Differential diagnosis of lung`s lesions in HIV-infected patients

Abstract

Introduction. Occurring of intercurrent diseases in HIV-infected and AIDS patients depends on the state of cellular and humoral immunity, on the level of CD4 + cells, which is reduced to 300 cells/ml and it is determining factor for the occurrence of a secondary pathology. In Ukraine a co-infection: tuberculosis and HIV/AIDS – has a malignant character, it has an extremely unfavorable course and high numbers of deaths from primarily diagnosed tuberculosis. The aim of the study. On example of clinical cases to show the difficulties in the differential diagnosis of pulmonary lesions in HIV-infected patients. Materials and methods. The clinical examples of patients with lungs diseases, associated with HIV infection, who were in the department of pulmonary tuberculosis № 1 Zaporizhzhya antituberculosis clinical dispensary were analyzed in this article. The results of research. The clinical examples. Patient C had clinical manifestations of respiratory system lesions, according to the X-ray: with bilateral lung cavities in them. Mycobacteria, Cryptococcus and Pneumocystis were not detected in the sputum. In blood cultures St. aureus was received. Patient U being in poor state with severe intoxication was treated in the intensive care unit. According to autopsy Pneumocystis pneumonia with endogenous intoxication and cerebral edema were revealed. HAART and prevention by Biseptol significantly reduced the incidence of Pneumocystis pneumonia. However, some patients in Ukraine absolutely refuse from both examination and treatment in centers of immune correction and therefore they are admitted to hospital in a critical state. Patient K had both symptoms of intoxication syndrome and symptoms of the respiratory system lesions. After a course of antibiotic treatment his state did not improve, neurological symptoms appeared. Cryptococcus were found in the cerebrospinal fluid. Patient A was admitted to the department with manifestations of intoxication syndrome and symptoms of lesions of the respiratory system. The microfocal dissemination was found in his lungs. HIV was primarily identified. She was treated irregularly, she took injected drugs. An acute intoxication after using unidentified narcotic substance was detected at autopsy. Conclusion. HIV-infected people in most cases are often drug users, that results in lesions of various organs and systems, that’s why it causes some difficulties in differential diagnosis. To reduce mortality from opportunistic infections and drug abuse it`s necessary to conduct measures to form commitment to highly active antiretroviral therapy (HAART) and to treat drug dependence.

Keywords

• HIV-infection
• pneumocystis pneumonia
• cryptococcosis
• staphylococcal pneumonia