Manuscrito aids

THE CHALLENGE OF DIAGNOSING AIDS IN THE ELDERLY

Authors: André Macedo Serafim Silva a, Guilherme Sousa Ribeiro b,c

a Internal Medicine Department – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo b Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health – Salvador - Brazil c Institute of Collective Health, Universidade Federal da Bahia – Salvador – Brazil

Electronic addresses: [e-mail]; [e-mail]

Corresponding author: Guilherme S. Ribeiro
Instituto de Saúde Coletiva, Universidade Federal da Bahia
Rua Basílio da Gama, s/n - Campus Universitário Canela, quinto andar
40.110-040 – Salvador-BA
Tel: [phone]

Abstract
Diagnosis of acquired immune deficiency syndrome (AIDS) and opportunistic infections among the elderly population attending the emergency room is frequently a difficult task. The clinical manifestations of HIV infection in older adults are nonspecific and the symptoms often are attributed to other diseases that are common in this age group. We present and discuss a case of an 82-years-old woman seeking for health care during three months of progressive headache. At emergency department she had unremarkable physical examination. A lumbar puncture was performed and revealed 5 white mononuclear cells/microL, 53 mg/dL of glucose and 30 mg/dL of protein. India ink staining showed images suggestive of Cryptococcus sp. The HIV test was positive and treatment for cryptococcal meningitis and AIDS was initiated. A gastroesophageal moniliasis was also detected and treated. The patient improved of the symptoms and was discharged after 32 days to AIDS reference service. This case highlights the importance of considering cryptococcal meningitis as a differential diagnosis in patients presenting chronic headache, even in older patient. Furthermore, HIV infection must not be neglected in the elderly subgroup as an increasing cause of immunodeficiency. A