RESUMO
The outbreak of COVID-19 disease has recently spread from its original place in Wuhan, Hubei province, China, to the entire world, and has been declared to be a pandemic by the World Health Organization in March 2020. All countries in America, in particular Chile, show an important increase in COVID-19 cases and deaths. The clinical manifestations of COVID-19 are a broad spectrum, from asymptomatic mild disease, to severe respiratory failure, shock, multiorgan dysfunction and death. Thus, high clinical suspicion and appropriate structure risk stratification are needed. Health care teams in endoscopy units, are at an increased risk of infection by COVID-19 from inhalation of droplets, mucosae contact, probably contamination due to contact with stools. Endoscopic aerosolized associated infections have also been reported. Different societies' recommendations, have recently placed digestive endoscopy (especially upper) among the high risk aerosol generating procedures (AGPs). In addition, live virus has been found in patient stools. On top of this, the infected health professionals may transmit the infection to their patients. Health care infection prevention and control (HCIPC), has been shown to be effective in assuring the safety of both health care personnel and patients. This is not limited to the correct use of personal protective equipment (PPE), but is based on a clear, detailed and well communicated HCIPC strategy, risk stratification, use of PPE, and careful interventions in patients with moderate and high risk of COVID-19. A conscientious approach regarding limited resources is important, as the simultaneous outbreak in all countries heavily affects the availability of health supplies. The Chilean Gastroenterology Society (SChGE) and Digestive Endoscopy Association of Chile (ACHED) are joining to provide continued updated guidance in order to assure the highest level of protection against COVID-19, for both patients and health care workers. This guideline will be updated online as needed.
El brote de la enfermedad denominada COVID-19, se ha extendido desde su origen en Wuhan, provincia de Hubei, China, a todo el mundo. La Organización Mundial de la Salud lo declaró pandemia en marzo de 2020. Todos los países de América, en especial Chile, presentan incremento de casos y fallecidos. Las manifestaciones clínicas de COVID-19 van desde una enfermedad leve, hasta insuficiencia respiratoria severa, shock, disfunción orgánica y muerte. Se necesita una alta sospecha clínica y una adecuada estratificación del riesgo. El equipo de salud en las unidades de endoscopia, tiene un mayor riesgo de COVID-19 que otras unidades clínicas y de apoyo diagnóstico, dada la mayor exposición a inhalación de gotas, contacto posible con mucosas y contaminación por contacto con deposiciones. Recomendaciones de diferentes sociedades colocan la endoscopia digestiva (especialmente la esofagogastroscopia o endoscopia digestiva alta, EDA) entre los procedimientos generadores de aerosoles (PGA) de alto riesgo. Además, se han encontrado virus viables en las deposiciones de los pacientes. Potencialmente, los profesionales de la salud infectados podrían contagiar a los pacientes. Se ha demostrado que la prevención y control de infecciones asociadas a la atención de salud (IAAS), son efectivos para garantizar la seguridad tanto del personal de salud, como de los pacientes. Esto no es solamente el correcto uso del equipo de protección personal (EPP), sino que se basa en una clara estrategia de IAAS, bien comunicada, con estratificación de riesgo, uso de EPP e intervenciones correctas en pacientes con riesgo moderado y alto. Es relevante un enfoque sobre los limitados recursos, dado la simultaneidad del brote en todos los países, que afecta la disponibilidad de insumos. La Sociedad Chilena de Gastroenterología (SChGE) y la Asociación Chilena de Endoscopia Digestiva (ACHED) publican esta guía actualizada para apoyar las buenas prácticas contra COVID-19, tanto para pacientes como para el equipo de salud. Esta guía podrá tener actualizaciones según avance la información disponible.
Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Endoscopia do Sistema Digestório/normas , Infecções por Coronavirus/prevenção & controle , Betacoronavirus , Pneumonia Viral/epidemiologia , Fatores de Risco , Controle de Infecções/métodos , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/epidemiologia , Pandemias , Unidades Hospitalares/normasRESUMO
Background: Atrophic gastritis (AG) and intestinal metaplasia (IM) are stages that appear in the process of gastric carcinogenesis. Their presence requires programmed endoscopic vigilance. Objectives: To determine the frequency of AG and IM in gastric biopsies (GB) taken according to Sydney Protocol and to correlate them with endoscopic findings. Methods: Retrospective descriptive analysis of 233 upper gastrointestinal endoscopies with GB per Sydney Protocol. OLGA (Operative Link for Gastritis Assessment) and OLGIM (Operative Link for Gastric Intestinal Metaplasia Assessment) scores were calculated based on the GB description. Endoscopic findings were analyzed for atypical findings and compared to the GB report. Statistic analysis for Kappa and ANOVA was performed via Stata 12. Results: Mean age of patients was 58 ± 12 years. 69% were women. The frequency of AG and IM was 44% and 33% in the antrum, 31% and 20% in the angular incisure and 14% and 9% in the body, respectively. AG and IM were more frequent in the antrum (p < 0.05). AG and IM were more severe in the angular incisure and body (p < 0.05). We were unable to calculate OLGA and OLGIM in 6% and 9% of cases, respectively, due to absence of severity description in GB. 53% were OLGA 0, 42% OLGA I-II and 5% OLGA III-IV. 70% were OLGIM 0, 25% OLGIM I-II and 5% OLGIM III-IV. Agreement between endoscopic and histological findings was best for IM in the antrum (75.5%, Kappa 0.4). Sensitivity and specificity of endoscopic findings were 39% and 70% for AG, and 30% and 85% for IM, respectively. Conclusion: AG and IM are frequent findings in our patients. Due to the low endoscopic sensitivity for AG and IM, we suggest a systematic GB sampling using Sydney Protocol in patients over 40 years old.
Introducción: La gastritis crónica atrófica (GCA) y la metaplasia intestinal (MI) son etapas en el proceso de carcinogénesis gástrica, su presencia requiere control endoscópico programado. Objetivos: Determinar la frecuencia de GCA y MI en biopsias gástricas (BG) por protocolo de Sydney y relacionarlas con el hallazgo endoscópico. Métodos: Estudio descriptivo mediante revisión de 233 endoscopias digestivas altas con BG por Protocolo Sydney. Se graduó puntaje OLGA (Operative Link for Gastritis Assessment) y OLGIM (Operative Link for Gastric Intestinal Metaplasia Assessment) según la descripción de la BG. Se definió el hallazgo endoscópico según su informe y se comparó con BG como patrón de referencia. Estadística: Stata 12 para Kappa y ANOVA. Resultados: Edad promedio 58 ± 12 años, 69% mujeres. La frecuencia de GCA y MI en antro fue de 44 y 33%, en ángulo 31 y 20% y en cuerpo 14 y 9%, respectivamente. Hubo mayor frecuencia de GCA y MI en antro (p < 0,05). La graduación de GCA y MI fue mayor en ángulo y cuerpo (p < 0,05). No se obtuvo OLGA en 6% y OLGIM en 9% por ausencia de graduación. La frecuencia de OLGA 0 fue de 53%, OLGA I-II 42%, OLGA III-IV 5%, OLGIM O 70%, OLGIM I-II 25% y OLGIM III-IV 5%. La mejor correlación se observó entre la MI antral endoscópica con la histológica (75,5%, Kappa 0,4). La sensibilidad y especificidad endoscópica fue de 39 y 70% para GCA y 30 y 85% para MI. Conclusión: GCA y MI son hallazgos frecuentes en nuestros pacientes. Por la baja sensibilidad endoscópica en la identificación de GCA y MI sugerimos la toma sistemática de BG por protocolo de Sydney en pacientes mayores de 40 años.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/epidemiologia , Gastrite Atrófica/diagnóstico , Gastrite Atrófica/epidemiologia , Metaplasia/diagnóstico , Metaplasia/epidemiologia , Lesões Pré-Cancerosas/patologia , Biópsia/métodos , Chile/epidemiologia , Protocolos Clínicos , Programas de Rastreamento/métodos , Epidemiologia Descritiva , Prevalência , Estudos Retrospectivos , Análise de Variância , Endoscopia Gastrointestinal , Sensibilidade e Especificidade , Mucosa Gástrica/patologia , Gastrite Atrófica/patologia , Metaplasia/patologiaRESUMO
Capsule endoscopy is a technique that allows the study of the small intestine, through a device that is swallowed by the patient, capturing images as it travels through the digestive tract. Capsule retention is the most serious complication. We report the case of a 69 year-old male presenting with iron deficiency anemia, with normal upper endoscopy and colonoscopy; but obscure gastrointestinal bleeding was diagnosed and therefore a study with capsule endoscopy was requested. The patient evolves with retained capsule in the small intestine with ulcerated stenosis as shown by imaging. This finding was confirmed by enteroscopy with biopsy, without being able to extract the capsule. Medical management with corticosteroids was indicated for intestinal obstruction secondary to inflammatory stenosis in the context of Crohn's disease: The capsule was expelled after 21 days of ingestion, with a positive outcome
