Bacha Hélio Arthur, Cimerman Sérgio, de Souza Simone A, Hadad David Jamil, Mendes Caio Márcio Figueiredo
Instituto de Infectologia Emílio Ribas Infectious Diseases Institute, São Paulo, SP, Brazil.
Braz J Infect Dis. 2004 Aug;8(4):290-5. doi: 10.1590/s1413-86702004000400004. Epub 2004 Nov 19.
In the advanced stages of AIDS, characterized by severe immunodepression, tuberculosis (TB) may present with a clinical picture of septic shock, due to typical bacteremia. Hematogenic dissemination of mycobacteria is frequent in immunodepressed patients with TB or disseminated mycobacteriosis, leading to increased positivity in detection by automated blood culture. The objective of our study was to determine the prevalence of mycobacteremia in patients with AIDS and with prolonged fever seen at the Emilio Ribas Institute of Infectology. Patients with a history of daily fever (> or = 37.8 degrees C), lasting more than 30 days, and with CD4+ helper lymphocyte counts below 200 cells/mL, were selected from February 2001 to March 2002. A 5 mL peripheral blood sample was collected from each patient for mycobacterial blood culture by an automated method, using the BACTEC 9000 MB and MB/BACT techniques. Forty-five patients aged on average 35 years, most of them males, were included in the study. The mean T CD4+ lymphocyte count was 58 cells/mL. Among the samples submitted to blood culture, 30% gave M. tuberculosis growth, with 62% sensitivity. Among the patients with a negative blood culture, nine had received a diagnosis of TB by another method. Automated blood culture proved to be a technique of relevant diagnostic value for M. tuberculosis in patients with prolonged fever in advanced stages of AIDS. The method is simple, and it helps the physician to select the best therapeutic option.
在艾滋病晚期，其特征为严重免疫抑制，结核病（TB）可能因典型菌血症而呈现脓毒性休克的临床表现。在患有结核病或播散性分枝杆菌病的免疫抑制患者中，分枝杆菌的血行播散很常见，这导致自动血培养检测的阳性率增加。我们研究的目的是确定在埃米利奥·里巴斯传染病研究所就诊的艾滋病患者和长期发热患者中分枝杆菌血症的患病率。从2001年2月至2002年3月，选择有每日发热史（≥37.8摄氏度）、持续超过30天且CD4 +辅助淋巴细胞计数低于200个细胞/毫升的患者。使用BACTEC 9000 MB和MB/BACT技术，通过自动化方法从每位患者采集5毫升外周血样本进行分枝杆菌血培养。45名平均年龄35岁的患者被纳入研究，其中大多数为男性。T CD4 +淋巴细胞平均计数为58个细胞/毫升。在提交血培养的样本中，30%培养出结核分枝杆菌，敏感性为62%。在血培养阴性的患者中，有9人通过另一种方法被诊断为结核病。对于艾滋病晚期长期发热的患者，自动血培养被证明是一种对结核分枝杆菌具有重要诊断价值的技术。该方法简单，有助于医生选择最佳治疗方案。
