Lung pathology and causes of death among hospitalized adult patients with HIV infection: pathological analysis
Journal Title: Туберкульоз, легеневі хвороби, ВІЛ-інфекція - Year 2019, Vol 0, Issue 2
Abstract
Objective — to analyze medical records, clinical and laboratory research data and autopsies of deceased HIVinfected adults in the hospital, to assess the level of coincidences and discrepancies of clinical and pathologic diagnoses. Materials and methods. A retrospective study of fatal outcomes was conducted at the NIFP NAMS of Ukraine clinic with a verified diagnosis of HIV infection over a 5year period. In total, 157 people died during this period, 20 of them (12.7 %) had HIV infection. The analysis included a number of clinical and anamnestic data, laboratory parameters presented in the patient’s case histories, as well as the results of macroscopic and microscopic examination at autopsy according to autopsy protocols. Comparison of the final clinical and pathologic diagnoses was made; the main cause of death was established in each case. We took into account the stage of HIV infection at the time of hospitalization of patients, the time of its detection. Results and discussion. Among all the deceased patients with HIV infection, Pneumocystis pneumonia was the most frequent diagnosis — 12 (60.0) % of cases, and it was quite often (10 cases, 83.3 %) combined with other infections — fungal, not identified in vivo (2 cases), cytomegalovirus infection (4 cases), mycobacteriosis (1 case), aspergillosis (2 cases), generalized tuberculosis (1 case). Only in 2 cases without autopsy, pneumocystic pneumonia was diagnosed without indicating other significant lung pathologies. In other cases mycobacterial infection was diagnosed, 5 cases (25.0 %), including verified tuberculosis (2 cases), and two cases — cryptococcal infection, invasive aspergillosis, hepatitis C and fungal infection without laboratory verification of a specific infection. Fatalities with HIV infection occurred at the AIDS stage, with a CD4 cell count below 250/µL. The proportion of discrepancies in the final clinical and pathologic diagnoses was 6 (54.5 %) of 11 cases according to the autopsy results. Moreover, in 5 cases from all 6 discrepancies, this was associated with the development of a fungal/mycobacterial infection. Almost all of the deceased patients had a significant amount of both background diseases and comorbidities, which made their timely intravital diagnostics very difficult. Conclusions. Pathological analysis of fatal outcomes among adult patients with HIV infection in a highly specialized hospital showed that in the vast majority of cases (70 % of our data) there was a combined or competing pathology as the main cause of death. Currently, the proportion of tuberculosis lesions as the main fatal disease has decreased, and fungal infections predominate. In the differential diagnosis of lung lesions in HIV-associated diseases, there is an urgent needing to use a wide range of modern various methods of studying biological material in order to identify one or more etiological agents and adequately assess the activity of inflammatory changes caused by different pathogens.
Authors and Affiliations
I. V. Liskina, L. М. Zagaba, О. D. Nikolaeva
Keywords
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- EP ID EP673958
- DOI 10.30978/TB2019-2-24
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