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pulmonary infiltrate in patients with AIDS
Etiology: AIDS
Epidemiology:
- almost 50% of patients with AIDS initially present with pulmonary disease
Laboratory:
1) induced sputum samples for
- Pneumocystis jirovecii (P carinii)
- Mycobacteria
- fungi
- bacteria
2) fiberoptic bronchoscopy
- bronchoalveolar lavage (BAL)
- transbronchial biopsy
3) open lung biopsy in patients in whom
- BAL is negative
- transbronchial biopsy is contraindicated
4) chest radiographs
- Pneumocystis jirovecii
- diffuse interstitial or alveolar infiltrates
- upper lobe infiltrates in patients receiving aerosolized pentamidine
5) arterial blood gas exchange abnormalities
Differential diagnosis:
1) opportunistic infections (majority of cases)
a) Pneumocystis jirovecii is the most common pulmonary infection in patients with AIDS
1] prophylaxis has reduced incidence
2] non-productive cough
3] dyspnea
b) Mycobacterium avium intracellulare (MAI)
c) cytomegalovirus (CMV)
d) Cryptococcus neoformans
e) Histoplasma capsulatum
f) Toxoplasma gondii
g) Coccidioides immitis
h) Blastomyces dermatitidis
i) Herpes simplex virus
2) non-opportunistic infections
a) Streptococcus pneumonia
b) Haemophilus influenzae
c) Mycobacterium tuberculosis
- non-cavitary infiltrates
- mediastinal & hilar adenopathy
3) neoplasms
q) Kaposi's sarcoma
b) non-Hodgkin's lymphoma
4) lymphocytic & non-specific interstitial pneumonitis
5) IV drug abuse may produce similar abnormalities
Management:
1) Empiric therapy for Pneumocystis pneumonia (PCP)
2) Glucocorticoids for PCP with paO2 < 75 mm Hg on RA
3) Specific therapy for documented
a) Pneumocystis jirovecii
b) fungus
b) bacteria
d) Mycobacterium tuberculosis
e) Mycobacterium avium intracellulare (MAI) may be resistant to therapy
f) radiotherapy for symptomatic airway obstruction or hemoptysis secondary to neoplasm.
Related
Acquired Immuno-Deficiency Syndrome (HIV infection stage 3, AIDS)
HIV1 infection; human immunodeficiency virus-1 infection
General
pulmonary infiltrate in immunocompromised host
References
Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 250