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Rodriguez-Barradas MC, McGinnis KA, Akgün K, Tate JP, Brown ST, Butt AA, Fine M, Goetz MB, Graber CJ, Huang L, Rimland D, Justice A, Crothers K. Validation for using electronic health records to identify community acquired pneumonia hospitalization among people with and without HIV. Pneumonia (Nathan) 2020; 12:6. [PMID: 32724760 PMCID: PMC7382068 DOI: 10.1186/s41479-020-00068-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 06/07/2020] [Indexed: 02/06/2023] Open
Abstract
Background Cohort studies identifying the incidence, complications and co-morbidities associated with community acquired pneumonia (CAP) are largely based on administrative datasets and rely on International Classification of Diseases (ICD) codes; however, the reliability of ICD codes for hospital admissions for CAP in people with HIV (PWH) has not been systematically assessed. Methods We used data from the Veterans Aging Cohort Study survey sample (N = 6824; 3410 PWH and 3414 uninfected) to validate the use of electronic health records (EHR) data to identify CAP hospitalizations when compared to chart review and to compare the performance in PWH vs. uninfected patients. We used different EHR algorithms that included a broad set of CAP ICD-9 codes, a set restricted to bacterial and viral CAP codes, and algorithms that included pharmacy data and/or other ICD-9 diagnoses frequently associated with CAP. We also compared microbiologic workup and etiologic diagnosis by HIV status among those with CAP. Results Five hundred forty-nine patients were identified as having an ICD-9 code compatible with a CAP diagnosis (13% of PWH and 4% of the uninfected, p < 0.01). The EHR algorithm with the best overall positive predictive value (82%) was obtained by using the restricted set of ICD-9 codes (480-487) in primary position or secondary only to selected codes as primary (HIV disease, respiratory failure, sepsis or bacteremia) with the addition of EHR pharmacy data; this algorithm yielded PPVs of 83% in PWH and 73% in uninfected (P = 0.1) groups. Adding aspiration pneumonia (ICD-9 code 507) to any of the ICD-9 code/pharmacy combinations increased the number of cases but decreased the overall PPV. Allowing COPD exacerbation in the primary position improved the PPV among the uninfected group only (to 76%). More PWH than uninfected patients underwent microbiologic evaluation or had respiratory samples submitted. Conclusions ICD-9 code-based algorithms perform similarly to identify CAP in PLWH and uninfected individuals. Adding antimicrobial use data and allowing as primary diagnoses ICD-9 codes frequently used in patients with CAP improved the performance of the algorithms in both groups of patients. The algorithms consistently performed better among PWH.
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Affiliation(s)
| | | | - Kathleen Akgün
- VA Connecticut Healthcare System, West Haven, CT USA.,Yale University, New Haven, CT USA
| | - Janet P Tate
- VA Connecticut Healthcare System, West Haven, CT USA.,Yale University, New Haven, CT USA
| | - Sheldon T Brown
- James J Peters VAMC, Bronx, NY USA.,Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Adeel A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, PA USA.,Weill Cornell Medical College, New York, NY USA.,Weill Cornell Medical College, Doha, Qatar
| | - Michael Fine
- VA Pittsburgh Healthcare System, Pittsburgh, PA USA
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System, and David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Christopher J Graber
- VA Greater Los Angeles Healthcare System, and David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Laurence Huang
- San Francisco General Hospital and University of California San Francisco, San Francisco, CA USA
| | - David Rimland
- VAMC and Emory University School of Medicine, Atlanta, GA USA
| | - Amy Justice
- VA Connecticut Healthcare System, West Haven, CT USA.,Yale University, New Haven, CT USA
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2
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Kc R, Adhikari S, Bastola A, Devkota L, Bhandari P, Ghimire P, Adhikari B, Rijal KR, Banjara MR, Ghimire P. Opportunistic Respiratory Infections in HIV Patients Attending Sukraraj Tropical and Infectious Diseases Hospital in Kathmandu, Nepal. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2019; 11:357-367. [PMID: 31920403 PMCID: PMC6939395 DOI: 10.2147/hiv.s229531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/14/2019] [Indexed: 12/19/2022]
Abstract
