AIDS TREATMENT NEWS No. 065 - September 23, 1988
John S. James
This study, published July 9 in The Lancet by researchers at the New York University School of Medicine, New York City Department of Public Health, and New York Hospital-Cornell Medical Center, can help physicians by letting them know which complications are most often missed, so that they can check carefully for these, especially in patients with undiagnosed problems.
Of all AIDS death records between May 1981 and May 1987 at two large teaching hospitals, one public and one private, 101 adult patients had autopsy and all other records available. The major unsuspected AIDS-related conditions were:
- CMV infection, 49 percent (of all 101 cases); - Systemic fungal infection, 20 percent; - Systemic KS, 14 percent; - MAI infection, 11 percent; - Systemic herpes infection, 9 percent.
Other problem diagnoses were fungal pneumonias (undiagnosed despite bronchoscopy and even biopsy), tuberculosis, and central nervous system lymphomas (sometimes treated unsuccess- fully as toxoplasmosis).
Bacterial pneumonias -- presumably treatable -- were important contributors to death in 30 percent of the patients.
Successful diagnosis was found for pneumocystis (over 90 percent of cases), and cryptococcal infection and CMV retinitis (diagnosed correctly in all cases).
Previous autopsy studies (when the cause of death was not AIDS related) have also found that many infectious diseases are missed.
For more information, see Wilkes, MS and others, "Value of Necropsy in Acquired Immunodeficiency Syndrome", The Lancet, July 9, 1988, pages 85-88.
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