O escarro induzido no diagnóstico das doenças pulmonares em pacientes positivos ao vírus da imunodeficiência humana

Silva, Rosemeri Maurici da; Teixeira, Paulo José Zimermann; Moreira, José da Silva

doi:10.1590/s1806-37132004000500009

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…8 It is estimated that 65% of the patients infected with HIV present with pulmonary involvement as their first clinical manifestation, and that approximately 80% of HIV-positive patients develop pulmonary disease over the course of the HIV infection. 9 Among various opportunistic infections, respiratory infections account for up to 70% of AIDS-defining illnesses. 10 In Nepal, lower respiratory tract infections (LRTIs) are increasingly reported as opportunistic infections.…”

Section: Introductionmentioning

confidence: 99%

<p>Opportunistic Respiratory Infections in HIV Patients Attending Sukraraj Tropical and Infectious Diseases Hospital in Kathmandu, Nepal</p>

Kc¹,

Adhikari²,

Bastola³

et al. 2019

HIV

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Introduction: Opportunistic bacterial and fungal infections are the major cause of morbidity and mortality among immune suppressed HIV-positive patients. The main objective of this study was to determine bacterial and fungal organisms causing respiratory infections and their susceptibility to commonly prescribed antimicrobials among HIV patients attending a tertiary infectious disease hospital in Kathmandu. Methods: Sputum samples were collected from the HIV-positive patients attending Sukraraj Tropical and Infectious Disease Hospital (STIDH) from August 2017 to March 2018. A total of 100 sputum samples were cultured on conventional bacterial and fungal culture media. Bacterial and fungal isolates were identified based on their colony characteristics, microscopic morphology and various biochemical tests. Antibiotic susceptibility test (AST) of bacterial isolates was performed by modified Kirby Bauer disc diffusion method. Results: Out of 100 sputum samples cultured, 24% (n=24) showed bacterial growth, 42% (n=42) showed fungal growth and 10% (n=10) had both bacterial and fungal growth. Among bacteria, 91.6% (n=22) were monomicrobial and 8.4% (n=2) were polymicrobial in growth, of which, Klebsiella pneumoniae (37.5%) were predominant isolates, followed by Pseudomonas aeruginosa (29.2%), and Escherichia coli (16.7%). The antibiotic susceptibility test (AST) showed 68% (17/25) of bacterial isolates were multi-drug resistant (MDR) and among them 41.2% (7/17) were found to be extended spectrum β lactamase (ESBL) producers. Fungal growth was observed in 42% of samples (42/100). A total of six different species of Candida and four different genera of molds were identified. On species differentiation, Candida albicans (20%) were followed by Candida parapsilosis (4%), and Candida dubliniensis (3%); and various molds were Aspergillus fumigatus (4%), Aspergillus flavus (2%), and Penicillium species (5%). CD4 count was inversely associated with bacterial and fungal infections. Fifty percent of the patients with the fungal infections had a CD4 count below 200. No fungal organisms were isolated from HIV-positive patients under antifungal drug treatment. Conclusion: HIV-positive patients with a CD4 count less than 200 cells/µL are more vulnerable to opportunistic infections of bacterial and fungal origin. Early isolation, identification and appropriate treatment can reduce mortality due to co-infections. Routine screening of opportunistic pathogens is critical to contain the disease progression.

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Section: Introductionmentioning

confidence: 99%

<p>Opportunistic Respiratory Infections in HIV Patients Attending Sukraraj Tropical and Infectious Diseases Hospital in Kathmandu, Nepal</p>

Kc¹,

Adhikari²,

Bastola³

et al. 2019

HIV

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“…It is known that HIV-positive patients are unable to produce a quantity of spontaneous sputum that is sufficient for testing. (27) Anemia is a common finding in patients with tuberculosis. In one study, (28) the prevalence of anemia among tuberculosis patients was reported to be 31.9%.…”

