title: HIV-related pneumococcal lung disease: does highly active antiretroviral therapy or bacteremia modify radiologic appearance?
abstract: We reviewed chest radiographs of 57 HIV-infected patients with pulmonary diseases in whom Streptococcus pneumoniae was the sole respiratory pathogen isolated to evaluate whether highly active antiretroviral therapy (HAART) or bacteremia modify radiographic appearance. Pneumococcal lung disease presented as lobar pneumonia in 40% of the cases, 54% of whom were on HAART; as bronchopneumonia in 42%, 58% on HAART; as interstitial infiltrates in 17%, 60% on HAART. Bacteremia was observed 38 times in 23 patients with CD4 less than 200/mm(3), and in 15 with CD4 greater than 200/mm(3) (p > 0.05). HAART does not significantly influences radiographic appearances of lung disease caused by Streptococcus pneumoniae (p > 0.05). Immunosuppression induced by HIV infection was a major risk factor for development of pneumococcal lung disease (p = 0.04) and influences radiographic appearance; bronchopneumonia (p = 0.006), in particular multifocal (p = 0.008), which was more frequent in subjects with CD4 less than 200/mm(3). Bacteremia influences radiographic appearance of pneumococcal lung disease; lobar pneumonia was more frequent (p = 0.003), and considering CD4 cell count, was more frequent if CD4 cell count was above 200/mm(3). An original finding of this study was the frequency of interstitial changes. This pattern of pneumonia, found in 17% of our patients, could represent a difference between HIV-seropositive and -seronegative subject in displaying pneumococcal lung disease.
authors.affiliation: Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy. radiologia@inmi.it
authors.forename: Elisa Busi
authors.initials: EB
authors.lastname: Rizzi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Schininá
authors.forename: Laura
authors.initials: L
authors.lastname: Rovighi
authors.forename: Massimo
authors.initials: M
authors.lastname: Cristofaro
authors.forename: Eugenio
authors.initials: E
authors.lastname: Bordi
authors.forename: Pasquale
authors.initials: P
authors.lastname: Narciso
authors.forename: Corrado
authors.initials: C
authors.lastname: Bibbolino
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D000328:Adult; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D001996:Bronchopneumonia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D011336:Probability; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis