pacientes necesitaron cuidados de terapia intensiva (40 por ciento), y la mortalidad global fue del 32 por ciento. Se revisa la información actualizada sobre el tema, destacando las pautas terapéuticas más aceptadas internacionalmente. Conflictos de interés: Los autores no declaran conflicto de interés con editores, patrocinadores ni otros autores.

Pneumothorax as a Pneumocistis carinii pneumonia complication in patients with AIDS is very frequent since the pandemic beginnings in 1982, and it is accompanied by a high mortality. In this work we report a series of 25 patients with Pneumothorax as a Pneumocistis carinii pneumonia complication in patients with AIDS, treated by the authors during five years of discontinuous work in the Southern Africa cone: three years in South Africa and two years in Zimbabwe. We report demographic data, the status of the patients when they arrived to the Surgery Service and their evolution after surgery. Thoracotomy was needed in eight patients (32 percent), ten patients needed intensive care (40 percent), and the global mortality was 32 percent. We review the updated information on the theme, emphasizing the most accepted therapeutic guidelines at the international level.

An analysis of three opportunistic infections in an outpatient HIV Clinic in Jamaica / Análisis de tres infecciones oportunistas en un paciente externo de la Clínica de VIH en Jamaica

OBJECTIVES: To determine the occurrence of opportunistic infection (OI) in HIV-positive patients and to identify any risk factors which may be associated with such. METHODS: A cross-sectional study of all patients attending the HIV out-patient clinic was conducted. Their hospital notes were examined between January 1 and December 31, 2007 inclusive, to identify any occurrence of opportunistic infection. In addition, the patient list was also cross-referenced with all patients hospitalized on the medical wards during the same time period. Clinical and demographic data were collected for all participants. The occurrence of opportunistic infections and the variables of age, gender, CD4 counts and viral loads: (first ever, last in 2007 and at diagnosis of OI [or within six months]), the use of primary and secondary prophylaxis, the discontinuation of prophylactic regimens and the HAART regime at diagnosis of an OI and the diagnostic and treatment protocols of these infections were calculated. RESULTS: Six hundred and three patients participated in the study and 4.7% (n = 28) were found to have experienced at least one opportunistic infection in 2007. Significant associations were found between first and last CD4 cell count, viral load in 2007, year of entry into the clinic and death (p < 0.05). CONCLUSIONS: Opportunistic infections continue to cause significant morbidity and mortality in the HIV-patient population in this study. Earlier entry to treatment facilities and the use of HAART and appropriate prophylaxis can reduce this impact and lead to improved quality of life for HIV-positive individuals.

OBJETIVOS: Determinar la ocurrencia de infecciones oportunistas (IO) en pacientes VIH-positivos e identificar factores de riesgo que puedan estar asociados con ellas. MÉTODOS: Se llevó a cabo un estudio transversal de todos los pacientes que asisten a la clínica externa de VIH. Sus apuntes de hospital fueron examinados entre el 1 de enero y el 31 de diciembre de 2007 inclusive, a fin de identificar cualquier manifestación de infección oportunista. Además, la lista de pacientes fue creada con referencias cruzadas en relación con todos los pacientes hospitalizados en las salas del hospital durante el periodo en cuestión. Se recogieron los datos clínicos y demográficos de todos los participantes. Se realizaron cálculos de la ocurrencia de infecciones oportunistas y las variables de edad, género, conteos de CD4 y las cargas virales: (la primeray la última en 2007 y en el diagnóstico de IO [o dentro de seis meses]), el uso de profilaxis primaria y secundaria, la descontinuación de los regimenes profilácticos y el régimen de TARGA en el diagnóstico de una IO, así como los protocolos de diagnóstico y tratamiento de estas infecciones. RESULTADOS: Seiscientos tres pacientes participaron en el estudio y se halló que 4.7% (n = 28) habían parecido por lo menos una infección oportunista en 2007. Se hallaron asociaciones significativas entre elprimer y el último conteo celular CD4, la carga viral en el 2007, el ano de entrada en la clínica y la muerte (p < 0.05). CONCLUSIONES: Las infecciones oportunistas continúan siendo la causa de morbilidad y mortalidad significativas entre la población de pacientes de VIH de acuerdo a este estudio. El ingreso temprano a los centros de tratamiento y el uso de la terapia de TARGA así como una profilaxis adecuada, puede reducir este impacto y llevar a una mejor calidad de vida de los individuos VIH positivos.

Lessons learned about opportunistic infections in southeast Asia.