Section: Discussionmentioning

confidence: 99%

Manifestações clínicas, radiológicas e laboratoriais em indivíduos com tuberculose pulmonar: estudo comparativo entre indivíduos HIV positivos e HIV negativos internados em um hospital de referência

2011

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Objective: To compare clinical, radiological, and laboratory characteristics of individuals with pulmonary tuberculosis co-infected or not with HIV. Methods: A cross-sectional study, in which signs and symptoms were assessed by anamnesis and physical examination in patients hospitalized with pulmonary tuberculosis. The results of sputum smear microscopy and culture for Mycobacterium tuberculosis, as well as hemoglobin levels and CD4 + T-cell counts, were obtained from medical records, and chest X-ray reports were consulted. Results: We included 50 pulmonary tuberculosis patients, who were divided into two groups (HIV-positive and HIV-negative; n = 25 per group). The mean age of the participants was 38.4 ± 10.5 years; 46 (92%) were males; and 27 (54%) were White. Expectoration was presented by 21 (84%) and 13 (52%) of the patients in the HIV-negative and HIV-positive groups, respectively (p = 0.016). Radiological findings of cavitation were present in 10 (43%) and 2 (10%) of the patients in the HIV-negative and HIV-positive groups, respectively (p = 0.016), whereas an interstitial pattern was observed in 18 (78%) and 8 (40%), respectively (p = 0.012). The mean hemoglobin level was 11.1 ± 2.9 g/ dL and 9.3 ± 2.2 g/dL in the HIV-negative and HIV-positive groups, respectively (p = 0.015). Conclusions: In our sample of tuberculosis patients, expectoration was less prevalent, hemoglobin levels were lower, and cavitation was less common, as was an interstitial pattern, among those co-infected with HIV than among those without HIV co-infection.Keywords: HIV; Tuberculosis; Acquired immunodeficiency syndrome. ResumoObjetivo: Comparar as manifestações clínicas, radiológicas e laboratoriais de indivíduos com tuberculose pulmonar coinfectados com HIV com aqueles sem a coinfecção. Métodos: Estudo transversal, no qual sinais e sintomas foram analisados por meio de anamnese e exame físico em pacientes internados com tuberculose pulmonar. A baciloscopia, a cultura para Mycobacterium tuberculosis, a dosagem de hemoglobina e a contagem de células T CD4 + foram obtidas de registros dos prontuários, assim como os laudos das radiografias de tórax. Resultados: Foram incluídos 50 pacientes com tuberculose pulmonar, que foram divididos em dois grupos (HIV positivo e HIV negativo; n = 25 por grupo). A média de idade dos participantes foi de 38,4 ± 10,5 anos, 46 (92%) eram do sexo masculino, e 27 (54%) eram caucasianos. Apresentaram expectoração 21 (84%) e 13 (52%) dos pacientes nos grupos HIV negativo e HIV positivo, respectivamente (p = 0,016). Achados radiológicos de cavitação estavam presentes em 10 (43%) e 2 (10%) dos pacientes nos grupos HIV negativo e HIV positivo, respectivamente (p = 0,016), ao passo que padrão intersticial estava presente em 18 (78%) e 8 (40%) dos pacientes nesses grupos (p = 0,012). O nível médio de hemoglobina foi de 11,1 ± 2,9 g/dL e 9,3 ± 2,2 g/dL nos grupos HIV negativo e HIV positivo, respectivamente (p = 0,015). Conclusões: Entre pacientes coinfectados com tuberculose e HIV desta amostra, houve me...

