A carregar...
Publicação
O ELISpot no Serviço de Infeciologia do Hospital Santa Maria : estudo retrospetivo dos resultados negativos
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 1 MB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Objetivo: Rever todos os casos clínicos do Serviço de Infeciologia do Hospital de Santa Maria nos quais, no decurso da investigação clínica, foi pedido um teste ELISPot, cujo resultado se mostrou negativo. Métodos: Breve revisão científica e criação de uma base de dados, seguida de análise descritiva e inferência estatística.
Resultados: 109 doentes (75 são VIH positivos) apresentaram um ELISpot negativo. O pedido de ensaio do ELISpot não foi acompanhado pelo exame cultural em 54 casos. Quadros clínicos arrastados, com envolvimento do sistema nervoso central ou pulmonar registaram mais pedidos. Em 22 doentes foram isolados outros agentes infecciosos além de Mycobacterium tuberculosis. Atendendo ao enquadramento clínico, não foi possível apurar justificação para o pedido do teste em 9 doentes.
Conclusão: A maioria dos quadros clínicos foram interpretados como infecção
recente de tuberculose e o teste poderá ter acelerado o processo diagnóstico pela exclusão desta hipótese.. Constatou-se negativização do IGRA em contexto pósexposição em 6 doentes VIH apesar de o ELISpot ser o IGRA que menor suscetibilidade oferece à anergia imunológica. Salienta-se a necessidade de apurar ainda mais critérios de aplicação do ELISpot na população VIH.
Purpose: Case review of all the patients from the Department of Infectious Diseases at the Hospital Santa Maria, who had a negative ELISpot result upon clinical investigation. Methods: Brief medical literature review and database organization, followed by statistical analysis. Results: 109 patients (75 are HIV positive) presented negative ELISpot results. Cultural exam was disregarded in 54 patients. Patients with insidious clinical conditions, central nervous system and pulmonary involvement registered more test requests. Other pathogens beyond Mycobacterium tuberculosis were isolated in 22 patients. Regarding the clinical picture, it was not possible to ascertain why ELISpot was requested in 9 patients. Conclusion: Most of the clinical conditions were interpreted as recent tuberculosis infection, and the test might have accelerated the diagnostic process by excluding this hypothesis. It was confirmed post-exposal ELISpot negativization in 6 HIV patients although it concerns the less susceptible IGRA to immunological anergy. The study points out the need to further refine the test application criteria in HIV population.
Purpose: Case review of all the patients from the Department of Infectious Diseases at the Hospital Santa Maria, who had a negative ELISpot result upon clinical investigation. Methods: Brief medical literature review and database organization, followed by statistical analysis. Results: 109 patients (75 are HIV positive) presented negative ELISpot results. Cultural exam was disregarded in 54 patients. Patients with insidious clinical conditions, central nervous system and pulmonary involvement registered more test requests. Other pathogens beyond Mycobacterium tuberculosis were isolated in 22 patients. Regarding the clinical picture, it was not possible to ascertain why ELISpot was requested in 9 patients. Conclusion: Most of the clinical conditions were interpreted as recent tuberculosis infection, and the test might have accelerated the diagnostic process by excluding this hypothesis. It was confirmed post-exposal ELISpot negativization in 6 HIV patients although it concerns the less susceptible IGRA to immunological anergy. The study points out the need to further refine the test application criteria in HIV population.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
ELISPOT Doenças transmissíveis Infectologia