Introduction Opportunistic bacterial and fungal infections are the major cause of morbidity and mortality among immune suppressed HIV-positive patients. The main objective of this study was to determine bacterial and fungal organisms causing respiratory infections and their susceptibility to commonly prescribed antimicrobials among HIV patients attending a tertiary infectious disease hospital in Kathmandu. Methods Sputum samples were collected from the HIV-positive patients attending Sukraraj Tropical and Infectious Disease Hospital (STIDH) from August 2017 to March 2018. A total of 100 sputum samples were cultured on conventional bacterial and fungal culture media. Bacterial and fungal isolates were identified based on their colony characteristics, microscopic morphology and various biochemical tests. Antibiotic susceptibility test (AST) of bacterial isolates was performed by modified Kirby Bauer disc diffusion method. Results Out of 100 sputum samples cultured, 24% (n=24) showed bacterial growth, 42% (n=42) showed fungal growth and 10% (n=10) had both bacterial and fungal growth. Among bacteria, 91.6% (n=22) were monomicrobial and 8.4% (n=2) were polymicrobial in growth, of which, Klebsiella pneumoniae (37.5%) were predominant isolates, followed by Pseudomonas aeruginosa (29.2%), and Escherichia coli (16.7%). The antibiotic susceptibility test (AST) showed 68% (17/25) of bacterial isolates were multi-drug resistant (MDR) and among them 41.2% (7/17) were found to be extended spectrum β lactamase (ESBL) producers. Fungal growth was observed in 42% of samples (42/100). A total of six different species of Candida and four different genera of molds were identified. On species differentiation, Candida albicans (20%) were followed by Candida parapsilosis (4%), and Candida dubliniensis (3%); and various molds were Aspergillus fumigatus (4%), Aspergillus flavus (2%), and Penicillium species (5%). CD4 count was inversely associated with bacterial and fungal infections. Fifty percent of the patients with the fungal infections had a CD4 count below 200. No fungal organisms were isolated from HIV-positive patients under antifungal drug treatment. Conclusion HIV-positive patients with a CD4 count less than 200 cells/µL are more vulnerable to opportunistic infections of bacterial and fungal origin. Early isolation, identification and appropriate treatment can reduce mortality due to co-infections. Routine screening of opportunistic pathogens is critical to contain the disease progression.
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Affiliation(s)
- Rooku Kc
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Sadiksha Adhikari
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Anup Bastola
- Sukraraj Tropical and Infectious Diseases Hospital, Kathmandu, Nepal
| | - Lina Devkota
- Sukraraj Tropical and Infectious Diseases Hospital, Kathmandu, Nepal
| | | | | | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
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3
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Mane A, Gujar P, Gaikwad S, Bembalkar S, Gaikwad S, Dhamgaye T, Risbud A. Aetiological spectrum of severe community-acquired pneumonia in HIV-positive patients from Pune, India. Indian J Med Res 2018; 147:202-206. [PMID: 29806610 PMCID: PMC5991133 DOI: 10.4103/ijmr.ijmr_1590_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Arati Mane
- Department of Microbiology, ICMR- National AIDS Research Institute, Pune 411 001, Maharashtra, India
| | - Pankaj Gujar
- Department of Tuberculosis & Chest Diseases, Sassoon General Hospitals, Pune 411 001, Maharashtra, India
| | - Shraddha Gaikwad
- Department of Microbiology, ICMR- National AIDS Research Institute, Pune 411 001, Maharashtra, India
| | - Shilpa Bembalkar
- Department of Microbiology, ICMR- National AIDS Research Institute, Pune 411 001, Maharashtra, India
| | - Sanjay Gaikwad
- Department of Tuberculosis & Chest Diseases, Sassoon General Hospitals, Pune 411 001, Maharashtra, India
| | - Tilak Dhamgaye
- Department of Tuberculosis & Chest Diseases, Sassoon General Hospitals, Pune 411 001, Maharashtra, India
| | - Arun Risbud
- Department of Microbiology, ICMR- National AIDS Research Institute, Pune 411 001, Maharashtra, India
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4
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Geretti AM, Brook G, Cameron C, Chadwick D, French N, Heyderman R, Ho A, Hunter M, Ladhani S, Lawton M, MacMahon E, McSorley J, Pozniak A, Rodger A. British HIV Association Guidelines on the Use of Vaccines in HIV-Positive Adults 2015. HIV Med 2018; 17 Suppl 3:s2-s81. [PMID: 27568789 DOI: 10.1111/hiv.12424] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | | | | | | | | | | | | | | | - Mark Lawton
- Royal Liverpool University Hospital, Liverpool, UK
| | - Eithne MacMahon
