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Serum markers in the diagnosis of pulmonary infections in AIDS patients

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Author(s):
Ana Isabela Morsch Passos
Total Authors: 1
Document type: Doctoral Thesis
Institution: Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Defense date:
Advisor: Maria Luiza Moretti
Abstract

The etiology and the frequency of fungal pulmonary infections in HIV-infected patients varies by geographical region and according to the availability of antiretroviral therapy (ART). The proper diagnosis of the etiological agent leads to an adequate therapy and a better understanding of the epidemiology of the pulmonary affections responsible for hospitalizations in this group of patients. Objective: To evaluate the occurrence and prevalence of fungal pulmonary infections in HIV-infected adult patients, hospitalized with acute respiratory diseases at the Clinics Hospital of the University of Campinas. Methods: A prospective, cross-sectional cohort study was conducted between 2012 and 2016, including adult patients, HIV-infected, hospitalized with pulmonary infection. The diagnosis of Pneumocystis jirovecii pneumonia (pneumocystosis) was defined by World Health Organization clinical criteria. The diagnosis of community acquired pneumonia (CAP) and lower respiratory tract infection (LRTI) was based on clinical and radiological criteria. Clinical and epidemiological data were collected from medical records. Blood samples were collected for analysis of: (1,3)-ß-D-Glucan (BG), galactomannan (GM) and lactate dehydrogenase (LDH), and respiratory samples were collected for P. jirovecii DNA test by loop-mediated isothermal amplification (LAMP). The association between the variables was studied by univariate and multivariate logistic regression analysis. P values <0.05 were considered significant. Results: Sixty-six patients (59% men) with a mean age of 43 years were included. Most patients (n = 32, 54%) had CD4 cell count below 100 cells/mm3. HIV viral load was undetectable in 13 cases (22%). The patients were classified into three groups according to the diagnosis: pneumocystosis (19 patients), CAP (18 patients) and other infections (23 patients: five with tuberculosis, nine with LRTI, two with histoplasmosis, one with nocardiosis, one with cryptococcosis, one with disseminated strongyloidiasis, one with pulmonary thromboembolism and three patients without a conclusive diagnosis). Nine patients died during hospitalization, four of them were in the pneumocystosis group. Higher values of BG were found in the pneumocystosis group (mean of 240 pg/mL vs. 36 pg/mL in the CAP group vs. 67 in the other infections group) (p<0,0001). Mean LDH was significantly higher in the pneumocystosis group (mean 762 U/L vs. 379 U/L in the CAP group vs. 442 U/L in the other infections group) (p = 0.003). Higher values of BG and LDH were the only independent variables associated with the diagnosis of pneumocystosis. Pneumocystosis was the AIDS-defining illness in 11 of the 16 patients diagnosed with HIV at the time of hospital admission. LAMP was useful in identifying P. jirovecii DNA in only five (1 bronchoalveolar lavage sample and 4 sputum samples) from 12 patients tested with pneumocystosis. Conclusion: In the era of antiretroviral therapy, pneumocystosis is still the most prevalent pulmonary infection and causes the greatest mortality, despite the existence of a National HIV/AIDS Program with free access to ART. BG and LDH were suitable serum markers in the diagnosis of pneumocystosis in the group of patients studied. There is a need for better strategies to achieve the precocious diagnosis of the HIV infection and the reduction of opportunistic infections in AIDS patients (AU)

FAPESP's process: 12/51158-0 - The project for new diagnostic approaches in the management of fungal infections in AIDS and other immunocompromised patients
Grantee:Maria Luiza Moretti
Support type: Regular Research Grants