Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Pneumocystis/genética , Pneumonia por Pneumocystis/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Líquido da Lavagem Broncoalveolar/microbiologia , Humanos , Epidemiologia Molecular , Pneumonia por Pneumocystis/epidemiologia , RNA , RNA Fúngico , RNA Mitocondrial , RNA RibossômicoRESUMO
Histoplasma capsulatum histoplasmosis occurs frequently in endemic areas and with the AIDS outbreak, it appears as an opportunistic fungus involved in disseminated disease. We report the clinical, biological and treatment features of seven cases diagnosed in the CISIH of the Eastern part of Paris. Clinically, four patients were suffering from pulmonary symptoms, in three cases digestive disorders and in three cutaneous lesions. In all cases, the mycologic diagnosis was necessary. Amphotericin B and itraconazole were used as treatment for five patients (two died before the diagnosis was completed). Among these five subjects, four died (death was attributed to histoplasmosis in only one case). These observations emphasize the importance of this infection in HIV-infected patients coming from endemic areas.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Síndrome da Imunodeficiência Adquirida/complicações , Histoplasmose , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/transmissão , Síndrome da Imunodeficiência Adquirida/microbiologia , Anfotericina B/uso terapêutico , Feminino , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Histoplasmose/transmissão , Humanos , Itraconazol/uso terapêutico , Masculino , Recidiva , Estudos RetrospectivosRESUMO
Diagnosis of Pneumocystis carinii pneumonia is based on the identification of the various stages of the parasite in lung samples by standard staining techniques. We therefore assessed the value of the PCR for detection of P. carinii in bronchoalveolar lavage, induced sputum, and blood samples relative to that of standard staining techniques.
Assuntos
DNA Fúngico/isolamento & purificação , Pneumocystis/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Reação em Cadeia da Polimerase , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Antígenos de Fungos/análise , Líquido da Lavagem Broncoalveolar/microbiologia , DNA Fúngico/sangue , Imunofluorescência , Fungemia/microbiologia , Humanos , Pneumocystis/genética , Pneumonia por Pneumocystis/microbiologia , Sensibilidade e EspecificidadeRESUMO
An indirect immunofluorescence monoclonal antibody assay was found to have higher sensitivity than usual stains for the detection of Pneumocystis carinii, particularly in bronchoalveolar lavage fluids in which there are only a few parasites, as in HIV-patients or in HIV+ patients with prophylaxis or treatment. For patients without any therapy, when different stains give conflicting results, decisions on therapeutic approaches to be used should consider the patient's clinical and biological status. Prospective studies are necessary to evaluate the predictive value of low parasitism in asymptomatic immunosuppressed patients.
