The prognosis in HIV-infected patients with pneumonia. Relation to microbiological diagnoses.
Ninety consecutive first-time fiberoptic bronchoscopies (FB) were performed on HIV-infected patients with pulmonary symptoms and radiographic evidence of active pneumonitis. Microbiological data were analysed for acute and long-term prognostic significance. 56/90 (63%) patients had one type of microbiological agent recovered from FB, 22/90 (24%) patients had more types recovered, and 12/90 (13%) patients had no types recovered. Nine patients (10%) died during the acute episode of pneumonia. A prognostic factor of a fatal outcome of the acute episode of pneumonia was concurrent multiple pulmonary infections (p = 0.002), mainly ascribed to patients with Pneumocystis carinii pneumonia (PCP) and concomitant bacterial pneumonia (p = 0.003). Specific microbiological findings at FB did not influence long-term survival of patients, and, when omitting patients who died during the acute episode of pneumonia (n = 9), no difference in survival was observed between patients with a) no agent, b) one type of agent or c) more types of agents recovered from FB. Only non-pulmonary parameters such as CD4-count, haemoglobin and age were found to be prognostic parameters. Thus, increased attention should be paid to co-pathogens presenting in HIV-infected patients with pulmonary infection and appropriate therapy instituted.
Jensen
B N
BN
Department of Infectious Diseases, Rigshospitalet, Copenhagen.
Gerstoft
J
J
Skinhøj
P
P
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D003457:Cryptosporidiosis / Q000209:etiology; D003586:Cytomegalovirus Infections / Q000209:etiology; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010419:Pentamidine / Q000627:therapeutic use; D011014:Pneumonia / Q000209:etiology / Q000382:microbiology*; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000209:etiology; D012307:Risk Factors; D016019:Survival Analysis; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D010419:Pentamidine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D015774:Ganciclovir