CHALLENGES IN DIAGNOSING SPLENIC ABSCESSES IN HIV-INFECTED PATIENTS

Abstract

Objective: Improve the quality of treatment for HIV-infected patients with heart attacks and splenic abscesses by optimizing the diagnosis of these pathological processes. Material and Methods: From 2004 to 2019, 14,405 HIV-infected patients, including 34 patients with suspected splenic abscesses, were treated in the surgical department of the Infectious Clinical Hospital State Budgetary Healthcare Institution (ICH SBHI) No.2. The average age was 34.9 years, 22 males and 12 females. Three patients had stage 3, ten people had stage 4A, ten patiens had stage 4B, and eleven people had stage 4B HIV infection. Patient management followed the generally approved algorithms of the Ministry of Health of the Russian Federation for surgical patients (taking into account the HIV-infection co-morbidity). The following was done: complaints and anamnesis were collected, the duration of HIV-infection, adherence to ART, presence of opportunistic and concomitant diseases were carefully determined, an abdominal ultrasound imaging and an abdominal CT scan were performed. Four patients were diagnosed with splenic infarction; they were treated conservatively and discharged in a satisfactory condition. Surgical treatment was performed in 30 out of 34 patients in the period from 1 to 57 days from admission to the hospital, usually on day 9. 26 of them were discharged and 4 patients died. All 30 surgical patients received antibiotic therapy, surgical material was examined histologically, the cause of the splenic process was determined and therapy was adjusted (if tuberculosis had been diagnosed, patients were moved to an anti-TB hospital, if lymphoma had been diagnosed, patients were moved to an oncohematology department). Results: When examining HIV-infected patients with complaints of abdominal pain and hyperthermia, a detailed history of HIV infection, adherence to ART, viral load and immune status (if the patient knows these data), the presence of concomitant pathological conditions should always be clarified, as wells as abdominal ultrasound and abdominal CT scan should be performed as early as possible. All surgical materials should be examined histologically to verify the cause of the splenic process. Patients in stages 4B-4B, not adhering to ART, with a high viral load and low immune status, suffering from drug addiction and HCV infection, more often get complicated forms of the disease.