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“…(7,8,(10)(11)(12)(13)(14)23,24) Anderson et al (8) compared a single IS sample with BAL specimens in HIV-negative patients and also reported low sensitivity for AFB smear testing using both techniques (19% and 12%, respectively), although the sensitivity of culture was 73% in IS and 87% in BAL fluid. Another group of authors (11) demonstrated higher sensitivity for AFB smear testing, comparing 3 IS samples with BAL specimens, and found no difference between HIV-negative and HIV-positive patients (34% and 36% for IS, and 38% and 40% for BAL fluid, respectively).…”

Section: Discussionmentioning

confidence: 99%

Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital

et al. 2009

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Objective: To determine the diagnostic sensitivity of bacteriological analyses in induced sputum (IS) for the diagnosis of pulmonary tuberculosis (TB) and to identify the clinical characteristics associated with the confirmed diagnosis, as well as to determine the diagnostic yield of bronchoscopy carried out when IS tests negative for AFB in smear microscopy. Methods: A retrospective, cross-sectional study of patients suspected of having active pulmonary TB and referred to our clinic for sputum induction. We consecutively reviewed the laboratory data of all patients submitted to sputum induction between June of 2003 and January of 2006, as well as their electronic medical records. In addition, the results of the bacteriological analysis of bronchoscopic specimens collected from the patients whose AFB tests were negative in IS were reviewed. Results: Of the 417 patients included in the study, 83 (19.9%) presented IS samples that tested positive for TB (smear microscopy or culture). In the logistic regression analysis, radiological findings of cavitation (OR = 3.8; 95% CI: 1.9-7.6) and of miliary infiltrate (OR = 3.7; 95% CI: 1.6-8.6) showed the strongest association with the diagnosis of pulmonary TB. In 134 patients, bronchoscopy was carried out after negative AFB results in IS and added 25 (64.1%) confirmed diagnoses of pulmonary TB. Conclusions: In our clinical practice, the frequency of confirmed diagnosis of pulmonary TB using IS (19.9%) was lower than that previously reported in controlled trials. Cavitation and miliary infiltrate increase the diagnostic probability of pulmonary TB using IS. The use of bronchoscopy when IS tests negative for AFB significantly increases sensitivity in the diagnosis of pulmonary TB.Keywords: Tuberculosis, pulmonary; Diagnosis; Sputum. ResumoObjetivo: Verificar a sensibilidade diagnóstica da análise bacteriológica do escarro induzido (EI) para o diagnós-tico de tuberculose (TB) pulmonar e identificar as variáveis clínicas associadas com o diagnóstico confirmado. Além disso, avaliar o rendimento diagnóstico da broncoscopia realizada se a pesquisa de BAAR for negativa no EI. Métodos: Estudo transversal e retrospectivo de pacientes com suspeita de TB pulmonar ativa, encaminhados ao serviço para a indução de escarro. Foram revisados consecutivamente os registros laboratoriais de todos os pacientes submetidos à indução de escarro entre junho de 2003 e janeiro de 2006, assim como o prontuário eletrônico de cada caso. Também foram revisados os resultados bacteriológicos das amostras broncoscópicas coletadas dos pacientes cujos resultados de BAAR em EI foram negativos. Resultados: Dos 417 pacientes estudados, 83 (19,9%) tiveram resultados positivos (BAAR e/ou cultura) no EI. Na análise de regressão logística, os achados radiológicos de cavitação pulmonar (OR = 3,8; IC95%: 1,9-7,6) e de infiltrado de padrão miliar (OR = 3,7; IC95%: 1,6-8,6) associaram-se mais significativamente com o diagnóstico de TB pulmonar. A broncoscopia foi realizada, após resultado de BAAR negativo no EI...

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O escarro induzido no diagnóstico das doenças pulmonares em pacientes positivos ao vírus da imunodeficiência humana

Cited by 5 publications

References 33 publications

<p>Opportunistic Respiratory Infections in HIV Patients Attending Sukraraj Tropical and Infectious Diseases Hospital in Kathmandu, Nepal</p>

<p>Opportunistic Respiratory Infections in HIV Patients Attending Sukraraj Tropical and Infectious Diseases Hospital in Kathmandu, Nepal</p>

Manifestações clínicas, radiológicas e laboratoriais em indivíduos com tuberculose pulmonar: estudo comparativo entre indivíduos HIV positivos e HIV negativos internados em um hospital de referência

Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital

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