However, Mycobacterium kansasii, is often associated with cavitation.
Mycobacterium avium complex is an uncommon cause of lung disease and infrequently produces cavities. With pulmonary tuberculosis, cavities are more common during earlier stages of HIV disease, when cellular immunity is relatively It is unusual in patients with pulmonary cryptococcosis,Ĭoccidioidomycosis, and histoplasmosis but occurs frequently in patients with invasive pulmonary aspergillosis. In patients with Pneumocystis carinii pneumonia, cavitation is an uncommon manifestation of a common disease. The differential diagnosis of cavitary pulmonary lesions in individuals infected with human immunodeficiency virus (HIV) isīroad, especially in patients with advanced disease. The ICU outcome of HIV-infected patients seems to be dependent not only on acute illness severity, but also on the administration of antiretroviral treatment.
Regarding HIV-infected patients admitted to ICU without using ART, those who have started this treatment during ICU stay presented a better prognosis when time and potential confounding factors were adjusted for. The use of ART in the ICU was negatively predictive of 6-month mortality in the Cox model, especially if this therapy was introduced during the first 4 days of admission to the ICU. CD4 T-cell count <50 cells/mm(3) was only associated with ICU mortality. Multivariate logistic regression analysis and Cox proportional hazards models demonstrated that the variables associated with in-ICU and 6-month mortality were sepsis as the cause of admission (odds ratio = 3.16 1.65-6.06]) hazards ratio = 1.37 ), an Acute Physiology and Chronic Health Evaluation II score >19, mechanical ventilation during the first 24 hours, and year of ICU admission. We excluded ICU readmissions (37), ICU admissions who stayed less than 24 hours (44), and patients with unavailable medical charts (36). The ICU of a tertiary-care teaching hospital at the Universidade de São Paulo, Brazil.Ī total of 278 HIV-infected patients admitted to the ICU were selected. The follow-up period extended for 6 months after ICU admission. To evaluate the impact of antiretroviral therapy (ART) and the prognostic factors for in-intensive care unit (ICU) and 6-month mortality in human immunodeficiency virus (HIV)-infected patients.Ī retrospective cohort study was conducted in patients admitted to the ICU from 1996 through 2006.
The care of HIV-positive patients presenting to neurosurgical services requires a multidisciplinary approach, which is reflected in the authorship of this review, as well as in the guidance given. It addresses the issues of diagnosis and intervention in HIV-positive patients in the era of combination antiretroviral therapy, while not ignoring the potential for opportunistic central nervous system infection in undiagnosed patients. This review outlines important conditions that cause brain lesions and hydrocephalus. Patients may also present to a neurosurgical service with conditions unrelated to their HIV status. Opportunistic infections of the central nervous system can be complicated by hydrocephalus, and the management is pathogen dependent.
The differential diagnosis in these cases is broad, including opportunistic infections and malignancies, and investigation should be tailored accordingly. HIV-positive individuals may present to neurosurgical services with brain lesions of unknown etiology. It renders the central nervous system susceptible to infectious and noninfectious diseases. Human immunodeficiency virus (HIV) is a global health problem.