AIDS AND THE LUNG
Section snippets
PNEUMOCYSTIS CARINII PNEUMONIA
Chagas17 originally described P. carinii as a trypanosome in the lungs in 1909. The Delanoes reclassified P. carinii as a separate species of protozoan in 1912, and it was first recognized as a human pathogen in 1957. PCP remained an uncommon infection until 1981, when its occurrence in homosexual men and injection drug users heralded the beginning of the AIDS epidemic.37,59 Today, PCP remains the most common AIDS-defining opportunistic infection in the United States, but its relative frequency
BACTERIAL PNEUMONIA
Bacterial infections are common in HIV-infected persons. HIV-infected persons are especially susceptible to infections by the encapsulated bacteria, Streptococcus pneumoniae and Haemophilus influenzae. Pneumonia caused by Pseudornonas aeruginosa appears to be increasing in frequency.
OBSTRUCTIVE LUNG DISEASES AND HUMAN IMMUNODEFICIENCY VIRUS
The initial focus in the evaluation of respiratory symptoms in an HIV-infected person is placed on prompt diagnosis of a possible pulmonary infection. HIV-infected persons, however, are also susceptible to a wide variety of noninfectious pulmonary conditions. Respiratory symptoms often are secondary to one of the obstructive lung diseases. This section reviews the current understanding of the obstructive lung diseases and HIV infection.
SUMMARY
Respiratory symptoms are common in HIV-infected persons. The challenge facing clinicians is to determine whether these respiratory symptoms are due to an opportunistic infection or to a chronic process, such as asthma, chronic bronchitis, bronchiectasis, or emphysema. This article reviewed the clinical presentation, diagnosis, and treatment of two important opportunistic infections, PCP and bacterial pneumonia. It also reviewed the current data on obstructive lung diseases as they relate to HIV.
References (114)
- et al.
Roentgenographic patterns of Pneumo-cystis carinii pneumonia in 104 patients with AIDS
Chest
(1987) - et al.
Prognostic indicators in the initial presentation of Pneumocystis carinii pneumonia
Chest
(1989) - et al.
Bronchoalveolar lavage as the exclusive diagnostic modality for Pneumocystis carinii pneumonia: A prospective study among patients with acquired immunodeficiency syndrome
Chest
(1986) - et al.
Bullous pulmonary damage in users of intravenous drugs
Chest
(1986) - et al.
Pulmonary involvement in the acquired immunodeficiency syndrome
Chest
(1985) - et al.
Serum lactate dehydrogenase activity in patients with AIDS and Pneumocystis carinii pneumonia: An adjunct to diagnosis
Chest
(1988) - et al.
High incidence of bronchospasm with regular administration of aerosolized pentamidine
Chest
(1992) - et al.
Diagnostic utility of lactate dehydrogenase levels in patients receiving aerosolized pentamidine
Chest
(1993) - et al.
Bronchial reactivity to methacholine in HIV-infected individuals without AIDS
Chest
(1993) - et al.
High resolution computed tomography of Pneumo-cystis carinii pneumonia in AIDS
Clin Radiol
(1990)
Diagnosis of Pneurnocystis carinii pneumonia by induced sputum in a city with moderate incidence of AIDS
Chest
Pulmonary complications of intravenous drug abuse: Experience at an inner-city hospital
Chest
Pulmonary complications associated with illicit drug use: An update
Chest
Abnormal airway function in individuals with the acquired immunodeficiency syndrome
Chest
Alteration of pulmonary function in intrave-nous drug abusers: Prevalence, severity, and characterization of gas exchange abnormalities
Am J Med
Aerosol pentamidine-induced bronchocon-striction: Predictive factors and preventive therapy
Chest
Serum lactate dehydrogenase (LDH) in Pneumocystis carinii pneumo- nia, tuberculosis, and bacterial pneumonia
Chest
Bronchopulmonary infection with Pseudomonas aeruginosa in patients infected with human immunodeficiency virus
Genitourin Med
Trimetrexate for the treatment of Pneumo-cystis carinii pneumonia in patients with the acquired immunodeficiency syndrome
N Engl J Med
Chronic bronchitis, asthma, and pulmonary emphysema: A statement by the Committee on Diagnostic Standards for Nontuberculous Respiratory Diseases
Am Rev Respir Dis
Time-related decrease in diffusion capacity in HIV-infected patients with impaired immune function
Scand J Infect Dis
Pseudomonas aeruginosa bronchopulmonary infection in late human immunodeficiency virus disease
Am Rev Respir Dis
Pneumocystis carinii pneumonia: CT and HRCT observations
J Comput Assist Tomogr
The usefulness of induced sputum in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunode-ficiency syndrome
Am Rev Respir Dis
Clindamycin and primaquine as primary treatment for mild and moderately severe Pneumocystis carinii pneumonia in patients with AIDS
