Assuntos
Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Amebíase/parasitologia , Meningoencefalite/parasitologia , Naegleria fowleri/isolamento & purificação , Infecções Oportunistas Relacionadas com a AIDS/líquido cefalorraquidiano , Infecções Oportunistas Relacionadas com a AIDS/fisiopatologia , Adulto , Amebíase/líquido cefalorraquidiano , Amebíase/fisiopatologia , Animais , Humanos , Masculino , Meningoencefalite/líquido cefalorraquidiano , Meningoencefalite/fisiopatologiaRESUMO
Five case of intestinal cryptosporidiosis with pulmonary involvement in patients with AIDS are reported. The diagnosis was based on the recognition of acid-fast oocysts in sputum or aspirated bronchial material and stool specimens. Coughing and excess secretions were present in all cases. Four patients had other associated pulmonary pathogens: two Mycobacterium tuberculosis, one Mycobacterium fortuitum and one Cytomegalovirus + Pneumocystis carinii; all of them had a previous (three cases) or simultaneous (one case) diagnosis of intestinal cryptosporidiosis, presenting with diarrhoea and vomiting. In the fifth patient Cryptosporidium was the only pulmonary pathogen found in a bronchial aspirate, and the onset of diarrhoea was 1 month after respiratory detection. Fifty-seven cases of respiratory cryptosporidiosis have been reported since 1980. In 17 of them, no other pathogen was found. Diarrhoea was present in 77% of the patients, cough in 77%, dyspnea in 58%, expectoration in 54%, fever in 45%, thoracic pain in 33%.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/parasitologia , Criptosporidiose/complicações , Criptosporidiose/diagnóstico , Infecções por HIV/complicações , Infecções por HIV/parasitologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/parasitologia , Adolescente , Adulto , Idoso , Animais , Brônquios/parasitologia , Criança , Cryptosporidium/isolamento & purificação , Infecções por Citomegalovirus/complicações , Diarreia/complicações , Diarreia/parasitologia , Fezes/parasitologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/complicações , Pleura/parasitologia , Infecções por Pneumocystis/complicações , Escarro/parasitologia , Tuberculose Pulmonar/complicações , Vômito/complicações , Vômito/parasitologiaRESUMO
Invasive aspergillosis is a devastating infection that mainly affects immunocompromised hosts. Nevertheless it is not a common infection in AIDS probably due to specific immune aspects. Even more rare in this group of patients is infection limited to the kidney without dissemination as occurred in our case reported here. He had heroin addiction, AIDS in advanced stage C3, neutropenia and received antifungal prophyllaxis as predisposing factors to aspergillosis. Despite correct therapy with Amphotericine B and drainage of one of the abscesses, he died due to antibiotic side-effects and persistence of not-drained contralateral abscess. Our experience supports the fact that we should have a high index of suspicion for fungal aetiology in kidney infection in AIDS patients with predisposing factors discussed in the text, in order to make early diagnosis and to establish prompt aggressive antifungal therapy supported by drainage of fungus collections, or even nephrectomy if required.