- Guy's & St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | | | - Anton Pozniak
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
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5
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van Gaalen S, Duff M, Arroyave LF, Rueda ZV, Kasper K, Keynan Y. Characteristics of hospital admissions for pneumonia in HIV-positive individuals in Winnipeg, Manitoba: a cross-sectional retrospective analysis. Int J STD AIDS 2017; 29:115-121. [PMID: 28661231 DOI: 10.1177/0956462417717654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Lung infection in human immunodeficiency virus (HIV)-positive individuals remains an important cause of morbidity and mortality, even in the current antiretroviral therapy era. Pneumonia is the most common cause of admission in HIV-positive individuals in our centre as reported in a previously published study. The objective of this retrospective observational study was to further characterize these admissions, with respect to index of disease severity at presentation, organisms identified, and investigations pursued including bronchoalveolar lavage (BAL). There were 123 unique patients accounting for a total of 209 admissions from 2005 to 2015. An organism was isolated in only 33% of all admissions (68/209). The most common organism was Pneumocystis jirovecii with a frequency of 29% of all admissions. Eighty-seven percent of presentations were mild, and 13% were moderate by CURB-65 criteria. A total of 39 BALs were performed, of which 27 yielded an organism (69%). Considering the burden of disease, low diagnostic yield of the current diagnostic strategy and increased morbidity and mortality caused by pneumonia in HIV-positive individuals, further methods are needed to more accurately target therapy. The preponderance of mild disease in this study suggests that better diagnostic tests may identify individuals that can be candidates for outpatient therapy.
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Affiliation(s)
- S van Gaalen
- 1 Department of Internal Medicine, 8664 University of Manitoba , Winnipeg, Canada
| | - Michael Duff
- 2 Department of Engineering, 8664 University of Manitoba , Winnipeg, Canada
| | | | - Zulma Vanessa Rueda
- 3 27983 Universidad de Antioquia , Medellin, Colombia.,4 28025 Universidad Pontificia Bolivariana , Medellin, Colombia
| | - Ken Kasper
- 1 Department of Internal Medicine, 8664 University of Manitoba , Winnipeg, Canada.,5 Department of Infectious Diseases, 8664 University of Manitoba , Winnipeg, Canada
| | - Y Keynan
- 1 Department of Internal Medicine, 8664 University of Manitoba , Winnipeg, Canada.,5 Department of Infectious Diseases, 8664 University of Manitoba , Winnipeg, Canada
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6
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Figueiredo-Mello C, Naucler P, Negra MD, Levin AS. Prospective etiological investigation of community-acquired pulmonary infections in hospitalized people living with HIV. Medicine (Baltimore) 2017; 96:e5778. [PMID: 28121925 PMCID: PMC5287949 DOI: 10.1097/md.0000000000005778] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The study of the etiological agents of community-acquired pulmonary infections is important to guide empirical therapy, requires constant updating, and has a substantial impact on the prognosis of patients. The objective of this study is to determine prospectively the etiology of community-acquired pulmonary infections in hospitalized adults living with HIV. Patients were submitted to an extended microbiological investigation that included molecular methods. The microbiological findings were evaluated according to severity of the disease and pneumococcal vaccine status. Two hundred twenty-four patients underwent the extended microbiological investigation of whom 143 (64%) had an etiology determined. Among the 143 patients with a determined etiology, Pneumocystis jirovecii was the main agent, detected in 52 (36%) cases and followed by Mycobacterium tuberculosis accounting for 28 (20%) cases. Streptococcus pneumoniae and Rhinovirus were diagnosed in 22 (15%) cases each and influenza in 15 (10%) cases. Among atypical bacteria, Mycoplasma pneumoniae was responsible for 12 (8%) and Chlamydophila pneumoniae for 7 (5%) cases. Mixed infections occurred in 48 cases (34%). S pneumoniae was associated with higher severity scores and not associated with vaccine status. By using extended diagnostics, a microbiological agent could be determined in the majority of patients living with HIV affected by community-acquired pulmonary infections. Our findings can guide clinicians in the choice of empirical therapy for hospitalized pulmonary disease.