Eur J Clin Microbiol Infect Dis
Clindamycin and primaquine therapy for mild-to-moderate episodes of Pneumocystis carinii pneumonia in patients with AIDS: AIDS Clinical Trials Group 044
Clin Infect Dis
A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome
N Engl J Med
Bronchoalveolar lavage and transbronchial biopsy for the diagnosis of pulmonary infections in the acquired immunodeficiency syndrome
Ann Intern Med
Microbiology of community-acquired bacterial pneumonia in persons with and at risk for human immunodeficiency virus type 1 infection: Implications for rational empiric antibiotic therapy
Arch Intern Med
Pulmonary function tests in HIV-infected patients
AIDS
Recommendations for prophylaxis against Pneumocystis carinii pneumonia for adults and adolescents infected with human immunodeficiency virus
MMWR
1993 revised classification system for HIV infection and expanded case definition for AIDS among adolescents and adults
JAMA
Novo trypanomaiazaia human
Mem Inst Oswaldo Cruz
Correlation between serial pulmonary function tests and fiberoptic bronchoscopy in patients with Pneumocystis carinii pneumonia and the acquired immune deficiency syndrome
Am Rev Respit Dis
Airways effects of aerosolized pentamidine isethionate
Am Rev Respir Dis
Bacterial pneumonia in HIV-infected patients
Semin Respir Infect
Emphysema-like pulmonary disease associated with human immunodeficiency virus infection
Ann Intern Med
Oral atovaquone compared with intrave-nous pentamidine for Pneurnocystis carinii pneumonia in patients with AIDS: Atova-quone Study Group
Ann Intern Med
Clinical manifestations and risk factors of Pseudomonas aeruginosa infection in patients with AIDS
J Infect Dis
A preliminary evaluation of 566C80 for the treatment of Pneumocystis pneumonia in patients with the acquired immunodeficiency syndrome
N Engl J Med
Serious Pseudornonas aeruginosa infections in patients infected with human immunodeficiency virus: A case-control study
Clin Infect Dis
A randomized controlled trial of a reduced daily dose of zidovudine in patients with the acquired immunodeficiency syndrome: AIDS Clinical Trials Group
N Engl J Med
Pseudomonas infections in patients with AIDS and AIDS-related complex
J Intern Med
Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome
N Engl J Med
The effectiveness of bronchoscopy in the diagnosis of Pneumocystis carinii and cytomegalovirus pulmonary infections in acquired immu-nodeficiency syndrome
Arch Pathol Lab Med
Pneumocystis carinii pneumonia in homosexual men
AJR Am J Roentgenol
Pneumococcal pneumonia in adult hospitalized patients infected with the human immunodeficiency virus
Arch Intern Med
Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: Evidence of a new acquired cellular immunodeficiency
N Engl J Med
Cited by (38)
Evaluation of Respiratory Disease
2013, Clinics in Chest MedicineCitation Excerpt :However, the character and duration of these symptoms may be useful to guide clinicians toward a particular diagnosis. For example, most patients with bacterial bronchitis or pneumonia present with cough productive of purulent sputum, whereas most patients with PCP have a dry, nonproductive cough.1 Bacterial pneumonias caused by S pneumoniae and Haemophilus spp characteristically present abruptly with patients reporting 3 to 5 days of symptoms; however, PCP often presents with an insidious onset with patients noting 2 to 4 weeks of symptoms.2
Pneumocystis pneumonia
2012, Sande's HIV/AIDS Medicine: Medical Management of AIDS 2013Respiratory Emergencies in HIV-Infected Persons
2010, Emergency Medicine Clinics of North AmericaCitation Excerpt :Certain symptoms may lead a clinician to favor a particular diagnosis (Table 1). Purulent sputum is typically associated with bacterial pneumonia, whereas a dry, nonproductive cough is typically associated with PCP.8 The duration of symptoms can also be useful in differentiating between pneumonias.
Pneumocystis Pneumonia
2008, Global HIV/AIDS MedicineAnterior Segment and External Ocular Disorders Associated with Human Immunodeficiency Virus Disease
2007, Survey of OphthalmologyCitation Excerpt :The patient had no evidence of systemic P. carinii infection. P. carinii infections are treated with trimethoprim-sulfamethoxazole (orally or intravenously), clindamycin/primaquine (orally or intravenously), atovaquone (orally), or pentamidine isethionate (intravenously).241 Microsporidia are spore-forming, obligate intracellular, protozoan parasites.132,567
Pneumocystis Pneumonia
2007, Global HIV/AIDS Medicine
Address reprint requests to Laurence Huang, MD Division of Pulmonary and Critical Care Medicine Room 5K1 San Francisco General Hospital 1001 Potrero Avenue San Francisco, CA 94110