La cápsula endoscópica es una técnica que permite el estudio del intestino delgado, mediante un dispositivo que es deglutido por el paciente y captura imágenes en su recorrido por el tubo digestivo. La complicación más grave es la retención de la cápsula. Se reporta el caso de un paciente de sexo masculino, de 69 años con anemia ferropénica, con endoscopia alta y colonoscopia normal; planteándose sangrado gastrointestinal de origen oscuro por lo que se solicita estudio con cápsula endoscópica. El paciente evoluciona con retención de la cápsula en intestino delgado, visualizándose en las imágenes la presencia de estenosis ulcerada, hallazgo que se confirma mediante enteroscopia con toma de biopsias, sin lograr extraer la cápsula. Se indica manejo médico con corticoides por obstrucción intestinal secundario a estenosis inflamatoria en contexto de enfermedad de Crohn, expulsando espontáneamente la cápsula al día 21 de su ingestión, sin complicaciones.
Assuntos
Humanos , Masculino , Idoso , Doença de Crohn/diagnóstico , Cápsulas Endoscópicas/efeitos adversos , Corpos Estranhos/etiologia , Corpos Estranhos/diagnóstico por imagem , Radiografia Abdominal , Tomografia Computadorizada por Raios X , Endoscopia por Cápsula/efeitos adversosRESUMO
Chronic pancreatitis (CP) is defined by chronic inflammation of the pancreas with progressive replacement by fibrosis that produces characteristic morphological changes. The clinical picture is variable, being the main problem the pain and relapses of pancreatitis with possible local complications. Over time, the result is the development of exocrine and endocrine failure. In the initial phase, flare-ups of CP can not be distinguished from recurrent acute pancreatitis (RAP). If there are intraductal stones in the duct of Wirsung, endoscopic extraction of obstructive stones may be the first step to prevent new relapses and complications. We present the case of a patient with five episodes of acute pancreatitis (AP), three of them in the past five months. The patient was referred for study and management of RAP. His recent imaging study already showed dilatation of the main pancreatic duct, calcifications and pancreatic stones, compatible with CP. Although the hypertriglyceridemia participated in the etiology of AP, the last two episodes already occurred with normal values of triglycerides. Another possible etiologic factor was not found. His laboratory results did not show endocrine or exocrine insufficiency. The patient was treated with papillotomy, pancreatic stone extraction and installation of terapeutic pancreatic stent. He has been asymptomatic, free from new episodes of AP in the past six months. In conclusion, the CP is one of the possible causes of RAP. Endoscopic treatment by obstructive stone extraction is an efficient therapy to avoid new relapse.
La pancreatitis crónica (PC) se define por la inflamación crónica del páncreas con reemplazo progresivo por fibrosis que produce cambios morfológicos característicos. El cuadro clínico es variable, siendo el principal problema el dolor, reagudizaciones de pancreatitis con eventuales complicaciones locales. Con el tiempo, el resultado final es el desarrollo de insuficiencia exocrina y endocrina. En la fase inicial, no se puede distinguir las reagudizaciones de la PC de una pancreatitis aguda recurrente (PAR). Si se encuentran cálculos intraductales en el conducto de Wirsung, la extracción endoscópica de cálculos obstructivos puede ser el primer paso para prevenir nuevas recaídas y complicaciones. Se presenta el caso de un paciente con cinco episodios de pancreatitis aguda (PA), tres de ellos en los últimos cinco meses. El paciente fue derivado para estudio y manejo de PAR. Su estudio imagenológico reciente ya demostró dilatación del conducto pancreático principal, calcificaciones y cálculos pancreáticos, compatible con PC. Aunque la hipertrigliceridemia participó en la etiología de las PA, los últimos dos episodios ocurrieron con valores normales de triglicéridos. No se encontró otro factor etiológico posible. Su estudio de laboratorio no mostró insuficiencia exocrina ni endocrina. El paciente fue tratado mediante papilotomía, extracción de cálculos pancreáticos e instalación de prótesis pancreática terapéutica. Ha estado asintomático, libre de nuevos episodios de PA en los seis meses transcurridos. En conclusión, la PC es una de las posibles causas de PAR. El tratamiento endoscópico mediante extracción de cálculos obstructivos es una terapia eficiente para evitar nuevas recaídas.
Assuntos
Humanos , Masculino , Adulto , Cálculos/cirurgia , Endoscopia do Sistema Digestório/métodos , Pancreatite Crônica/prevenção & controle , Recidiva , Cálculos/etiologia , Cálculos/diagnóstico por imagem , Pancreatite Crônica/cirurgia , Pancreatite Crônica/complicações , Prevenção SecundáriaRESUMO
The term Choledocholithiasis refers to the presence of biliary stones in the extrahepatic bile ducts, which are found in 5 to 10% of patients undergoing cholecystectomy for gallstones. Nowadays, with the adoption of the laparoscopic cholecystectomy(LC) as a standard, multiple minimally invasive treatment options for bile duct stones are feasible, with no consensus to date on the procedure of choice. The two stage endoscopic techniques involve the use of Endoscopic Retrograde Cholangiopancreatography(ERCP) before or after performing a LC, which has the main advantage of separating the bile duct procedure from the LC. However, the need for two separate anesthesia times, the possibility of blank or failed ERCP, and the chance for calculi migration between procedures increase the length of hospital stay and associated costs. The single stage procedures include the Laparoscopic Bile Duct Exploration (LBDE), and more recently, the performance of a laparoscopy guided intraoperative ERCP(Rendez Vous). The LBDE, when performed by an experienced surgical team, is an effective and safe technique. Nonetheless, it is considered a technically demanding procedure, whose results cannot be extrapolated to the general surgical community. Recently, the Rendez Vous has become a treatment alternative that simplifies both the surgical and the endoscopic procedures, decreases morbidity, and requires a single anesthesia time. On the downside, Rendez Vous technique involves complex operating room (OR) logistics, requiring both a trained surgical and endoscopic team at the same time. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Coledocolitíase/terapia , Coledocolitíase/cirurgia , Coledocolitíase/fisiopatologia , ColecistolitíaseRESUMO
Digestive endoscopy is a complex tool for diagnosis and treatment, with continuous development both in technical aspects and in their application for the different pathologies where this technique is required. Therefore, a continuous education program is necessary for the practitioner using this technique. With the purpose of reaching an agreement between different aspects of the performance of these procedures and also generating proposals for its application that are useful for the physicians of this area of expertise, during 2013 the Chilean Association of Digestive Endoscopy (ACHED) developed a workshop called Relevant aspects of digestive endoscopy. Evidence-based suggestions. This workshop was attended by gastroenterologists and trainee practitioners, who worked in groups during a period of two months where they reviewed available evidence to answer several questions relating to milestones and lesions that need to be described in upper gastrointestinal endoscopy, the preparation of the GI endoscopy report, technical aspects and quality measures in colonoscopy. This review resulted in proposals that were analyzed and agreed on in the form of recommendations presented for further analysis and discussion amongst endoscopic teams in our country.
