Legionnaires disease and HIV infection.
OBJECTIVE
To compare the outcome of Legionnaires disease (LD) in patients with and without HIV infection.


METHODS
Retrospective review of clinical charts.


METHODS
Six hundred-bed university hospital.


METHODS
We studied the clinical findings of 64 patients without HIV and 15 patients with HIV. Patients with a serologic diagnosis only were not included. Patients with previous immunosuppressive therapy or transplant recipients were excluded from the former group. In the HIV group, the mean CD4 cell count was 347.5/ microL, plasma viral load was undetectable in 50% of the patients, and only one patient (7%) was receiving cotrimoxazole as prophylaxis against Pneumocystis carinii at the time of pneumonia. No differences were observed in the two groups with respect to community or nosocomial acquisition, delay in the initiation of appropriate treatment, the use of macrolides or fluoroquinolones, and Fine score in cases of community-acquired LD.


RESULTS
Univariate analysis showed that time to apyrexia was longer, and respiratory symptoms, bilateral infiltrates in chest radiograph, hyponatremia, increase in aspartate aminotransferase and creatine phosphokinase (CK), and respiratory failure were more frequent in the HIV group. Mortality was greater in patients with HIV, achieving a statistically significant value of 20%; however, multivariate analysis only confirmed these differences with respect to the increase in CK.


CONCLUSIONS
LD has a more severe clinical presentation and worse evolution in patients with HIV.
Pedro-Botet
Maria Luisa
ML
Infectious Disease Unit, University Hospital Germans Trias i Pujol, Universitat Autònoma, Badalona, Spain. mlpbotet@ns.hugtip.scs.es
Sabrià
Miquel
M
Sopena
Nieves
N
García-Núñez
Marian
M
Dominguez
María Jesús
MJ
Reynaga
Esteban
E
Rey-Joly
Celestino
C
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007877:Legionnaires' Disease / Q000150:complications / Q000401:mortality; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D019562:Viral Load
D015662:Trimethoprim, Sulfamethoxazole Drug Combination