Acute appendicitis in people living with HIV: What does the emergency surgeon needs to know?

Abstract

Acute appendicitis is among the commonest surgical emergencies seen in an acute setting. Individuals living with the Human Immunodeficiency Virus (HIV) and/or the Acquired Immunodeficiency Syndrome (AIDS) have an increased risk of encountering complications with acute appendicitis. We conducted a literature search using the words appendicitis and HIV in google scholar, Medline, Scopus and PubMed. The search also extended to cover HIV presented with acute appendicitis, their outcome during and following the management of acute appendicitis. Several studies showed that HIV is associated with a higher rate of acute appendicitis than the general population. HIV can directly affect the appendix, through opportunistic infections, immune reconstitution inflammatory syndrome associated with start of antiretroviral medication. High index of suspicion is needed to exclude conditions that mimic acute appendicitis (abdominal tuberculosis, pyelonephritis, cytomegalovirus, cryptosporidium, pneumococcus, Amoebic appendicitis and pill impaction). The clinical presentation may not be typical of acute appendicitis and can be associated with low white cell count and variable fever. The Alvarado score for predicting acute appendicitis can be used and more research is needed to establish cut-off point value. Computed tomography scan and ultrasound are widely used in clinical diagnosis. Importantly, acute appendicitis with HIV/AIDS can be associated with high rate of post-surgical complications like infections, delay of healing, perforation, peritonitis, intra-abdominal abscess and longer hospital stay. HIV/AIDS with acute appendicitis is complex condition. Therefore, we conclude that patients with known HIV and acute appendicitis should also be managed in close liaison with HIV physicians during, before and after surgical treatment.

Estudo De Polimorfismos No Gene Receptor Da Vitamina D Em Pacientes Com a Doença De Alzheimer

“…Após a apendicectomia, os pacientes evoluem com bom prognóstico, principalmente quando diagnosticados e tratados precocemente. Por outro lado, em casos que cursam com complicações como sepse, abscessos avançados e peritonite, podem ter resolução tardia e complicada, possivelmente exigindo procedimento adicional ou outras intervenções (JONES; LOPEZ;DEPPEN, 2021;MAHMOOD et al, 2021).…”

“…Isso se deve ao fato de que o HIV pode comprometer o apêndice por diversos meios, sendo eles: acometimento direto do apêndice, predisposição do órgão a infecções oportunistas e desenvolvimento da síndrome inflamatória de reconstituição imune, a qual está intrinsecamente relacionada à terapia antirretroviral combinada. Além disso, existem diversas complicações que podem ser observadas no peri e pós-operatório desses indivíduos em decorrência de sua imunodepressão (MAHMOOD et al, 2021).…”

“…Além dos sinais e sintomas comumente relatados na apendicite, como dor no QID e febre, esses pacientes também podem ter outras manifestações atípicas, como mal-estar geral, diarreia, flatulência e indigestão. Dessa forma, exalta-se a relevância do domínio acerca da fisiopatologia e apresentação clínica de patologias como tuberculose abdominal e pielonefrite, as quais podem simular uma AA, levando a uma conduta terapêutica errônea e mau prognóstico (MAHMOOD et al, 2021…”

Acute appendicitis secondary to Entamoeba histolytica infestation

“…[ 1 2 ] Since amoebic appendicitis is associated with a higher rate of surgical complications and increased mortality rate if left untreated, it is crucial to correctly diagnose it. [ 1 2 4 ] Histopathology remains the gold standard for identification of amoebic infestation of the appendix; hence, careful examination of the submitted sample is mandatory. [ 4 5 6 ] We hereby report a case of a middle-aged man presenting with features of acute appendicitis with inflamed base of the appendix.…”

“…[ 1 2 4 ] Histopathology remains the gold standard for identification of amoebic infestation of the appendix; hence, careful examination of the submitted sample is mandatory. [ 4 5 6 ] We hereby report a case of a middle-aged man presenting with features of acute appendicitis with inflamed base of the appendix. A diagnosis of amoebic appendicitis was established after histopathological examination.…”