Aspergilose em paciente vivendo com HIV/aids
Data
2023-08
Autores
Truda, Vanessa Souza Santos 
Orientadores
Colombo, Arnaldo Lopes
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A infecção pelo HIV não tratada pode levar a imunossupressão profunda e aumentar a suscetibilidade de pessoas vivendo com HIV/aids (PVHA) à aspergilose. Objetivos: Relatar a prevalência e a história natural da aspergilose documentada em PVHA admitidas em 5 centros médicos no Brasil. Pacientes e Métodos: Dados clínicos, epidemiológicos e laboratoriais foram coletados em todos os casos sequenciais de aspergilose comprovada ou provável documentados em PVHA internadas em 5 centros médicos entre 2012-2020. Resultados: Foram incluídos 25 pacientes com idade entre 23 e 58 anos (média = 39), incluindo 11 pacientes com aspergilose invasiva (AI) e 14 com aspergilose pulmonar crônica (APC). A taxa de prevalência de aspergilose foi de 0,1% entre 19.616 PVHA avaliados. No geral, 72,7% dos pacientes com AI apresentaram contagem de linfócitos T CD4+ < 100 células/mm³ e 42,8% dos pacientes com APC apresentaram contagem de linfócitos T CD4+ > 200 células/ mm³. A maioria dos pacientes tinha história de tuberculose, principalmente aqueles com APC (85,7%). A AI foi documentada após uma média de 16,5 dias de internação, principalmente em pacientes críticos expostos a corticosteroides e antimicrobianos de amplo espectro. No grupo APC, a cultura positiva (71,4%) e as alterações radiológicas foram os achados mais frequentes que corroboraram o diagnóstico. Os episódios de AI foram diagnosticados, principalmente, por achados de biópsias de tecido. As taxas brutas de mortalidade associada a essa infecção fúngica foram de 72,7% e 42,8% em pacientes com AI e APC, respectivamente. Conclusões: Apesar de ser considerada uma complicação incomum em PVHA (0,1%), a AI deve ser considerada em pacientes com imunossupressão profunda e pneumonia refratária à terapia convencional. A APC deve ser investigada em PVHA com deterioração crônica da função pulmonar e diagnóstico prévio de tuberculose.
Background: Untreated HIV infection can lead to profound immunosuppression and increase susceptibility of people living with HIV/AIDS (PLHA) to aspergillosis. Objectives: Reporting the burden and natural history of aspergillosis documented in PLHA admitted in 5 medical centers in Brazil. Patients and Methods: Clinical, epidemiological and laboratory data were collected in all sequential cases of proven or probable aspergillosis documented in PLHA hospitalized in 5 medical centers between 2012-2020. Results: we enrolled 25 patients aging between 23 and 58 years (mean = 39) including 11 patients with invasive aspergillosis (IA) and 14 with chronic pulmonary aspergillosis (CPA). The prevalence rate of aspergillosis was 0.1% of 19.616 PLHA. Overall, 72.7% of patients with IA exhibited CD4+ < 100 cells/ml and 42.8% of patients with CPA exhibited CD4+ count > 200 cells/ml. Most patients had a history of tuberculosis, especially those with CPA (85.7%). IA was documented after a mean of 16.5 days of hospitalization, mainly in critically ill patients exposed to corticosteroids and broad-spectrum antibiotics. In the CPA group, a positive culture (71.4%) and radiological alterations were the most frequent findings supporting their diagnosis. Episodes of IA were mostly documented by tissue biopsies. Association to fungal infeccion mortality rates were 72.7% and 42.8% in patients with IA and CPA, respectively. Conclusions: Despite being considered an unusual complication in PLHA (0.1%), IA should be considered in patients with profound immunosuppression and pneumonia refractory to conventional therapy. CPA should be investigated in PLHA with chronic deterioration of pulmonary function and previous diagnosis of tuberculosis.
Background: Untreated HIV infection can lead to profound immunosuppression and increase susceptibility of people living with HIV/AIDS (PLHA) to aspergillosis. Objectives: Reporting the burden and natural history of aspergillosis documented in PLHA admitted in 5 medical centers in Brazil. Patients and Methods: Clinical, epidemiological and laboratory data were collected in all sequential cases of proven or probable aspergillosis documented in PLHA hospitalized in 5 medical centers between 2012-2020. Results: we enrolled 25 patients aging between 23 and 58 years (mean = 39) including 11 patients with invasive aspergillosis (IA) and 14 with chronic pulmonary aspergillosis (CPA). The prevalence rate of aspergillosis was 0.1% of 19.616 PLHA. Overall, 72.7% of patients with IA exhibited CD4+ < 100 cells/ml and 42.8% of patients with CPA exhibited CD4+ count > 200 cells/ml. Most patients had a history of tuberculosis, especially those with CPA (85.7%). IA was documented after a mean of 16.5 days of hospitalization, mainly in critically ill patients exposed to corticosteroids and broad-spectrum antibiotics. In the CPA group, a positive culture (71.4%) and radiological alterations were the most frequent findings supporting their diagnosis. Episodes of IA were mostly documented by tissue biopsies. Association to fungal infeccion mortality rates were 72.7% and 42.8% in patients with IA and CPA, respectively. Conclusions: Despite being considered an unusual complication in PLHA (0.1%), IA should be considered in patients with profound immunosuppression and pneumonia refractory to conventional therapy. CPA should be investigated in PLHA with chronic deterioration of pulmonary function and previous diagnosis of tuberculosis.