Two quite dyspneic HIV positive patients were admitted to the Emergency Room; they presented with aspects and images suggesting pericardial effusion. The analysis of an initial liquid puncture did not show any specificity and the patients did not register any clinical improvement. Both patients were submitted to a subxiphoid pericardial window, all the effusion liquid was drained, and a biopsy of the pericardium tissue was completed revealing a granulomatous process. Good evolution was the result of specific treatment. Such findings draw attention to a high possibility of pericardial suffusion in AIDS patients being tuberculosis, in particular if one considers the high prevalence of this disease in Brazil. The results also showed that the opening of a subxiphoid pericardial window and the specific triple scheme is a procedure that leads to good therapeutic evolution in this kind of patients.

Microsporidiosis is a rapidly emerging protozoon infection that has been reported predominantly in severely immunosuppressed persons with acquired immunodeficiency syndrome (AIDS). Since the first case of human microsporidian infection was reported in 1956, over 400 cases have been documented. The initial description of microsporidian infection in AIDS patients occurred in 1985. Five genera have been identified as the agents of microsporidiosis in immunocompromised persons (Enterocytozoon, Encephalitozoon, Septata, Pleistophora and Nosema). Respiratory tract infection due to microsporidia is associated almost exclusively with disseminated disease produced by members of the genera Encephalitozoon and Septata. Metronidazole and albendazole were recently reported to be responsible for clinical improvement of patients. The authors reported a case of a woman with AIDS and respiratory symptoms related to two pulmonary pathogens: Mycobacterium tuberculosis and Encephalitozoon cuniculi, identified by polymerase chain reaction (PCR) using diagnostic primers targeting the small subunit ribosomal RNA.

Keywords: Microsporidiosis. Respiratory tract infection. Acquired immunodeficiency syndrome.

The authors report a case of bronchoesophageal fistula found unsuspectedly in bronchoscopy. The radiological findings were compatible and etiologic confirmation was established by histopathological studies.

Keywords: Bronchoesophageal fistula. AIDS.

Chronic obstructive pulmonary disease is currently considered a systemic disease, presenting structural and metabolic alterations that can lead to skeletal muscle dysfunction. This negatively affects the performance of respiratory and peripheral muscles, functional capacity, health-related quality of life and even survival. The decision to prescribe ergogenic aids for patients with chronic obstructive pulmonary disease is based on the fact that these drugs can avert or minimize catabolism and stimulate protein synthesis, thereby reducing the loss of muscle mass and increasing exercise tolerance. This review summarizes the available data regarding the use of anabolic steroids, creatine, L-carnitine, branched-chain amino acids and growth hormones in patients with chronic obstructive pulmonary disease. The advantage of using these ergogenic aids appears to lie in increasing lean muscle mass and inducing bioenergetic modifications. Within this context, most of the data collected deals with anabolic steroids. However, to date, the clinical benefits in terms of increased exercise tolerance and muscle strength, as well as in terms of the effect on morbidity and mortality, have not been consistently demonstrated. Dietary supplementation with substances of ergogenic potential might prove to be a valid adjuvant therapy for treating patients with advanced chronic obstructive pulmonary disease, especially those presenting loss of muscle mass or peripheral muscle weakness.

Keywords: Lung diseases, obstructive; Respiratory muscle; Dietary supplements; Anabolic agents/therapeutic use; Exercício; Energy metabolism

Objective: To evaluate the epidemiological profile of patients with tuberculosis (TB) only and that of patients with TB/AIDS in the state of Espírito Santo, Brazil, between 2000 and 2006. Methods: For the patients of interest, we collected demographic and clinical data from the Epidemiological Surveillance Center (TB database), Brazilian Case Registry Database, and Brazilian National Mortality Database, as well as the Brazilian National CD4+/CD8+ T Lymphocyte Count and Viral Load Network Laboratory Test Control System and the Logistic Medication Monitoring System (HIV/AIDS databases). All of the compiled data were cross-referenced. Results: During the study period, we identified 9,543 TB patients > 15 years of age, 437 of whom (4.6%) had AIDS. The median age did not differ between TB/AIDS and TB-only patients (35 years vs. 38 years). Of the 437 TB/AIDS patients, 298 (68.2%) were male, and 156 (35.8%) were in the 30-39 age bracket. In terms of TB treatment outcome, 79.0% were cured, 9.7% were referred to other facilities, 6.0% died, 5.2% abandoned treatment, and 0.2% developed multidrug-resistant TB. Death was 4.75 times more common in patients with TB/AIDS than in those with TB only. Pulmonary TB accounted for 82.4% of the cases. The combination of pulmonary and extrapulmonary TB was 8.2 times more common in the TB/AIDS patients than in the TB-only patients (95% CI: 6.2-10.8). Conclusions: Our results emphasize the significance of AIDS among TB patients in Brazil, as well as the importance of evaluating secondary data in order to improve their quality and develop public health interventions.

Keywords: Tuberculosis; Acquired immunodeficiency syndrome; Brazil.

Hepatopulmonary syndrome is characterized by a triad consisting of liver disorder, pulmonary vascular dilatation, and hypoxemia. No case of hepatopulmonary syndrome associated with AIDS has been reported so far. In this study, the authors report the case of a 43-year woman with AIDS and virus C cirrhosis taking prophylactic cotrimoxazole for pneumocystosis and retroviral therapy. Upon admission, the patient presented dyspnea, cyanosis, digital clubbing, vascular spiders, and normal chest examination. Chest X-ray revealed bilateral interstitial infiltration and evidenced increased alveolar-arterial gradient and liver function impairment. Intrapulmonary shunt was evidenced by contrast-enhanced echocardiography and radionuclide perfusion scanning, thus confirming hepatopulmonary syndrome.

Keywords: Hepatopulmonary syndrome. Acquired human immunodeficiency syndrome. Human viral hepatitis. Anoxemia. Liver cirrhosis.

Background: Tuberculosis become important challenge to health care settings. Brazil has high prevalence of the disease and Rio de Janeiro has high incidence rates with 30% of cases notified at hospitals. Objective: To evaluate prevalence of initial and acquired drug resistance at a general hospital, reference for aids treatment in Rio de Janeiro and to identify associated factors. Methods: Mycobacterium tuberculosis strains from 165 patients were analyzed, between August 1996 and February 1998. Results: Twenty per cent (33/165) were resistant to at least one drug; 13% (12/165) to isoniazid; 3.64% (6/ 165) to rifampin and 3.64% (6/165) to both. Among HIV seropositive subjects (52/165); 28.85% (15/52) were resistant to at least one drug. Acquired resistance occurred in 15.79% of 19 patients that mentioned previous antiTB treatment. Association statistically significant was found with non cavitation on X-ray in bivariate analyses ( P=0.05). Eighty four patients refereed no previous treatment (NPT). Resistance to 1 or more drugs was found in 28.57% (24/84) of NPT patients. Association statistically significant with initial resistance was found with health care workers (P=0.004), unemployment (P=0.03), and diarrhea (P=0.01) in bivariate analyses. On multivariate analyses, health care workers ( P=0.002) remained significantly associated with initial resistance. Conclusions: High resistance rates was found. It corroborates that hospitals needs attention for TB control especially which concerns to health care works infection.

Keywords: Mycobacterium tuberculosis. Drug resistance. Disease transmission, patient to professional. Hospitals.

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.

Keywords: Tuberculosis/epidemiology. Tuberculosis/complications. Acquired immunodeficiency syndorme/tuberculosis. Mycobacterium tuberculosis/indicators of morbidity and mortality.