Clinical and immunological characteristics of bacterial pneumonia associated with HIV infection coupled to drug addiction

Bacterial pneumonia holds the second place after respiratory tuberculosis in patients with HIV infection. In recent years, sexual transmission of HIV was replaced by injection drug route. It seems of high relevance to advance medical aid to patients with HIV infection and bacterial pneumonia depending on psychoactive substance use.Aim of study — assessment of clinical and immunological manifestations of bacterial pneumonia coupled to HIV infection with respect to verified injection drug use.Materials and methods. Clinical and immunological data collected from 224 patients with HIV infection and pneumonia were retrospectively analyzed: group 1 group — 70 patients with HIV infection, IDU, verified bacterial pneumonia; group 2 — 16 injecting drug users (IDU) with HIV infection and pneumonia of unverified etiology; group 3 — 65 patients with HIV and bacterial pneumonia of verified etiology without injection drug use, group 4 — 73 patients with HIV infection and bacterial pneumonia of unverified etiology, without injection drug use. The data obtained were analyzed by using software Statistica 13.3. Methods of descriptive statistics with calculation of nonparametric criterion — the Kruskall—Wallis test (H-criterion) and χ2 test — were used.Results. Immunological manifestations of HIV infection and bacterial pneumonia were characterized by decreased count of CD4+ cells paralleled with increased count of CD3+ and CD8+ cells at higher magnitude without injection drug use being also featured with peak viral load upon developing pneumonia. Bacterial pneumonia coupled to HIV infection showed clinical manifestations similar both in injecting drug users and non-users, proceeding in 10% cases during normothermia. Injection drug user patients often demonstrated clinical picture of pneumonia resembling those found in sepsis such as pain in the body, muscles, bone aches untypical to HIV-sexually infected subjects. In addition, systolic murmur on a heart top was more often auscultated in this patient group.Conclusion. Subjects self-considered healthy being at risk of sexually transmitted infections should examined for HIV. All subjects manifested with symptoms of the lower airway tract infections in admission department should not be rejected to be hospitalized and undergo chest X-ray examination

Genitourinary tuberculosis in the structure of autopsy morphological findings in deceased patients at the late stages of HIV infection

Introduction. The problem of tuberculosis (TB) has not lost its significance due to the overlapping epidemic of HIV infection and the addition of specific lesions at its late stages. It is due to the lack of adherence to antiretroviral therapy in a large number of patients. The high mortality rate in HIV-associated TB requires an increase in the interest of all doctors for the early detection of various TB localizations against the background of HIV, allowing the patient to be cured. For urologists, information on the frequency of genitourinary TB in HIV patients is of interest to improve its diagnosis.Purpose of the study. To identify the proportion of genitourinary TB in the structure of the specific lesions in patients with HIV-associated TB.Materials and methods. The case-records of 115 deceased patients with a combination of HIV infection and TB were retrospectively analyzed using a continuous method. The number of men among them was 81.7 ± 3.6% (94). The average age of men was 37.1 ± 27.2 years, women — 31.9 ± 6.3 years. The research results were processed statistically.Results. The average period from the moment of HIV infection detection to the registration of a lethal outcome was 2.8 ± 1.3 years, from the moment of TB diagnosis — 6.96 ± 7.3 years. The majority of patients with HIV infection had a stage of secondary diseases (93.1 ± 2.4%). At the time of admission to the TB dispensary, the average CD4 + lymphocyte level was 131.06 ± 75.8 cells/pL, 10.03 ± 2.5%. Anti-retroviral therapy was observed only in 19 (16.5 ± 3.5%) patients. In deceased patients disseminated pulmonary TB was more often verified at autopsy — 52.2 ± 4.7%, miliary — 7.8 ± 2.5%, infiltrative — 11.3 ± 3.0%. In patients with disseminated and miliary pulmonary TB, foci of dropout were often observed in the spleen (71.7 ± 5.8% and 55.6 ± 16.6%) and liver (46.7 ± 6.4% and 33.3 ± 15,7%). The kidney damage occurred in 60.0 ± 6.3% of patients with disseminated and 44.4 ± 16.6% miliary pulmonary TB. Kidneys TB was confirmed by bacterioscopic urine examination in three cases only (2.6 ± 1.5%) during life. Prostate TB was confirmed by analysis of expressed prostatic secretion on Mycobacterium tuberculosis (2.6 ± 1.5%) and was combined with kidney TB. The lesions of the lymphatic system during life were exposed in 17.4 ± 3.5% of patients. A pathomorphological examination revealed TB of intrathoracic lymph nodes in 37.4 ± 4.5%, intra-abdominal lymph nodes — in 22.6 ± 3.9%, peripheral — 6.1 ± 2.2%, more often in miliary and disseminated pulmonary TB. TB meningitis was registered in 31 cases as well as meningoencephalitis in 32 patients during life and at autopsy, respectively. Intestinal TB was confirmed by autopsy in 9.6 ± 2.7% of patients; during life, it was accompanied by the detection of the pathogen in the feces. The pancreatic TB was detected in 2.6 ± 1.5%, TB spondylodiscitis in 1.7 ± 1.2%, myocardial TB in 0.9 ± 0.9% and pericardium TB in 0.9 ± 0.9% cases.Conclusion. Thus, generalized TB is diagnosed in patients in the late stages of HIV infection, in the structure of which kidney damage is in second place, yielded only to spleen damage. Obtaining this information should form the alertness of urologists in terms of detecting and diagnosing genitourinary TB in patients with HIV infection

