[Pneumopathies caused by Streptococcus pneumoniae in 27 HIV infected patients].
OBJECTIVE
Determine the clinical features and outcome of acute pneumonia due to Streptococcus pneumoniae in HIV infected patients compared with non-HIV infected patients.


METHODS
From January 1986 to February 1992, we observed 33 episodes of pneumococcal pneumonia in 27 HIV-infected patients. Most of the patients were drug addicts (16/27), and/or originated from Central Africa or Haiti (10/27). In 9/27 (33%) patients, HIV infection was previously unknown. Eleven of the 27 patients were at the CDC stages II-III and CD4 cell count was greater than 200/mm3 and CD8 cell count was greater than 1000/mm3 in 12/23 patients and 10/20 patients respectively.


RESULTS
In 10/33 episodes, respiratory symptoms were severe: bilateral pneumonia (n = 2) and/or hypoxaemia (n = 9). In 22/33 episodes, hospitalization occurred less than 24 h after the onset of symptoms and in 9/33 episodes, the initial chest X-ray was normal. Streptococcus pneumoniae was isolated in 16/33 episodes, from blood (n = 10), bronchoalveolar lavage (n = 3) or sputum (n = 3). Penicillin G or amoxicillin was used and allowed a favorable and quick response in all episodes. Recurrence occurred in 5/18 (27%) followed patients. These recurrences were not favoured by a low CD4 cell count since it was more than 200/mm3 in these five patients. However, the mean count of CD8 cells was higher in patients with recurrence than in patients without recurrence, 1990/mm3 versus 995/mm3 (p = 0.03).


CONCLUSIONS
CD8 hyperlymphocytosis could increase the risk of recurrence and would help identify a subgroup with higher risk of pneumococcal pneumonia among HIV infected persons.
Duval
X
X
Service des Maladies infectieuses et tropicales, Hôpital Bichat-Claude Bernard, Paris.
Paty
M C
MC
Longuet
P
P
Lacassin
F
F
Perronne
C
C
Leport
C
C
Vildé
J L
JL
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000188:drug therapy; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000293:Adolescent; D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000008:administration & dosage / Q000627:therapeutic use; D011018:Pneumonia, Pneumococcal / Q000150:complications* / Q000188:drug therapy; D012008:Recurrence; D012189:Retrospective Studies
D000658:Amoxicillin; D010400:Penicillin G
Pneumopathies dues à Streptococcus pneumoniae chez 27 malades infectés par le VIH.