Southeast Asia is a region where the number of people infected with HIV/AIDS is one of the fastest growing in the world. Tuberculosis (TB) has grown along with the HIV epidemic. TB is not only the most common AIDS-defining illness but is also the leading cause of morbidity and mortality in AIDS patients. Cryptococcosis (meningitis or disseminated) is one of the most common opportunistic infections in AIDS patients. Cryptococcal meningitis is the first in the differential diagnosis considered with meningeal irritation. Penicillosis, a unique systemic mycosis, is an important emerging public health problem and has been classified as an AIDS defining illness in endemic areas like Thailand. Pneumocystis carinii (jiroveci) pneumonia has been one of the most important opportunistic infections in AIDS patients. Among parasitic infections, cryptosporidiosis is the most common intestinal protozoan infection relating to diarrhea in AIDS patients and toxoplasmosis is the only parasitic infection of the nervous system with a substantial incidence, up to 14.8%. Cytomegalovirus (CMV) retinitis has a lower prevalence compared to other opportunistic infections. In the era of highly active antiretroviral therapy (HAART), the incidence of opportunistic infections has significantly reduced in the past few years. Subsequently, the phenomena of immune restoration inflammatory syndrome (IRIS) in AIDS patients has been reported in this region as a result of HAART.

Occurrence of pneumocystis pneumonia in hiv-infected patients and the interference of the highly active antiretroviral therapy

From the beginning of the AIDS epidemic, pneumocystis pneumonia (PCP) has been distinguished as one of the most frequent opportunistic diseases with high morbid-mortality. As from 1996, the advent of the highly active antiretroviral therapy (HAART) has changed the characteristics of such epidemic by reducing its related diseases and, as a result, AIDS-related mortality. With the purpose to estimate PCP occurrence and HAART interference, 376 HIV-infected or AIDS patients were studied from January 1992 to December 2002. Among them, 58 (15.5 percent) PCP cases were found. There was a higher occurrence of PCP in the group of patients in which HAART was not used, with 40 (69.0 percent) of the episodes. As regards the studied period, a tendency to a linear reduction in annual PCP incidence was observed. The mean of T CD4+ lymphocytes in the patients with PCP (117 cells/mm³) was significantly lower when compared to that of the other individuals (325 cells/mm³). Therefore, this study suggests a temporal reduction in PCP occurrence related to HAART use with higher T CD4+ lymphocyte counts. Nevertheless, this opportunistic infection still shows significant incidence in AIDS patients. (NCT00516581).

Tuberculose como doença definidora de síndrome da imunodeficiência adquirida: dez anos de evolução na Cidade do Rio de Janeiro / Tuberculosis as a disease defining acquired immunodeficiency syndrome: ten years of surveillance in Rio de Janeiro, Brazil

OBJETIVO: Analisar a freqüência da tuberculose e das outras principais doenças oportunistas definidoras de síndrome da imunodeficiência adquirida, no momento em que estes casos são notificados, no Município do Rio de Janeiro. MÉTODOS: Análise do banco de dados do Sistema de Vigilância Epidemiológica do Programa de Doenças Sexualmente Transmissíveis e Síndrome da Imunodeficiência Adquirida da Cidade do Rio de Janeiro, no período de 1993 a 2002. RESULTADOS: A expansão da definição de casos de síndrome da imunodeficiência adquirida ocorrida em 1998 criou um aumento substancial no número de casos notificados de síndrome da imunodeficiência adquirida, principalmente por aqueles que passaram a ser definidos pelo critério imunológico. Dentre os casos de síndrome da imunodeficiência adquirida que foram definidos apenas por doença, a candidíase em suas diversas formas manteve-se como a doença oportunista de maior freqüência no momento da notificação. Embora a pneumonia por Pneumocystis carinii se apresentasse como a segunda doença mais freqüente na maioria dos anos observados, a partir de 2001, a tuberculose ultrapassou-a em freqüência, tornando-se a segunda doença mais freqüente no momento da notificação dos casos de síndrome da imunodeficiência adquirida. CONCLUSÃO: Apesar da diminuição do número de casos de síndrome da imunodeficiência adquirida definidos por doença, a tuberculose manteve-se como um importante evento definidor dessa síndrome, sendo atualmente de ocorrência mais freqüente do que a pneumonia por Pneumocystis carinii e a toxoplasmose, provavelmente por sua alta taxa de prevalência na cidade.

