Tuberculose extrapulmonar em pacientes com AIDS na cidade do Rio Grande, Brasil. Diagnóstico laboratorial

ABSTRACTOne hundred two specimens of extrapulmonary material from 74 AIDS patients from the AIDS Service of University Hospital, FURG, Rio Grande, RS, Brazil, were examined at Mycobacteria Laboratory, between September 1997 and December 1999. This study had the aim to evaluate laboratoy importance in the diagnosis of extrapulmonary tuberculosis in AIDS patients with clinical suggestive symptoms of tuberculosis. Acid-fast bacilli (AFB) stains were performed using the Kinyon Method (cold stainning). Mycobacterial isolation was made In the Ogawa medium. The Ogawa medium added with p-nitrobenzoic acid, 2-tiophenocarboxylic acid hidrazide and pyruvic acid sodium salt was used to the Identification of mycobacterial species. Confirmation of Mycobacterium tuberculosis was done by the niacin test. The extrapulmonary tuberculosis diagnosis was done in 12,74% of specimens from 17,56% of the patients. Distribution of specimens with positive results in relation to the obtained sites were: 8/13 lymph node biopsies, 2/13 liver biopsies, 2/13 ascitic nuid and 1/13 pleural nuid. ABF were found on microscopic examination from 7/13 specimens and 10/13 in culture. The microscopic examination of ABF stain was the only method responsible for the extrapulmonary tuberculosis diagnostic in 3/13 cases and the culture in 6/13 cases. Among the positive specimens at microscopic examination or ABF stains, 6/7 were lymph node biopsies and In ascitic fluid. The used methods in the diagnosis, of the extrapulmonary tuberculosis showed good results, by this way we strongly recommend the realization of both as routine in our place.REV PORT PNEUMOL 2000; VI (4): 277-28

Tuberculose associada à AIDS: características demográficas, clínicas e laboratoriais de pacientes atendidos em um serviço de referência do sul do do Brasil

Introdução: A sinergia entre a tuberculose e o vírus da imunodeficiência humana é responsável pelo aumento da morbi-mortalidade dos pacientes com AIDS.Objetivo: Delinear o perfil de pacientes com tuberculose e AIDS na cidade de Rio Grande (RS) relacionando dados demográficos, clínicos e laboratoriais. Método: A amostra foi constituída por todos os casos de tuberculose confirmados pelo isolamento de Mycobacterium tuberculosis ocorridos no Serviço de AIDS do Hospital Universitário/FURG entre setembro de 1997 e dezembro de 2000, em 31 pacientes reportados como casos definidos de AIDS. Foram examinados 33 materiais clínicos pulmonares e extrapulmonares através da cultura pelo método de Ogawa-Kudoh e da baciloscopia pelo Kinyoun. A identificação de M. tuberculosis foi feita pelos métodos fenotípicos usuais. Para determinação da resistência das cepas isoladas foi empregado o método das proporções.Resultados: A média de idade foi de 33,8 ± 9,9 anos, com uma relação homem/mulher de 2,87:1. Eram brancos 80,7% dos pacientes. Todos os pacientes apresentavam manifestações clínicas gerais e/ou específicas de tuberculose no momento da suspeita diagnóstica. Em 20 deles foram constatados fatores de risco: uso de droga endovenosa,alcoolismo, desnutrição, encarceramento. A doença pulmonar ocorreu em 19 casos, a extrapulmonar em 10 e a associada em 2 deles. Entre aqueles com a forma extrapulmonar,predominou o comprometimento ganglionar. As 33 cepas isoladas foram identificadas como M. tuberculosis, e 28 mostraram sensibilidade à isoniazida e à rifampicina.Conclusão: A tuberculose nos pacientes com AIDS apresentou-se com manifestações clínicas variáveis, comprometendo homens e mulheres em condições sociais desfavoráveis, em plena fase produtiva de suas vidas.Background: Synergism between tuberculosis and HIV is responsible for the increased morbidity-mortality rate in AIDS patients.Objective: To delineate the profile of patients with tuberculosis and AIDS in the city of Rio Grande by relating demographic, clinical and laboratory data.Method: The sample comprised all cases of tuberculosis defined by identification of Mycobacterium tuberculosis that occurred in the AIDS Service of the University Hospital/FURG between September, 1997 and December, 2000, which added to a total of 31 patients confirmed as definite cases of AIDS. Using the Ogawa-Kudoh culture method and the Kinyoun bacilloscopy, 33 clinical pulmonary and extrapulmonary specimens were analyzed. Identification of M. tuberculosis was made by the usual phenotype methods. The method of proportions was chosen to establish resistance of isolated strains.Results: The mean age was of 33.8±9.9 years, with a man/ woman ratio of 2.87:1 and 80.7% of Caucasians. All patients(n=31) exhibited overall or specific clinical manifestations of turberculosis at the time of suspicion diagnosis. In 20 of the cases risk factors were observed: use of injected drugs, alcoholism, malnutrition, imprisonment. Pulmonary disease occurred in 19 cases, extrapulmonary in 10 and the association of both in two. Lymph node commitment was more frequent among those with extrapulmonary disease.The isolated strains (33) were identified as M. tuberculosis and 28 were tested and showed sensibility to Isoniazid and Rifampin.Conclusion: In AIDS patients, tuberculosis appeared with various clinical manifestations, jeopardizing both men and women of less favored social conditions while at a fully productive stage of their lives