Cardiovascular pathology in patients with newly diagnosed tuberculosis and chronic obstructive pulmonary disease

Introduction. Chronic obstructive pulmonary disease and cardiovascular diseases (arterial hypertension, ischemic heart disease, chronic heart failure) are among the comorbid conditions that mutually aggravate each other. The addition of tuberculosis in this category of patients requires additional efforts from the doctor to improve treatment outcomes.Purpose. Тo assess the prevalence of chronic obstructive pulmonary disease, arterial hypertension, coronary heart disease and chronic heart failure in patients with newly diagnosed tuberculosis hospitalized in an anti-tuberculosis hospital.Materials and methods. We examined 462 patients with newly diagnosed tuberculosis, hospitalized in a tuberculosis dispensary, aged 17 to 88 years, the median (Me (P25; 75) age was 43.68 (32.00; 54.00) years, including 266 men (57.6%) and 196 women (42.4%) All patients underwent clinical, laboratory, instrumental examination to establish or confirm the diagnosis.Results. The incidence of chronic obstructive pulmonary disease among patients with newly diagnosed tuberculosis was 31.4%, with arterial hypertension – 12.1%, coronary heart disease – 6.1%, chronic heart failure – 6.1%. The incidence of cardiovascular pathology in the group of tuberculosis + chronic obstructive pulmonary disease was 40%, in the group of tuberculosis without chronic obstructive pulmonary disease 6%.Conclusions. The prevalence of comorbid cardiovascular pathology in patients with tuberculosis + chronic obstructive pulmonary disease is significantly higher than among patients with only tuberculosis, which requires the involvement of doctors of various specialties to manage this category of patients to prevent adverse treatment outcomes, disability and mortality

Sensitivity of <i>Streptococcus</i> <i>viridans</i> to antibacterial agents in HIV-positive patients coupled to respiratory diseases

