Infecção pelo citomegalovirus em pacientes com sindrome da imunodeficiencia adquirida (AIDS): relacoes clinico-virologicas e anatomopatologicas / Infection by cytomegalovirus in patients with acquired immunodeficiency syndrome (AIDS): clinical, virological and histopathological correlations

Com o objetivo de determinar a prevalencia da infeccao pelo Citomegalovirus (CMV) em pacientes com AIDS, bem como relacionar os achados clinicos virologicos decorrentes desta infeccao com as repercussoes anatomopatologicas, estudamos 50 pacientes adultos atendidos entre abril de 1986 a junho de 1987, em dois hospitais publicos de Sao Paulo (HSP e HSPE). Estes pacientes foram acompanhados clinica e laboratorialmente, por periodo medio de 2 meses com coletas seriadas de sangue, urina e saliva. Foram realizados isolamento do CMV em monocamadas de fibroblastos humanos e testes sorologicos de Imunofluorescencia Indireta (IFI-IgG/IgM) e Reacao Imunoenzimatica (ELISA-IgG). No momento da admissao no estudo 20 por cento (10/50) dos pacientes apresentavam anticorpos IgM CMV especificos e 100 por cento (50/50) deles anticorpos IgG (IFI). Durante o acompanhamento, 5 pacientes inicialmente IgM negativos tornaram-se IgM positivos, sugerindo reativacao ou reinfeccao pelo CMV. O CMV foi isolado de sangue periferico em 12,5 por cento, da urina em 23,2 por cento, da saliva em 21,9 por cento dos pacientes. Exames anatomopatologicos foram realizados em 24 pacientes, correspondendo a 60 por cento dos pacientes que evoluiram para obito durante o periodo de estudo...

[Infection by cytomegalovirus in patients with acquired immunodeficiency syndrome (AIDS): clinical, virological, and histopathological correlations]. / Infecção pelo citomegalovírus em pacientes com síndrome da immunodeficiência adquirida (AIDS): relações clínico-virológicas e anatomopatológicas.

Between April 1986 and June 1987, 50 patients meeting the CDC criteria for AIDS were studied for serological and virological evidence of CMV infection. Attempts for virus isolation from peripheral blood, urine and saliva were performed in cell culture lines of human foreskin fibroblasts and CMV specific IgG and IgM were assayed by IFI and IgG by ELISA. A total of 121 blood, 119 urine and 96 saliva samples were collected. During the study period viremia was noted at least once in 12.5%, viruria in 23.2%, and excretion in saliva in 21.9%. When admitted in the study, 20% (10/50) of the patients had anti-CMV IgM antibodies and 100% (50/50) of them had IgG anti-CMV antibodies (IFI). Five of the 40 patients IgM negative at admission presented anti-CMV IgM antibodies during the study, suggesting CMV reactivation or reinfection. Active CMV infection based on virus isolation and/or IgM positivity was demonstrated in 60% of the patients. Histopathological studies were performed in 24 patients. CMV was found in 50% of the autopsies, mainly in the digestive system, lungs and adrenals. There was no correlation between clinical, virological (serology and isolation) and histopathological diagnosis.