LUNGS IN HIV
TB IN HIV POSITIVE INDIVIDUAL
- Can appear at any stage of HIV infection.
- Most common agent in tropical countries-Mycobacterium tuberculosis
- MAC infection occurs when CD4 + T cells counts are < 50/ml
- M. tuberculosis infection develops early in the course with CD4 T cells counts > 300/ml.
In early stages TB
- present as typical pattern as Upper lobe involvement
- Cavitation without significant Lymphadenopathy or effusion.
In late stages TB
- Present as diffuse interstitial or Miliary pattern
- With little Cavitation with Lymphadenopathy.
- Active TB can accelerate course of HIV infection.
- Extrapulmonary TB is common in HIV Patients.
The diagnosis of TB in HIV Patients is difficult because of:
- increased sputum negativity
- atypical radiography
- lack of classic granulomas
- Negative PDD skin tests.
- World wide about one third of all AIDS related deaths are due to TB.
Clinical manifestations
- Depend on CD4 CELL COUNTS.
- In patients with low CD CELL COUNTS
- Disseminated disease is more common.
- Pleural effusions
- Miliary spread
- Lymphadenopathy
- bilateral reticulonodular pattern
- In patients with High CD4 CELL COUNTS,
- Typical pattern as Upper lobe involvement with Cavitation
- Without significant Lymphadenopathy or effusion is seen.
- Heart disease is a common post mortem finding in HIV infected patients.
- ‘Paradoxical reactions’ (Exacerbations in signs and symptoms) have been reported with administration of HAART.
Antituberculous Drugs:
First-line agents for the treatment of tuberculosis:
- Isoniazid,
- Rifampin,
- Pyrazinamide,
- Ethambutol, and streptomycin
- Second-line drugs(for resistant to first-line drugs)
- Kanamycin, amikacin, and capreomycin and the oral agents
- Ethionamide, cycloserine, and PAS, ofloxacin, levofloxacin and sparfloxacin.
- Other second-line drugs include clofazimine, amithiozone (thiacetazone).
- Both adults and children consists of
- a 2-month initial phase of isoniazid, rifampin, and pyrazinamide
- followed by a 4-month continuation phase of isoniazid and rifampin.
- Infected with a drug-resistant strain,
- ethambutol (or streptomycin) should be included in the regimen for the first 2 months
- or until the results of drug susceptibility testing become available.
PNEUMONIA IN AIDS:
Symptomps
- Dyspnea and non- productive cough
- x-ray shows
- bilateral perihilar opacities
- Without pleural effusion
- Lymphaden-opathy
- Bronchoalveolar lavage that demonstrates
- “hat-shaped” structures in alveoli
- Stain with silver stains.
- The most characteristic histopathological feature of pneumocystis carinii pneumonia in adults is
- predominantly alveolar
- foamy vacuolated
- eosinophilic exudates.
- Interstitial pneumonitis is
- mild
- Shows infiltration with PML and mononuclear cells.
Prophylaxis Against Pneumocystis Pneumonia in HIV Positive
Prophylaxis offered to:
- Patients with CD4 counts below 200 cells/mcL
- CD4 lymphocyte percentage below 14%
- Or weight loss or oral candidiasis .
- Patients with a history of Pneumocystis pneumonia
- Should receive secondary prophylaxis
- Until durable virologic response to HAART for at least 3-6 months seen
- CD4 count of > 250 cells/mcL.
Fungal infection
- Coccidiodes immunitis
- Aspergillosis
- Histoplasmosis.
Idiopathic interstitial pneumonia
Lymphoid interstitial pneumonia (LIP)
Nonspecific intestinal pneumonitis
Sinusitis
- Maxillary sinus is involved.
- MC causative organism are
- H. influenzae
- Streptococcas
Exam Important
- AIDS patient most common mico-organism responsible for pneumonia is Pneumocystis carinii
- Mycobacterium tuberculosis is the Most common agent causing tuberculosis in AIDS patient in tropical countries
- Mycobacterium tuberculosis can cause disease in HIV+ve patient with a CD4 count of 600/ cu.mm
- The most characteristic histopathological feature of pneumocystis carinii pneumonia in adults is predominantly alveolar, foamy vacuolated, eosinophilic exudates.
- Respiratory system infections in HIV is seen with Streptococcus, H.influenzae, Pneumocystis carinii
- Chest X-ray findings in tuberculosis associated with HIV are Disseminated tuberculosis, Pleural effusion, Hilar lymphadenopathy
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