The streptococcus group consists of multiple species of globular Gram-positive facultative anaerobic bacteria, the classification of which is based on assessing their capacity to erythrocyte hemolysis. The viridans group streptococci produce a green coloration being a part of normal microflora in the oral cavity. However, in case of developing immunodeficiency states, oncology, and neutropenia, this pathogen can cause diseases such as bacteremia, sepsis, endocarditis, as well as pneumonia in some cases. Respiratory diseases commonly require medical assistance in HIV-infected patient cohort. The role of commensal S. viridans in development of bacterial diseases in HIV-infected patients remains poorly examined. A potential association between S. viridans and other bacterial communities, including pathogenic microorganisms is obscure. In addition, it might be worth evaluating sensitivity of S. viridans to antibacterial agents in regions with high HIV infection incidence. The aim of the study was to evaluate sensitivity to antibiotics in sputum viridans group streptococci collected from HIV-infected patients with symptomatic pneumonia. Materials and methods. The data on sputum microbiological study conducted within the 01.01.2012—01.01.2019 interval were collected from all HIV-infected patients with suspected pneumonia (n = 684) and analyzed at the Infectious Clinical Hospital No. 1 named after D.M. Dalmatov, among which S. viridans was detected in 193 patients (28.2%). Bacteriological examination of patient samples was conducted to isolate pure bacterial culture by using standard methods. Next, S. viridans was assessed for sensitivity to antibacterial agents (n = 78) according to the 2018 clinical recommendations. Initially, antibiotic resistance was assessed by disk-diffusion method as a routine approach broadly used in clinical laboratory. After that, the minimal inhibitory concentration was measured by using AutoScan 4 Microscan analyzer (bacteriological semi-automatic analyzer, Beckman Coulter, USA) to identify and determine antibacterial sensitivity. Results. A disk-diffusion method allowed to find in sputum samples streptococci resistant to penicillin in 28.2% cases, ampicillin — in 42.3% and cefazolin — in 43.6%. While assessing the minimal inhibitory concentration for antibacterial agents, similar data were obtained. Good sensitivity was found for cefotaxime, ceftriaxone, cefepime, fluoroquinolones and vancomycin

Smoking and COPD: update and reduced possible risks (review of literature)

Chronic obstructive pulmonary disease (COPD) kills more than 3 million people worldwide every year. Understanding the pathogenetic processes of disease progression, new approaches to therapy allowed to slow down the progression of the disease somewhat and to affect mortality. The main reasons for the development of COPD remain smoking, the use of biofuels, industrial and aerosolutions. A definite contribution to the development and progression of the disease is the presence of concomitant diseases. Smoking cessation programs, increasing physical activity, early detection and treatment of co-morbidities are another key component for reducing the burden of the disease. However, this is possible only if there are political and economic efforts at the state level.Хроническая обструктивная болезнь легких (ХОБЛ) ежегодно убивает более 3 миллионов человек во всем мире. Понимание патогенетических процессов прогрессирования заболевания, новые подходы к терапии позволили несколько замедлить прогрессирование заболевания и повлиять на смертность. Основными причинами развития ХОБЛ остаются курение, использование биотоплива, производственные и аэрополлютанты. Определенный вклад в развитие и прогрессирование болезни несет наличие сопутствующих заболеваний. Программы прекращения курения, повышение физической активности, раннее выявление и лечение сопутствующих заболеваний является еще одним ключевым компонентом для снижения бремени болезни. Однако это возможно только при наличии политических и экономических усилий на государственном уровне

ОПЫТ ПРИМЕНЕНИЯ ПРОТИВОТУБЕРКУЛЕЗНОЙ И АНТИРЕТРОВИРУСНОЙ ТЕРАПИИ У БОЛЬНЫХ ТУБЕРКУЛЕЗОМ С ВИЧ -ИНФЕКЦИЕЙ

In the territory of the Omsk region HIV infection and tuberculosis at patients come to light at the same time (61,0%) more often. Combination of these two infectious diseases men (81,5%), aged from 30 till 39 years (45,0%) at which the parenteral way of infection (87,3%) HIV infection prevailed are subject to a thicket. Tuberculosis, in this group of patients came to light at early stages of HIV infection (74,5%) that affected frequent percent of infiltrative tuberculosis of lungs (45,5%). Among patients tuberculosis in a combination HIV infection the low motivation to treatment met, however at an assessment of efficiency of treatment of tuberculosis data similar to those at patients with the isolated tuberculosis were obtained. From treatment we explain good effect with a combination of antitubercular therapy with antiretrovirus.На территории Омской области ВИЧ-инфекция и туберкулез у больных чаще выявляются одновременно (61,0%). Сочетанием этих двух инфекционных заболеваний чаще подвержены мужчины (81,5%) в возрасте от 30 до 39 лет (45,0%), с преобладанием парентерального пути заражения ВИЧ (87,3%). Туберкулез в данной группе больных выявлялся на ранних стадиях ВИЧ-инфекции (74,5%), что повлияло на высокий процент инфильтративного туберкулеза легких (45,5%) в структуре клинических форм. Среди больных туберкулезом в сочетании с ВИЧ-инфекцией встречалась низкая мотивация к лечению, однако при оценке эффективности лечения туберкулеза были получены данные, сопоставимые с таковыми у больных с изолированным туберкулезом