OBJECTIVE: To analyze the frequency of tuberculosis and of the other principal opportunistic infections defining acquired immunodeficiency syndrome at the time such cases were reported in the city of Rio de Janeiro, Brazil. METHODS: Analysis of the data compiled in the Rio de Janeiro Municipal Program for the Surveillance of Sexually Transmitted Diseases and Acquired Immunodeficiency Syndrome database from 1993 to 2002. RESULTS: The expanded definition of a case of acquired immunodeficiency syndrome, implemented in 1998, resulted in a substantial increase in the number of reported cases of acquired immunodeficiency syndrome, especially of those defined by immunologic criteria. Among the cases of acquired immunodeficiency syndrome defined only by disease, esophageal candidiasis, in its various forms, remained the most common opportunistic infection present at the time the cases of acquired immunodeficiency syndrome were reported. Although Pneumocystis carinii pneumonia was the second leading opportunistic infection in most of the years evaluated, it was surpassed by tuberculosis in 2001. CONCLUSION: Despite the decreased numbers of cases of acquired immunodeficiency syndrome defined by disease, tuberculosis remains a significant acquired immunodeficiency syndrome-defining event, currently more common than P. carinii pneumonia and toxoplasmosis. This is probably due to the high rate of tuberculosis prevalence in the city.

Neumonía por Pneumocystis carinii en niños infectados por el virus de inmunodeficiencia humana (VIH) / Pneumonia Due to Pneumocystis carinii in HIV-Infected Children

La introducción de nuevos agentes antirretrovirales y el desarrollo de nuevos esquemas de profilaxis antimicrobiana contra agentes oportunistas, ha conducido a una mejor calidad de vida en los pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Estos nuevos esquemas de tratamiento han cambiado la epidemiología de las infecciones oportunistas que, previo al uso de terapia antirretroviral (AR V) altamente activa, se presentaban con una elevada frecuencia en los niños infectados por el VIH. Específicamente, la neumonía por Pneumocystis carinii (PCP) ocurría en 12 al 40% de estos pacientes y estaba asociada con una elevada mortalidad. Actualmente, el uso de la terapia antirretroviral combinada y la administración de esquemas de profilaxis han resultado en una disminución importante en los casos de PCP. Sin embargo, en países en vías de desarrollo como el nuestro, la terapia altamente activa y la administración de estas profilaxis no están al alcance de todos los pacientes, por lo se encuentran en alto riesgo de presentar infecciones oportunistas, sobre todo producidas por Pneumocystis carinii, las cuales pueden acortar y afectar notablemente su supervivencia. El propósito de este articulo es hacer una revisión de la neumonía debida al Pneumocystis carinii, con especial énfasis, en las características epidemiológicas, clínicas y terapéuticas de la enfermedad en niños con VIH/SIDA.

Introduction of new antiretroviral agents and development of new prophylaxis schedules against opportunistic microorganisms have allowed increase in survival as well as better quality of life in HIV-infected patients. These new treatment schedules have changed the epidemiology of opportunistic infections that previous to use of highly active antiretroviral therapy (HAART), fomerly occurred with high frequency in HIV-infected children. Specifically, pneumonia due to Pneumocystis carinii formerly occurred in 12 to 80% of these patients and was associated with high mortality. Currently, with use of combined antiretroviral therapy (ART) and prophylactic treatments important reduction of PCP has been observed. However, despite these benefits ART is not yet available for many patients from several developing countries who are at risk for opportunistic infections, mainly due to Pneumocystis carinii. which can affect life expectancy. Therefore, the purpose of this paper was a review of epidemiologic, clinical, and therapeutic characteristics of P. carinii pneumonia in HIV-infected children.

The spectrum of HIV-related disease in rural Central Thailand.

To determine the spectrum of HIV-related illnesses presenting to a rural primary and secondary healthcare facility in Central Thailand, a cross-sectional study was conducted. Routinely collected data were extracted from outpatient medical notes for all adult HIV-infected new attenders of the Manorom Christian Hospital Infectious Disease Clinic. Data concerning inpatient admissions of HIV-infected individuals were collected from ward admission books and discharge summaries. Complete data were available for 229 outpatients, 70% of whom were men. The median age at presentation was 31 years for men and 30 years for women. The majority of the outpatients were married (69%) and infected heterosexually (91%). The commonest conditions requiring admission were cryptococcal meningitis (15%), bacterial pneumonia (12%), extrapulmonary tuberculosis (12%), Pneumocystis carinii pneumonia (7%), cerebral toxoplasmosis (4%) and pulmonary tuberculosis (3%). Of the patients presenting for the first time, 32% had AIDS-defining illnesses. Presentations with some conditions, such as tuberculosis and septicemia, were fewer than expected. The common opportunistic infections among HIV-infected adults in this rural region are treatable and preventable. Most patients present with advanced disease and earlier diagnosis, through improved access to voluntary counseling and testing, would enable them to receive appropriate preventive therapies and antiretrovirals as they becomes available. The high prevalence of cryptococcal disease suggests that prophylactic anti-fungal therapy may be of value in this area. Septicemia and tuberculosis may be under-diagnosed, highlighting the need for improved diagnostic laboratory facilities or treatment based upon validated clinical algorithms. Community care and palliative care services for HIV-infected individuals will increasingly be required in this region.

