AVALIAÇÃO FUNCIONAL PULMONAR EM PORTADORES DE LEISHMANIOSE VISCERAL

Introducao: A leishmaniose visceral (LV) e uma antropozoonose grave com relevância mundial dada a sua incidencia e caracterizada pelo acometimento sistemico e alta letalidade. A apresentacao clinica depende da resposta imune do hospedeiro, e inclui as formas assintomatica, oligossintomatica e classica, sendo esta ultima caracterizada por febre, esplenomegalia, anemia, hepatomegalia, astenia e tosse seca. O acometimento pulmonar na LV e pouco conhecido, comumente associado a complicacoes infecciosas da doenca e importante causa de obito. A espirometria e um teste de funcao pulmonar com bom custo-beneficio e pode ser o primeiro exame a identificar a presenca de doenca pulmonar. Seus resultados poderao fornecer dados objetivos aos estudos sobre disfuncao pulmonar e, juntamente com os resultados da avaliacao clinica e radiografica, pode esclarecer as repercussoes respiratorias da LV, contribuindo para a prevencao de complicacoes e minimizando os possiveis efeitos cronicos da doenca. Em decadas passadas, pesquisadores descreveram histologicamente a presenca de uma pneumonite intersticial, caracterizada por espessamento difuso dos septos alveolares e intenso infiltrado celular. Posteriormente a doenca inflamatoria intersticial foi confirmada atraves da realizacao de exames de imagem. Objetivos : Descrever a sintomatologia respiratoria e determinar a frequencia de alteracoes espirometricas em pacientes portadores de leishmaniose visceral. Material e  Metodos: Realizou-se avaliacao clinica, radiografia de torax e espirometria em pacientes internados com diagnostico de LV no Hospital Universitario em Aracaju-SE-Brasil entre julho de 2013 e julho de 2018. Resultados: A amostra consistiu de 39 pacientes. Houve predominância do sexo masculino e a idade media dos participantes foi de 28,2 anos. Sintomas respiratorios foram observados em 35,9% dos participantes, sendo a tosse o mais frequente, seguido de taquipneia e hemoptise. Alteracoes a radiografia de torax foram vistas em quatro pacientes. Ja a espirometria esteve alterada em mais da metade dos pacientes. O padrao ventilatorio restritivo foi o mais encontrado e o obstrutivo foi o menos encontrado. A presenca de alteracao da funcao respiratoria nao foi relacionada com sintomas respiratorios, febre, palidez e hepatomegalia. Conclusoes: A alta frequencia de alteracoes espirometricas revela o comprometimento funcional pulmonar na leishmaniose visceral, independente da presenca de sintomas e de complicacoes infecciosas pulmonares. O tempo relativamente grande durante a investigacao, entre o inicio dos sintomas e a admissao hospitalar, possibilitaria evolucao fisiopatologica e consequentemente, favoreceria a presenca de disturbio ventilatorio. Tambem e conhecido que doenca inflamatoria pode resultar em disturbio ventilatorio funcional, particularmente restritivo. A falta de associacao entre sintomas respiratorios e alteracoes espirometricas demonstra que a avaliacao da funcao pulmonar nao deve ser retardada em casos assintomaticos. Introduction : Visceral leishmaniasis(VL) is a severe zoonosis characterized by systemic involvement and high mortality. Depending on the host immune response, the clinical presentation of the disease includes the asymptomatic, oligosymptomatic and classic forms, the latter being characterized by fever, splenomegaly, anemia, hepatomegaly, asthenia and dry cough. Lung involvement in visceral leishmaniasis is poorly understood and is commonly associated with infectious complications of the disease and important cause of death. Spirometry is the best test of lung function with respect to cost-benefit analysis and can be the first to identify the presence of lung disease. Spirometry testing provides objective data to studies on lung dysfunction and, together with the results of clinical evaluation, can clarify the respiratory repercussions of VL, thus contributing to the prevention of complications and minimizing the possible chronic effects of the disease. In past decades, the main lung alteration in individuals with leishmaniasis was determined to be interstitial pneumonitis, which is characterized by diffuse thickening of the alveolar septa and intense cell infiltration. Subsequently, the interstitial inflammatory disease was confirmed by imaging studies. Objectives : To describe respiratory symptoms and define the frequency of spirometric changes in patients with visceral leishmaniasis Material and Methods : To assess the respiratory compromise in visceral leishmaniasis, we analyzed the symptoms, chest radiography and spirometry results of inpatients diagnosed with this disease at the University Hospital in Aracaju-SE-Brazil between July 2013 and July 2018. Results : The sample comprised 39 patients. There was a predominance of males and the average age of participants was 28.2 years. Respiratory symptoms were observed in 35.9% of participants. The most frequent symptom was cough, followed by tachypnea and hemoptysis. Changes in chest radiography were reported in four patients. Spirometric alterations were detections in more than half of the patients. The restrictive ventilatory pattern was the most found and obstructive pattern was the least found. The presence of respiratory functional alterations was not associated with respiratory symptoms Conclusions : The high frequency of spirometric alterations demonstrates the incidence of lung function impairment in individuals with visceral leishmaniasis, even in the absence of pulmonary infectious complications. Inflammation of the lower airways causes alveolar disarrangement and progression to interstitial fibrosis, distortion of the lung parenchyma and loss of alveolar-capillary units, with consequent impairment of lung function. This pathophysiological sequence might account for higher frequency of ventilatory alterations if there is no early diagnosis. Inflammatory lung disease can lead to functional ventilatory disorders, particularly restrictive ventilatory disoders. The lack of an association between respiratory symptoms and spirometric alterations demonstrates that the assessment of the lung function should not be delayed in asymptomatic cases.