Weinberg A, Duarte M I
Department of Infectious Diseases, Hospital das Clínicas, University of São Paulo School of Medicine, Brazil.
Rev Inst Med Trop Sao Paulo. 1993 Mar-Apr;35(2):129-39. doi: 10.1590/s0036-46651993000200004.
To determine how often and by what means an indentifiable pulmonary pathogen can be recognized in human immunodeficiency virus (HIV) infected patients with respiratory disorders in Brazil, which are the most frequently observed microorganisms and what impact specific therapy has on these agents.
Thirty-five HIV seropositive subjects with respiratory complaints were studied. All patients had a complete history, physical examination and blood counts. The pulmonary assessment included chest radiograms; sputum examination for bacterial and fungal pathogens; bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. Patients with treatable complications received standard antimicrobial therapy.
One or more microorganisms were found in 24 subjects and another 3 individuals showed nonspecific interstitial pneumonitis. The sputum examination identified the pulmonary pathogens in 7 cases. The bronchoalveolar lavage and the histopathologic examination were diagnostic in 14% and 83%, respectively, of the 28 individuals that were submitted to bronchoscopy. The most frequently identified microorganism was P. carinii (55%), followed by M. tuberculosis (41%) and cytomegalovirus (8%). The clinical, laboratory and radiographic findings failed to distinguish the specific pulmonary pathogens. Twenty-three individuals with P. carinii pneumonitis and/or tuberculosis received specific therapy; among the evaluable patients the therapeutic response rates were 79% for PCP and 100% for TB.
We have determined that tuberculosis, P. carinii and cytomegalovirus pneumonitis are the most common respiratory opportunistic diseases in Brazilian patients infected with HIV. The histologic evaluation was crucial in order to identify the pulmonary pathogens. Tuberculosis in AIDS individuals displayed clinical and radiographic findings atypical for reactivation disease. However, most of the features observed in HIV infected patients had been previously described in infection of the normal host. Furthermore, the AIDS subjects showed a good therapeutic response to anti-tuberculous drugs.
确定在巴西患有呼吸系统疾病的人类免疫缺陷病毒（HIV）感染患者中，可识别的肺部病原体被识别的频率和方式、最常观察到的微生物以及特定治疗对这些病原体的影响。
对35名有呼吸道症状的HIV血清阳性受试者进行了研究。所有患者均有完整的病史、体格检查和血常规检查。肺部评估包括胸部X线片；痰细菌和真菌病原体检查；支气管镜检查及支气管肺泡灌洗和经支气管活检。有可治疗并发症的患者接受标准抗菌治疗。
24名受试者中发现了一种或多种微生物，另外3名个体表现为非特异性间质性肺炎。痰检在7例中鉴定出肺部病原体。支气管肺泡灌洗和组织病理学检查分别对接受支气管镜检查的28名个体中的14%和83%具有诊断价值。最常鉴定出的微生物是卡氏肺孢子虫（55%），其次是结核分枝杆菌（41%）和巨细胞病毒（8%）。临床、实验室和影像学检查结果未能区分特定的肺部病原体。23名患有卡氏肺孢子虫肺炎和/或结核病的个体接受了特异性治疗；在可评估的患者中，卡氏肺孢子虫肺炎的治疗有效率为79%，结核病为100%。
我们确定结核病、卡氏肺孢子虫肺炎和巨细胞病毒肺炎是巴西HIV感染患者中最常见的呼吸道机会性疾病。组织学评估对于识别肺部病原体至关重要。艾滋病患者的结核病表现出与再激活疾病不同的临床和影像学特征。然而，HIV感染患者中观察到的大多数特征先前已在正常宿主感染中描述过。此外，艾滋病患者对抗结核药物显示出良好的治疗反应。
