Other HIV-Associated Pneumonias

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Key points

  • The lung is commonly involved with infectious complications in individuals infected with human immunodeficiency virus (HIV).

  • In addition to Pneumocystis pneumonia discussed in another article in this issue, pulmonary infections in individuals infected with HIV can be related to nontuberculosis mycobacteria, cytomegalovirus, fungi, parasites, uncommon bacterial pneumonia, and other microorganisms.

  • A high index of suspicion is needed, and awareness that the clinical presentation and treatment of

The Organisms

Nontuberculous mycobacteria (NTM) can be isolated from water and soil. Unlike M tuberculosis, there are no known latent NTM infections. The mode of transmission of NTM is from recent acquisition through inhalation and ingestion. No isolation is required for patients hospitalized with pneumonia from NTM because there have been no documented cases of person-to-person transmission. Given that these organisms are ubiquitous in the environment, a positive respiratory sample culture must be

Organisms

Medically important fungi that cause pulmonary infections in patients infected with HIV are categorized into 3 different groups in this review: Aspergillus species, Cryptococcus neoformans, and dimorphic fungi.

Aspergillus species are ubiquitous hyaline molds that can be isolated from air and soil. A fumigatus is the most common species that causes infections in patients infected with HIV.36, 37 Other common species include A flavus, A niger, A terreus, and A nidulans. The mode of pulmonary

Organisms

This review focuses only on cytomegalovirus (CMV) pneumonitis although other respiratory viruses such as influenza virus, parainfluenza virus, respiratory syncytial virus, adenovirus, and metapneumovius can also cause pneumonia in patients infected with HIV. CMV and herpes simplex virus (HSV) cause pneumonitis relatively rarely in patients infected with HIV.

Human CMV or Human herpesvirus 5 (HHV-5) is a double-stranded DNA virus that commonly infects most individuals early in life, and

Organisms

Uncommon bacteria that can cause pulmonary infection in patients infected with HIV with a low CD4 cell count are discussed in this section, focusing on bacteria in the genera Nocardia and Rhodococcus. These organisms belong to the same family, Nocardiaceae. Bacteria in the genus Nocardia are gram-positive with partially acid-fast beading branching filaments, which can be isolated in soil worldwide. The most common species causing pulmonary infection is N asteroids, whereas N brasiliensis is the

Organisms

Parasitic pneumonia is uncommon in patients infected with HIV. However, pulmonary infection from Toxoplasma gondii is more common compared with MAC, CMV, and HSV infections. Other parasites that have reportedly been implicated as causative agents for pneumonia in this population are cryptosporidia and microsporidia.102, 103, 104, 105, 106, 107, 108, 109 This review focuses on pulmonary toxoplasmosis.

Cats are the definitive hosts for T gondii. The routes of transmission to human are through

Summary

The differential diagnosis of pneumonia in patients infected with HIV is broad. The clinical manifestations of pulmonary infections in this population are nonspecific. Radiographic findings are varied and nonpathognomonic for any particular organism and may overlap with noninfectious pulmonary diseases. Given the disseminated nature of many of these infections, the findings of diffuse bilateral interstitial infiltrates or ground-grass opacities are characteristic radiographic features of many

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    Disclosures: The authors have no financial, institutional, or other relevant relationships that would constitute a potential conflict of interest with this review.

    Supported by: NIH-R01-HL-62150 to AHL, and funds from the Mayo Foundation.

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