Pneumococcal pneumonia: clinical features, diagnosis and  management in HIV-infected and HIV noninfected patients.
OBJECTIVE
In this review, we focus on the clinical features, diagnosis and management of pneumococcal pneumonia in HIV-infected and noninfected patients, with particular attention to the most recent advances in this area.


RESULTS
Classical clinical features are found in young adults, whereas atypical forms occur in immunocompromised patients including HIV-infected individuals. Bacteremic pneumococcal pneumonia is more frequently observed in HIV-infected and also in low-risk patients, according to the Pneumonia Severity Index (PSI). Pneumococcal pneumonia diagnostic process includes physical examination, radiologic findings and microbiologic diagnosis. However, etiologic diagnosis using traditional culture methods is difficult to obtain. In this setting, urinary antigen test, which recognizes Streptococcus pneumoniae cell wall C-polysaccharide, increases the probability of etiologic diagnosis. A correct management approach is crucial in reducing pneumococcal pneumonia mortality. The use of the PSI helps clinicians in deciding between inpatient and outpatient management in immunocompetent individuals, according to Infectious Diseases Society of America (IDSA)-American Thoracic Society (ATS) guidelines. Recent findings support PSI utility also in HIV-infected patients. Recently, efficacy of pneumococcal vaccine in reducing pneumococcal disease incidence has been evidenced in both HIV-infected and noninfected individuals.


CONCLUSIONS
Rapid diagnosis and correct management together with implementation of preventive measures are crucial in order to reduce pneumococcal pneumonia related incidence and mortality in HIV-infected and noninfected patients.
Madeddu
Giordano
G
Department of Infectious Diseases, University of Sassari, Sassari, Italy. giordano.madeddu@uniss.it
Fois
Alessandro Giuseppe
AG
Pirina
Pietro
P
Mura
Maria Stella
MS
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications; D006801:Humans; D022242:Pneumococcal Vaccines / Q000627:therapeutic use; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D013296:Streptococcus pneumoniae / Q000472:pathogenicity
D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines