Jornal Brasileiro de Pneumologia (Jun 2006)
Alterações radiográficas em pacientes com a co-infecção vírus da imunodeficiência humana/tuberculose: relação com a contagem de células TCD4+ Radiographic alterations in patients presenting human immunodeficiency virus/tuberculosis coinfection: correlation with CD4+ T cell counts
Abstract
OBJETIVO: Correlacionar os padrões radiológicos com a contagem de células TCD4+ em pacientes co-infectados por tuberculose e vírus da imunodeficiência humana. MÉTODO: Foram avaliados os pacientes admitidos no Hospital Nereu Ramos, Florianópolis (SC), co-infectados por tuberculose e vírus da imunodeficiência humana, no período de janeiro de 2000 a dezembro de 2003. RESULTADOS: Foram incluídos no estudo 87 pacientes, com média de idade de 34 ± 8 anos, sendo 6,8% não caucasianos. A média de linfócitos TCD4+ foi de 220,2 células/mm³ e a mediana foi de 144 células/mm³, sendo que 56,4% dos pacientes possuíam menos de 200 células/mm³. Os padrões radiográficos isolados foram relacionados com a contagem de células TCD4+. O padrão de consolidação alveolar estava presente em 50,6% dos casos (56,8% TCD4+ OBJECTIVE: To look for correlations between radiological patterns and CD4+ T cell counts in patients coinfected with tuberculosis and human immunodeficiency virus. METHODS: Patients included were selected from among those presenting human immunodeficiency virus/tuberculosis coinfection and admitted to the Nereu Ramos Hospital, located in Florianópolis, Brazil, between January of 2000 and December of 2003. RESULTS: A total of 87 patients were included. The mean age was 34 ± 8 years, and 6.8% were non-Caucasian. The mean CD4+ T cell count was 220.2 cells/mm³ (median, 144 cells/mm³), and 56.4% of the patients presented less than 200 cells/mm³. We identified the following radiographic patterns and related them to the CD4+ T cell counts: the alveolar pattern in 50.6% of the cases (56.8% CD4+ T cells < 200); the interstitial pattern in 32.2% (53.6% CD4+ T cells < 200); pleural effusion in 24.1% (47.6% CD4+ T cells < 200); cavitation in 24.1% (57.1% CD4+ T cells < 200); enlarged mediastinal or hilar lymph nodes in 11.5% (90% CD4+ T cells < 200); and a normal pattern in 11.5% (60% CD4+ T cells < 200). The mean CD4+ T cell counts for the radiologic patterns isolated were as follows: 235.2/mm³ (alveolar consolidation); 208.8/mm³ (interstitial); 243.3/mm³ (pleural effusion); 265/mm³ (cavitation); 115.1/mm³ (enlarged mediastinal or hilar lymph nodes) (p < 0.05); and 205.5/mm³ (presenting no radiological alterations). As noted, mediastinal/hilar lymph node enlargement was the only pattern that correlated with the degree of cell-mediated immunity in a statistically significant way. CONCLUSION: With the exception of mediastinal/hilar lymph node enlargement, the radiographic patterns were randomly distributed in relation to the CD4+ T cell counts.
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