RESUMO
Esophageal ulcer (EU) represents an important comorbidity in AIDS. We evaluated the prevalence of EU, the accuracy of the endoscopic and histologic methods used to investigate viral EU in HIV-positive Brazilian patients and the numerical relevance of tissue sampling. A total of 399 HIV-positive patients underwent upper gastrointestinal (UGI) endoscopy. HIV-positive patients with EU determined by UGI endoscopy followed by biopsies were analyzed by the hematoxylin-eosin (HE) and immunohistochemical (IH) methods. EU was detected in 41 patients (mean age, 39.2 years; 23 males), with a prevalence of 10.27%. The median CD4 count was 49 cells/mm(3) (range, 1-361 cells/mm(3)) and the viral load was 58,869 copies per milliliter (range, 50-77,3290 copies per milliliter). UGI endoscopy detected 29 of 41 EU suggestive of cytomegalovirus (CMV) infection and 7 of 41 indicating herpes simplex virus (HSV) infection. HE histology confirmed 4 of 29 ulcers induced by CMV, 2 of 7 induced by HSV, and 1 of 7 induced by HSV plus CMV. IH for CMV and HSV confirmed the HE findings and detected one additional CMV-induced case. UGI endoscopy showed 100% sensitivity and 15% specificity for the diagnosis of EU due to CMV or HSV compared to HE and IH. HE proved to be an adequate method for etiologic evaluation, with 87% sensitivity and 100% specificity compared to IH. The number of samples did not influence the etiologic evaluation. The data support the importance of IH as a complementary method for HE in the diagnosis of EU of viral etiology.
Assuntos
Doenças do Esôfago/diagnóstico , Doenças do Esôfago/epidemiologia , Infecções por HIV/complicações , Úlcera/diagnóstico , Úlcera/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Brasil/epidemiologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/virologia , Endoscopia Gastrointestinal , Amarelo de Eosina-(YS) , Doenças do Esôfago/complicações , Doenças do Esôfago/virologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Hematoxilina , Herpes Simples/complicações , Herpes Simples/diagnóstico , Herpes Simples/epidemiologia , Herpes Simples/virologia , Humanos , Imuno-Histoquímica/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Sensibilidade e Especificidade , Simplexvirus/isolamento & purificação , Úlcera/complicações , Úlcera/virologiaAssuntos
Bluetongue/complicações , Surtos de Doenças/veterinária , Doenças do Esôfago/veterinária , Pneumonia Aspirativa/veterinária , Doenças dos Ovinos/epidemiologia , Animais , Brasil/epidemiologia , Doenças do Esôfago/epidemiologia , Doenças do Esôfago/patologia , Doenças do Esôfago/virologia , Músculo Esquelético/patologia , Pneumonia Aspirativa/epidemiologia , Pneumonia Aspirativa/patologia , Pneumonia Aspirativa/virologia , Ovinos , Doenças dos Ovinos/patologia , Doenças dos Ovinos/virologiaRESUMO
Thirty five esophageal biopsies from AIDS patients with clinical symptoms of esophagitis sent to "Emilio Ribas Institute", Pathology Laboratory, in a 2 year period were revised for possible infectious agents. Microorganisms were seen in 17 cases (48.6%). In 6 cases (17.1%), Acid-Fast bacilli were observed. One of these cases also had characteristic cytomegalic inclusions in endothelial cells. Inflammatory responses were composed of lymphocytes, some plasma cells and many histiocytes, with absence of giant cells in 4 cases of mycobacteriosis; in the other 2 cases, acid-fast bacilli were seen over the epithelium. Exclusive infection by cytomegalovirus was detected in 5 cases (14.3%), and candidiasis in 5 cases (14.3%). In one case there was association of cytomegalovirus and candidiasis. Esophageal ulcers in AIDS patients caused by Mycobacterium sp, may be more common than previously reported, and certainly an overlooked diagnosis. Once esophageal biopsy is an easy diagnostic procedure, this method may be used in routine screening for tuberculosis in patients with AIDS.