Community-acquired Pseudomonas aeruginosa pneumonia in patients with HIV infection.
OBJECTIVE
To describe the clinical and radiographic presentation, risk factors, response to therapy and outcome of 16 patients with HIV infection and pulmonary infections caused by Pseudomonas aeruginosa.


METHODS
Retrospective review of medical records.


METHODS
An academic tertiary-care hospital.


METHODS
Sixteen patients who met the case definition were included for retrospective review.


RESULTS
P. aeruginosa pneumonia was community-acquired in 15 patients (94%). The majority of patients (94%) had a diagnosis of AIDS with a mean CD4 cell count of 27 x 10(6)/l cells. Traditional risk factors for the development of P. aeruginosa were missing in most patients. Cavitary infiltrates were present on admission chest radiograph in eight patients (50%). An additional three patients (19%) presented with pulmonary infiltrates that cavitated subsequently. Clinical course was extremely varied with an in-hospital mortality of only 19%, but with an additional 25% of patients developing chronic or recurrent disease.


CONCLUSIONS
Community-acquired pneumonia caused by P. aeruginosa occurs in patients with end-stage HIV infection. The presence of cavitary pulmonary infiltrates on chest radiograph in a patient with a low CD4 count should raise suspicion of P. aeruginosa infection. Obvious risk factors for P. aeruginosa infection may be absent. While the initial mortality rate is lower than that observed in other immunocompromised hosts, the potential for chronic or recurrent infection should be recognized and patients should be followed closely.
Schuster
M G
MG
Division of Infectious Diseases, University of Pennsylvania Medical Center, Philadelphia.
Norris
A H
AH
D017088:AIDS-Related Opportunistic Infections / Q000503:physiopathology* / Q000628:therapy / Q000635:transmission; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D018410:Pneumonia, Bacterial / Q000503:physiopathology* / Q000628:therapy / Q000635:transmission; D011552:Pseudomonas Infections / Q000503:physiopathology* / Q000628:therapy / Q000635:transmission; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents