title: Opportunistic infections in patients with pulmonary alveolar proteinosis.
abstract: OBJECTIVE
  To describe the demographics, clinical manifestations, treatment, and outcomes of patients with pulmonary alveolar proteinosis (PAP) who developed an opportunistic infection with Nocardia spp., mycobacteria or fungal pathogens.
  
  
  METHODS
  A case of PAP and Nocardia spp. brain abscess is described. A comprehensive review of the English-language literature was conducted to identify all reported cases of PAP and opportunistic infections between 1950 and July, 2010.
  
  
  RESULTS
  Seventy five cases were reviewed. Thirty two patients (43%) had nocardial infection, 28 (37%) mycobacterial infection, and 15 (20%) fungal infection. Thirty nine patients (65%) were male. Seventeen patients (23%) were immunosuppressed. Twenty patients (27%) were active smokers. PAP was the initial diagnosis in 19 patients (33%), while infection presented first in 23 patients (40%); 16 patients (27%) had a concurrent diagnosis of PAP and infection. The average interval between PAP diagnosis and an opportunistic infection was 16 months. Lungs were the most common site of infection; extra-pulmonary infection was present in 27 patients (32%). Thirty nine patients (57%) survived through the follow-up period, while 31 died.
  
  
  CONCLUSIONS
  Opportunistic infections can either precede or follow a diagnosis of PAP. PAP should be considered in apparently immunocompetent patients who present with an opportunistic infection and diffuse alveolar infiltrates.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA.
authors.forename: Ankit D
authors.initials: AD
authors.lastname: Punatar
authors.forename: Shimon
authors.initials: S
authors.lastname: Kusne
authors.forename: Janis E
authors.initials: JE
authors.lastname: Blair
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Seville
authors.forename: Holenarasipur R
authors.initials: HR
authors.lastname: Vikram
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D001922:Brain Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D009617:Nocardia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D009894:Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D011649:Pulmonary Alveolar Proteinosis / Q000150:complications*; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents