title: Dual pulmonary infection with Mycobacterium tuberculosis and Pneumocystis carinii in patients infected with human immunodeficiency virus.
abstract: During a 22-month period, we identified 39 patients with human immunodeficiency virus (HIV) infection (mean CD4(+) count, 90 cells/mm(3)) who were hospitalized with pneumonia and who had sputum and/or other specimens that tested concurrently positive for both Mycobacterium tuberculosis and Pneumocystis carinii. The most common chest x-ray abnormality was a reticulonodular pattern or bilateral infiltrates (n=26). Serum lactate dehydrogenase levels were elevated in 17 (85%) of 20 of patients tested (mean value, 2208 U/L). Mean O(2) saturation and PO(2) were 89% and 64 mm Hg, respectively. A majority (24 patients [62%]) received both antituberculous and anti-PCP therapy (17 with steroids), and 22 improved. All ten patients who received no treatment for PCP improved and were discharged from the hospital, whereas 4 (80%) of the 5 persons who received no antituberculous treatment had a poor outcome (P<.001; OR=43). Patients with HIV or acquired immune deficiency syndrome may present with both TB and PCP; of the 2, TB seems to account for the most severe features of disease.
authors.affiliation: Sizwe Tropical Diseases Hospital, University of the Witwatersrand/South African Institute for Medical Research, Johannesburg, South Africa.
authors.forename: D
authors.initials: D
authors.lastname: Orlovic
authors.forename: R
authors.initials: R
authors.lastname: Kularatne
authors.forename: V
authors.initials: V
authors.lastname: Ferraz
authors.forename: R A
authors.initials: RA
authors.lastname: Smego
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D015337:Multicenter Studies as Topic; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011010:Pneumocystis / Q000302:isolation & purification; D011020:Pneumonia, Pneumocystis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents; D007770:L-Lactate Dehydrogenase