La endoscopia digestiva es una herramienta de diagnóstico y tratamiento médico compleja, en continuo desarrollo tanto en lo técnico como en los conceptos de manejo de las patologías en las que se utiliza.Por lo tanto, es deseable una estrategia de formación continua del profesional que la realiza. Con el objetivode consensuar diferentes aspectos en la realización de estos procedimientos y generar propuestas de manejoque sean de utilidad para todos los médicos involucrados en esta especialidad, la Asociación Chilenade Endoscopia Digestiva (ACHED) realizó durante el año 2013 un curso taller denominado Aspectosrelevantes en la realización de la endoscopia digestiva. Propuestas basadas en la evidencia. Este cursoconvocó a gastroenterólogos y médicos en formación de la especialidad que conformaron grupos de trabajoque durante 2 meses revisaron la evidencia disponible para responder diversas preguntas en relación a los hitos y lesiones a describir en endoscopia digestiva alta (EDA), la realización del informe en EDA, aspectos técnicos y medidores de calidad en colonoscopia. La revisión les permitió generar propuestas que fuerondiscutidas y consensuadas en recomendaciones que se proponen para su discusión por los equipos endoscópicos de nuestro país.
Assuntos
Humanos , Medicina Baseada em Evidências , Endoscopia Gastrointestinal/normas , Gastroenteropatias/cirurgia , Gastroenteropatias/diagnóstico , Controle de QualidadeRESUMO
UNLABELLED: The association of HIV infection and lymphoma in patients attending at the South Health Metropolitan Reference Centre is presented. OBJECTIVE: To analyse its incidence, clinical and pathologic manifestations, treatment and outcome. PERIOD OF STUDY: January 1990 to December 2002. RESULTS: 14 cases were detected, 10 non Hodgkin lymphoma patients (7 with high malignancy and 50% in stages III-IVB) and 4 with Hodgkin lymphoma (3 with mixed cellularity, 2 in stage IVB). The annual incidence was 0.68%. Ten patients were classified under stage C3 of AIDS CDC criteria, the mean CD4 count was 139 cells/mm3 and mean CV was 5,32 log. Eighty six percent of patients presented with unique or multiples lymphonodes, with predominance of advanced lymphoma stage. Conventional CHOP chemotherapy was the treatment for high risk and extended non Hodgkin lymphomas and for extended Hodgkin lymphomas the ABVD protocol was administered. Six patients received antiretroviral therapy, 4 simultaneously with chemotherapy. Global mortality in this series was 71%, attributable to tumor disease per se or to sepsis. Four patients survived (18 to 50 months) in complete remission, 2 non Hodgkin lymphomas and 2 Hodgkin lymphomas. The low incidence of lymphoma and AIDS association and the high frequency of lymphomas with localized or generalized lymphonodes in this series are remarkable.
Assuntos
Linfoma Relacionado a AIDS , Linfoma não Hodgkin , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Contagem de Linfócito CD4 , Chile/epidemiologia , Feminino , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/epidemiologia , Humanos , Incidência , Linfoma Relacionado a AIDS/diagnóstico , Linfoma Relacionado a AIDS/tratamento farmacológico , Linfoma Relacionado a AIDS/epidemiologia , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/epidemiologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Análise de Sobrevida , Carga ViralRESUMO
The association of HIV infection and lymphoma in patients attending at the South Health Metropolitan Reference Centre is presented. Objective: to analyse its incidence, clinical and pathologic manifestations, treatment and outcome. Period of study: January 1990 to December 2002. Results: 14 cases were detected, 10 non Hodgkin lymphoma patients (7 with high malignancy and 50 percent in stages III-IVB) and 4 with Hodgkin lymphoma (3 with mixed cellularity, 2 in stage IVB). The annual incidence was 0.68 percent. Ten patients were classified under stage C3 of AIDS CDC criteria, the mean CD4 count was 139 cells/mm³ and mean CV was 5,32 log. Eighty six percent of patients presented with unique or multiples lymphonodes, with predominance of advanced lymphoma stage. Conventional CHOP chemotherapy was the treatment for high risk and extended non Hodgkin lymphomas and for extended Hodgkin lymphomas the ABVD protocol was administered. Six patients received antiretroviral therapy, 4 simultaneously with chemotherapy. Global mortality in this series was 71 percent, attributable to tumor disease per se or to sepsis. Four patients survived (18 to 50 months) in complete remission, 2 non Hodgkin lymphomas and 2 Hodgkin lymphomas. The low incidence of lymphoma and AIDS association and the high frequency of lymphomas with localized or generalized lymphonodes in this series are remarkable.
Se revisó la asociación de linfoma e infección por VIH en un complejo hospitalario de la Región Metropolitana Sur de Santiago de Chile, su incidencia, características clínicas y patológicas, terapia y evolución en 14 casos. La incidencia acumulada (enero 1990 y diciembre 2002) fue de 0,68 por ciento. Diez pacientes tenían linfoma no Hodgkin (siete de alto grado de malignidad y 50 por ciento en estadios III-IVB) y cuatro Hodgkin (tres con celularidad mixta, dos en estadio IVB). Diez pacientes con linfoma estaban en etapa C3 de SIDA según criterios del CDC, con un promedio de CD4 de 139 células/mm³ y carga viral de 212.600 copias de ARN/ml. Ochenta y seis por ciento tenía afección ganglionar, localizada o generalizada. El tratamiento de los linfomas no Hodgkin de alto grado y extendidos fue con quimioterapia CHOP convencional, y en los linfomas de Hodgkin avanzados se aplicó el esquema ABVD. Seis pacientes recibieron tratamiento antiretroviral, cuatro simultáneamente con quimioterapia. La mortalidad global fue de 71 por ciento, por progresión tumoral y/o sepsis. Cuatro pacientes sobreviven (18 a 50 meses) en remisión completa, dos linfomas no Hodgkin y dos Hodgkin. Se discuten la baja incidencia de la asociación linfoma y SIDA y la mayor frecuencia de linfomas con adenopatías localizadas o generalizadas.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Linfoma Relacionado a AIDS , Linfoma não Hodgkin , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Chile/epidemiologia , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/epidemiologia , Incidência , Linfoma Relacionado a AIDS/diagnóstico , Linfoma Relacionado a AIDS/tratamento farmacológico , Linfoma Relacionado a AIDS/epidemiologia , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/epidemiologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Análise de Sobrevida , Carga ViralRESUMO
La terapia antiretroviral (TARV) de alta actividad cambió la epidemiología de la neumonía por Pneumocystis jiroveci (NPj) en pacientes con SIDA. La incidencia global ha descendido y ahora prevalece en pacientes sin TARV o con fracaso de ésta. Además, la restauración inmune por TARV genera una forma de NPj incluida en los síndromes inflamatorios por restauración inmune (SIRI). A fines del 2004, 75,5% de pacientes con infección por VIH en control en el Hospital de Enfermedades Infecciosas Dr. Lucio Córdova tenían TARV. Esta serie describe las características clínicas de la NPj, comparando el grupo con TARV (n: 6) y sin TARV (n: 12). De aquellos con TARV, 83,3% (5/6) estaban con fracaso inmunológico y 16,7% (1/6) en éxito virológico. El recuento de CD4 fue bajo en ambos grupos (mediana 20 céls/mm3 sin TARV y 51 céls/mm3 con TARV). No hubo diferencia en la mayoría de las características de la NPj, tampoco casos de SIRI. El grupo con TARV tuvo menos severidad y complicaciones, y menos indicación de corticoterapia (p 0,023).
Assuntos
Humanos , Masculino , Adulto , Feminino , Infecções por HIV/microbiologia , Infecções por HIV/tratamento farmacológico , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS , Fármacos Anti-HIV , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Pneumonia por Pneumocystis/imunologiaRESUMO
Highly active antiretroviral therapy (HAART) has changed the epidemiology of Pneumocystis jiroveci pneumonia (PCP) in AIDS patients. Global incidence of PCP has decreased and now it is prevalent in AIDS patients who do not receive HAART or are unsuccessfully treated with persistent immune depression. Moreover, the immunologic response to HAART has caused a PCP form which is included in the immune restoration inflammatory syndrome (IRIS). As of late 2004, 75.5% of patients cared for at Dr. Lucio Córdova Infectious Diseases Hospital were receiving HAART. This study compares PCP clinical characteristics in patients under the effect of HAART (n: 6) with those without antiretroviral therapy (n: 12). Among those with HAART, 83.3% (5/6) were without immunologic responses and 16.7% with virologic response. The median CD4 counts were low in both groups: 20 cells/mm(3) without HAART and 51 cells/mm(3) with HAART. There were no differences in most of PCP characteristics, and no IRIS cases were observed. HAART-receiving group had less severe disease and lower frequency of both, complications and steroidal therapy prescription (P 0.023).