[Legionnaires' disease and HIV infection: an opportunistic infection?].
OBJECTIVE
Legionella infections are not frequent in HIV-infected patients, although clinical manifestations and outcome are particularly severe in this subset. This manuscript analyzes the clinical features and immunological situation of HIV-infected patients with Legionnaires' disease (LD).


METHODS
The clinical files of HIV-infected patients diagnosed with LD from 1983 to December 2003 were reviewed. The incidence of hospital-acquired Legionella pneumonia (HALP) from 1997-2000 in HIV-infected patients was compared with that of non infected patients.


RESULTS
Eighteen patients were included. 72.2% were diagnosed by the Legionella urinary antigen assay. The incidence of HALP in HIV-infected and non infected patients was 0.3 and 0.25/1000 admissions/year, respectively (p = 0.42). 83.3% received appropriate antibiotic treatment at the Emergency department. The mean lymphocyte CD4 count was 348.1/microl, 53.8% had an undetectable viral load and 64.7% were on antiretroviral therapy. 72.2% were smokers, 38.8% had cancer and 16.7% were on chemotherapy. 93.8% had cough, 75% dyspnea, 62.5% extrarespiratory symptoms, 76.5% increased AST, 50% increased CK and 56.3% hyponatremia. Moreover, 50% developed bilateral pulmonary infiltrates, 83.3% respiratory failure and 22.2% died.


CONCLUSIONS
Although LD is not more frequent in HIV-infected than in non infected patients, its clinical severity suggests that it is an opportunistic infection.
Pedro-Botet
María Luisa
ML
Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain. mlpbotet@ns.hugtip.scs.es
García Cruz
Arantxa
A
Sopena
Nieves
N
Domínguez
María Jesús
MJ
Sarroca
Odile
O
Rey Joly
Celestino
C
Sabrià
Miquel
M
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000276:immunology; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D015704:CD4 Antigens / Q000276:immunology; D015897:Comorbidity; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000276:immunology; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007877:Legionnaires' Disease / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D008297:Male; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D015704:CD4 Antigens; D015662:Trimethoprim, Sulfamethoxazole Drug Combination