Pattern of opportunistic pulmonary infections in HIV sero-positive subjects: observations from Pondicherry, India.

Prospective analysis for a period of six-and-a-half years was done in 190 patients with HIV infection, which showed post-primary tuberculosis with sputum positive for acid-fast bacilli in 65% of cases. Extrapulmonary forms of tuberculosis especially lymph nodes infection was more frequent. Cervical group of lymph node involvement was the commonest presentation. Procedures such as FNAC/biopsy of lymph nodes and pleura provided the immediate diagnostic yields. These procedures must be considered early in the course of illness of HIV infected patients with suspected extrapulmonary and disseminated tuberculosis. Tuberculosis constitutes a common pathology with an appreciable mortality in disseminated subjects. Majority of patients with tuberculosis responded to 2EHRZ/7HR therapy indicating infection by Mycobacterium tuberculosis rather than by atypical mycobacteria, without any serious adverse reactions. Retrospective analysis of two groups (February 1991-May 1994) and (June 1994-October 1997) shows a significant increase in disseminated tuberculosis and Pneumocystis carini pneumonia indicating late stage of HIV disease.

Neumonía por pneumocystis carinii: factores predisponentes, manifestaciones clínicas y respuesta a tratamiento / Pneumocystis carinii pneumonia: risk factors, clinical manifestations and treatment outcome

Presentamos una serie de 43 pacientes con neumonía por P. carinii confirmada ya sea por anatomía patológica y/o RPC, destacando como patología de base más frecuente el SIDA, pero también se pesquisaron casos en pacientes con otras inmunodeficiencias, leucemia linfoblástica aguda, tratamiento inmunosupresor y linfopenia idiopática. En los pacientes infectados por VIH la evolución del cuadro fue larvada mientras que en los pacinetes leucémicos la presentación clínica del cuadro fue más agresiva. Destacó la tríada sintomática de fiebre, tos y disnea como los hallazgos clínicos más frecuentes, junto a una elevación constante de LDH y un recuento de CD4 inferior a 200 células/mm3. La mayoría de los pacientes presentó un patrón radiológico de tipo retículo nodular, aunque se evidenciaron también condensaciones y radiografías de tórax normales. La mayoría de los pacientes presentó una evolución clínica favorable con pocas reacciones adversas severas a cotrimoxazol, pero sí más frecuentes a pentamidina intravenosa. En el subgrupo de pacientes admitidos en UCI se observó una elevada letalidad

Infección por virus de inmunodeficiencia humana en mujeres: experiencia de un hospital de enfermedades infecciosas en Chile: 1988-1994 / Human immunodeficiency virus infection in women: experience of an infectious disease hospital in Chile: 1988-1994

Se revisaron retrospectivamente las fichas clínicas de 26 mujeres con infección por VIH atendidas en el Hospital Dr. Lucio Córdova L. entre enero de 1988 y diciembre de 1994. El 79,6 por ciento de las pacientes tenía entre 20 y 39 años. La infección fue adquirida en forma sexual en 73,1 por ciento, por transfusiones sanguíneas en 15,4 por ciento, ambos antecedentes estaban presentes en 7,7 por ciento y el mecanismo fue desconocido en 3,8 por ciento. El principal factor de riesgo fue el contacto sexual con pareja portadora del VIH (69,2 por ciento). La patología definitoria de SIDA más frecuente fue la neumonitis intersticial por P. carinii confirmada o presunta. La candidiasis orofaríngea y las manifestaciones herpéticas oro-genitales fueron las patologías más prevalentes. Dos pacientes (7,7 por ciento) tuvieron Ca. cérvico-uterino. Ocho enfermas (30,7 por ciento) fallecieron, 5 por complicaciones neurológica

Pneumocystis carinii pneumonia in human immunodeficiency virus infected patients in Bombay: diagnosed by bronchoalveolar lavage cytology and transbronchial lung biopsy.

