Passos Ana Isabela Morsch, Dertkigil Rachel Polo, Ramos Marcelo de Carvalho, Busso-Lopes Ariane Fidelis, Tararan Cibele, Ribeiro Erivan Olinda, Schreiber Angélica Zaninelli, Trabasso Plinio, Resende Mariangela Ribeiro, Moretti Maria Luiza
Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brazil.
Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas, SP, Brazil.
Braz J Infect Dis. 2017 Nov-Dec;21(6):606-612. doi: 10.1016/j.bjid.2017.07.002. Epub 2017 Jul 29.
The etiology of pulmonary infections in HIV patients is determined by several variables including geographic region and availability of antiretroviral therapy.
A cross-sectional prospective study was conducted from 2012 to 2016 to evaluate the occurrence of pulmonary fungal infection in HIV-patients hospitalized due to pulmonary infections. Patients' serums were tested for (1-3)-β-D-Glugan, galactomannan, and lactate dehydrogenase. The association among the variables was analyzed by univariate and multivariate regression analysis.
60 patients were included in the study. The patients were classified in three groups: Pneumocystis jirovecii pneumonia (19 patients), community-acquired pneumonia (18 patients), and other infections (23 patients). The overall mortality was 13.3%. The time since diagnosis of HIV infection was shorter in the pneumocystosis group (4.94 years; p=0.001) than for the other two groups of patients. The multivariate analysis showed that higher (1-3)-β-D-Glucan level (mean: 241pg/mL) and lactate dehydrogenase (mean: 762U/L) were associated with the diagnosis of pneumocystosis. Pneumocystosis was the aids-defining illness in 11 out of 16 newly diagnosed HIV-infected patients.
In the era of antiretroviral therapy, PJP was still the most prevalent pulmonary infection and (1-3)-β-D-Glucan and lactate dehydrogenase may be suitable markers to help diagnosing pneumocystosis in our HIV population.
HIV患者肺部感染的病因由多种因素决定，包括地理区域和抗逆转录病毒疗法的可及性。
2012年至2016年进行了一项横断面前瞻性研究，以评估因肺部感染住院的HIV患者发生肺部真菌感染的情况。检测患者血清中的（1-3）-β-D-葡聚糖、半乳甘露聚糖和乳酸脱氢酶。通过单因素和多因素回归分析变量之间的关联。
60例患者纳入研究。患者分为三组：耶氏肺孢子菌肺炎（19例）、社区获得性肺炎（18例）和其他感染（23例）。总死亡率为13.3%。肺孢子菌病组自诊断HIV感染以来的时间（4.94年；p=0.001）比其他两组患者短。多因素分析显示，较高的（1-3）-β-D-葡聚糖水平（平均：241pg/mL）和乳酸脱氢酶（平均：762U/L）与肺孢子菌病的诊断相关。在16例新诊断的HIV感染患者中，有11例肺孢子菌病是艾滋病界定疾病。
在抗逆转录病毒治疗时代，耶氏肺孢子菌肺炎仍是最常见的肺部感染，（1-3）-β-D-葡聚糖和乳酸脱氢酶可能是有助于诊断我们HIV人群中肺孢子菌病的合适标志物。
