title: Prognosis and clinical evaluation of infection caused by Rhodococcus equi in HIV-infected patients: a multicenter study of 67 cases.
abstract: OBJECTIVE
  To assess the clinical characteristics and the factors that influenced the prognosis of patients with HIV and infection caused by Rhodococcus equi.
  
  
  METHODS
  Observational, multicenter study in 29 Spanish general hospitals.
  
  
  METHODS
  These hospitals comprised a total of 20,250 beds for acute patients and served a population of 9,716,880 inhabitants.
  
  
  METHODS
  All patients with HIV and diagnosed R equi infection until September 1998.
  
  
  RESULTS
  During the study period, 19,374 cases of AIDS were diagnosed. Sixty-seven patients were included (55 male patients; mean +/- SD age, 31.7 +/- 5.8 years). At the time of diagnosis of R equi infection, the mean CD4+ lymphocyte count was 35/ micro L (range, 1 to 183/ micro L) and the stage of HIV infection was A3 in 10.4% of patients, B3 in 31.3%, C3 in 56.7%, and unknown in 1.5%. R equi was most commonly isolated in sputum (52.2%), blood cultures (50.7%), and samples from bronchoscopy (31.3%). Chest radiographic findings were abnormal in 65 patients (97%). Infiltrates were observed in all of them, with cavitations in 45 patients. The most active antibiotics against the strains isolated were vancomycin, amikacin, rifampicin, imipenem, ciprofloxacin, and erythromycin. After a mean follow-up of 10.7 +/- 12.8 months, 23 patients (34.3%) died due to causes related to R equi infection and 6 other patients showed evidence of progression of the infection. The absence of highly active antiretroviral therapy (HAART) was independently associated with mortality related to R equi infection (relative risk, 53.4; 95% confidence interval, 1.7 to 1,699). Survival of patients treated with HAART was much higher than that of patients who did not receive this therapy.
  
  
  CONCLUSIONS
  Infection by R equi is an infrequent, opportunistic complication of HIV infection and occurs during advanced stages of immunodepression. In these patients, it leads to a severe illness that usually causes a bacteremic, cavitary pneumonia, although HAART can improve the prognosis.
authors.affiliation: hospital Punta de Europa, Algeciras, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Torres-Tortosa
authors.forename: Julio
authors.initials: J
authors.lastname: Arrizabalaga
authors.forename: José L
authors.initials: JL
authors.lastname: Villanueva
authors.forename: Juan
authors.initials: J
authors.lastname: Gálvez
authors.forename: María
authors.initials: M
authors.lastname: Leyes
authors.forename: M Eulalia
authors.initials: ME
authors.lastname: Valencia
authors.forename: Juan
authors.initials: J
authors.lastname: Flores
authors.forename: José M
authors.initials: JM
authors.lastname: Peña
authors.forename: Elisa
authors.initials: E
authors.lastname: Pérez-Cecilia
authors.forename: Carmen
authors.initials: C
authors.lastname: Quereda
mesh_terms: D000193:Actinomycetales Infections / Q000188:drug therapy / Q000401:mortality*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000401:mortality*; D011379:Prognosis; D016929:Rhodococcus equi / Q000302:isolation & purification