We report Pneumocystis carinii pneumonia (PCP) diagnosed by bronchoalveolar lavage cytology and transbronchial lung biopsy in three out of five human immunodeficiency virus (HIV) positive adult patients presenting with interstitial pneumonitis. One of these patients was serologically positive for HIV at the time of presentation and the remaining two patients were detected to be HIV positive on follow up after the diagnosis had been established. All the three patients were treated with co-trimoxazole. One patient recovered and was discharged; another patient improved with treatment but died after jugular vein cannulation and the third patient succumbed to cryptosporidial diarrhoea. The remaining two patients with non-specific interstitial pneumonitis treated with prednisolone and bronchodilators were recovered and were discharged from the hospital.

Neumonía por Pneumocistis carinii en pacientes con SIDA en El Hospital Santo Tomas / Pneumocistis carinii pneumonia in patients with AIDS at the Saint Thomas Hospital

The authors examined material from the respiratory tract obtained from 55 patients, with silver Methenamine and Giemsa stains to detect Pneumocystis carinii. Twenty five patients were positive. All had fever and fatigue, 80% had dyspnea, 72% had productive cough, and significant weight loss occurred in 48%. None of the patients had signs of pulmonary consolidation. Chest X-Ray showed diffuse infiltrates in 55.2%. Nodular lesions in both lung fields were present in 6.9%. A local infiltrate was seen in 13.6% and no infiltrates were seen in 10.3%. LDH was elevated in all (ranging from 885 4500 UI), 84% of the patients had a PO2 of 70 mmHg or less. Most of the patients, 80%, responded to therapy with Trimethoprim-Sulfa

Etiología de la neumopatía en pacientes con SIDA

El presente trabajo pretende determinar en nuestro medio, la etiología de la enfermedad respiratoria en pacientes con SIDA, para lo cual se estudiaron 28 pacientes con prueba confirmatoria para VIH y síntomas respiratorios. Se realizó medición de DHL, gases arteriales, estudio radiológico de tórax y lavado broncoalveolar del cual se tomaron muestras para estudio microbiológico en diferentes medios; el sedimento se utilizó para coloración de micobacterias, el calco flúor blanco para P.carinii. Los principales patógenos encontrados fueron: P. carinii en nueve pacientes (32.2 por ciento), S. pneumoniae en seis (21.4 por ciento), M.tuberculosis en cinco (18 por ciento). Los hallazgos clínicos pueden orientar hacia el diagnóstico etiológico, no encontrandose relación con los exámenes paraclínicos: por esta razón pacientes con neumopatía y SIDA no deben recibir terapia empírica. Es necesario incluir en el estudio técnicas virales de diagnóstico para lograr una etiología más exacta.

Neumonía por Pneumocystis carinii en pacientes con SIDA: una amenaza creciente / Pneumocystis carinii penumonia in patients with AIDS: an increasing threat

Día a día es mayor la número de médicos que se ven enfrentados al problema del síndrome de inmunodeficiencia adquirida (SIDA). El virus de inmonodeficiencia humana (VIH) está librando una batalla sin tregua con el sistema inmunitario y las personas infectadas sucumben ante los tumores o las infecciones oportunistas. Una de las más graves de tales es la neumonía por Pneumocystis carinii. El presente artículo resume las características fundamentales de esta enfermedad cuyas implicaciones deben ser conocidas por todos los médicos.

Síndrome de inmunodeficiencia adquirida (SIDA): definición; historia; epidemiología; etiología; dimensiones sociales; prevención / Acquired immunodeficiency syndrome (AIDS): definition; history; epidemiology; ethiology; social dimension; prevention

Este trabajo de revisión, que fue expuesto durante el Simposio SIDA`90, incluye los conceptos fundamentales sobre la historia de la epidemia del síndrome de inmunodefiencia adquirida (SIDA), los últimos datos epidemiológicos, tanto a nivel mundial como de la Argentina, los grupos poblacionales de riesgo y las formas de transmisión. Se describe también al agente etiológico del síndrome, el virus de la inmunodeficiencia humana (HIV), su estructura, su arquitectura genética y su forma de replicación. Por último, se analizan los alcances sociales de la enfermedad, los principales métodos de prevención y las medidas sanitarias, legales y educativas necesarias, que permitan una eficaz atención del paciente y eficientes acciones preventivas