Клинические формы туберкулёза у детей с соматической и инфекционной патологией

The analysis of influence of difference pathology at children on structure of clinical forms of tuberculosis will allow to create approaches to prophylaxis of tuberculosis. Our retrospective research included 1165 children from 0 to 14 years with tuberculosis. Predisposition to development of tuberculosis of respiratory organs in children with the accompanying infectious pathology (90,3%) and with a combination infectious and somatic (93,6%) (χ²= 16,161, р = 0,000). The children with the isolated somatic pathology had the lowest indicators of a lesion of respiratory organs tuberculosis (84%). Extrapulmonary tuberculosis is bound to existence of somatic pathology (8%) (χ²= 9,598, р = 0,029).Проведен анализ влияния сопутствующей патологии у детей на структуру клинических форм туберкулеза. В ретроспективное исследование включены 1165 детей от 0 до 14 лет с туберкулёзом. Отмечена предрасположенность к развитию туберкулёза органов дыхания у детей с сопутствующей инфекционной патологией (90,3%) и с сочетанием инфекционной и соматической (93,6%) (χ²= 16,161, р = 0,000). При этом дети только с соматической патологией имели более низкий процент поражения органов дыхания туберкулёзом (84%). Внелегочный туберкулёз связан с наличием соматической патологии (8%) и редко возникал у детей с сопутствующими инфекционными болезнями (5,4%)(χ²= 9,598, р = 0,029)

Заболевания органов дыхания при ВИЧ-инфекции (обзор)

The review purpose – to analyse modern epidemiological and clinical laboratory data on the most actual diseases of respiratory organs at HIV-positive persons. Questions of distribution, features of a clinical course of tuberculosis of lungs, pnevmotsistny, toksoplazmozny, Cytomegaloviral, bacterial pneumonia and their combined options at HIVpositive patients are considered. According to domestic and foreign literature advantages and restrictions of methods of beam and nuclear diagnostics in identification of the most typical pathological changes in lungs of various genesis are established.The modern data concerning questions of differential diagnostics at identification at the patient with HIV infection of a so-called “pulmonary syndrome” are presented in the review. The practicing therapists, infectiologists, phthisiatricians, doctors of other specialties have to know about this pathology in due time to suspect possible damage of lungs at HIV-positive patients, to conduct careful laboratory and tool examination, to choose adequate further tactics of maintaining the patient.Цель обзора – проанализировать современные эпидемиологические и клинико-лабораторные данные по наиболее актуальным заболеваниям органов дыхания у ВИЧ-инфицированных лиц. Рассмотрены вопросы распространения, особенностей клинического течения туберкулеза легких, пневмоцистной, токсоплазмозной, цитомегаловирусной, бактериальных пневмоний и их сочетанных вариантов у ВИЧ-инфицированных пациентов. По данным отечественной и зарубежной литературы установлены преимущества и ограничения методов лучевой и ядерной диагностики в выявлении наиболее типичных патологических изменений в легких различного генеза.В обзоре представлены современные сведения, касающиеся вопросов дифференциальной диагностики, при обнаружении у больного ВИЧ-инфекцией так называемого «легочного синдрома». Практикующие терапевты, инфекционисты, фтизиатры, врачи других специальностей должны знать о данной патологии для того, чтобы своевременно заподозрить возможное поражение легких у ВИЧ-инфицированных пациентов, провести тщательное лабораторно-инструментальное обследование, выбрать адекватную дальнейшую тактику ведения больного