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Affiliation(s)
- Claudia Figueiredo-Mello
- Scientific Division, Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brazil
- Department of Infectious Diseases, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Pontus Naucler
- Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna S. Levin
- Department of Infectious Diseases, University of São Paulo Medical School, São Paulo, SP, Brazil
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7
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Abstract
Few modern diseases have experienced as rapid and dramatic change in prognosis and treatment as HIV infection. The introduction of active antiretroviral therapy (ART) and effective prophylaxis of opportunistic infections ushered in a new era in the treatment of HIV infection and changed dramatically the natural history of this disease. The rates of admission to the intensive care unit (ICU) and intensive care mortality in patients with HIV infection have shifted repeatedly during the AIDS epidemic, influenced by attitudes of patients and providers toward utility of care. In the ART era, patients with HIV infection admitted to the ICU fall into 3 general categories: those with AIDS-related opportunistic infections, those who are experiencing complications related to ART, and those with medical problems unrelated to HIV infection. In this article, the authors provide a review of the most common life-threatening complications in patients with HIV infection.
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Affiliation(s)
- Raul E Davaro
- UMass Memorial Health Care, Worcester, MA 01605, USA.
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8
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Lower respiratory tract infections among HIV positive and control group in Nepal. Virusdisease 2015; 26:77-81. [PMID: 26436125 DOI: 10.1007/s13337-015-0254-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022] Open
Abstract
Lower respiratory tract infections (LRTIs) are the most frequent respiratory diseases among HIV infected patients and are frequently the first clinical manifestations of the HIV infections. LRTIs are common not only among the HIV seropositive cases but also the commonest domiciliary and nosocomial infections among the general population. The present study was carried out to determine the comparative prevalence of common bacterial and fungal organism among the HIV positive and control population. This cross sectional study was conducted among 220 people attending National Public Health Laboratory, Kathmandu, Nepal. Out of them 120 were HIV sero-positive and rest were HIV sero-negative. Sputum samples were collected and processed soon after its collection. Macroscopic examination was done to determine the sample integrity. Gram stain, AFB stain and KOH preparation was performed for preliminary identification of the pathogens. Culture was carried out for bacterial and fungal pathogens. Antibiotic susceptibility test (Kirby-Bauer disc diffusion method) was performed from the isolated organisms. The 85 out of 120 HIV sero-positive patients were found to be infected with one or more microbial pathogens. The overall infection rate was found to be significantly lower in HIV seronegative people (27 %). Among HIV seropositive cases prevalence of LRTIs was strongly associated with lower CD4 counts (<200/mm(3)). The prevalence of mycobacterium tuberculosis was found to be 10 % among HIV/AIDS patients which was significantly higher than among the non-HIV cases (3 %). The bacterial pathogens was observed among 46.6 % of HIV positive and 22.0 % of HIV negative people. Among the positive cases, K. pneumoniae was the predominant bacterial pathogens, followed by E. coli and S. pneumoniae. C. albicans was found to be predominant fungal pathogen followed by Aspergillus spp. germ tube negative Candida spp. and Penicillium spp. Similar types of organisms were found to be associated with LRTIs among HIV positive and negative people. The prevalence of both fungal and bacterial infections was significantly higher among HIV seropositive people than HIV seronegative people. All in all, lower respiratory tract illness is significantly higher in HIV/AIDS cases than in HIV seronegative cases.
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9
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Barakat LA, Juthani-Mehta M, Allore H, Trentalange M, Tate J, Rimland D, Pisani M, Akgün KM, Goetz MB, Butt AA, Rodriguez-Barradas M, Duggal M, Crothers K, Justice AC, Quagliarello VJ. Comparing clinical outcomes in HIV-infected and uninfected older men hospitalized with community-acquired pneumonia. HIV Med 2015; 16:421-30. [PMID: 25959543 DOI: 10.1111/hiv.12244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Outcomes of community-acquired pneumonia (CAP) among HIV-infected older adults are unclear. METHODS Associations between HIV infection and three CAP outcomes (30-day mortality, readmission within 30 days post-discharge, and hospital length of stay [LOS]) were examined in the Veterans Aging Cohort Study (VACS) of male Veterans, age ≥ 50 years, hospitalized for CAP from 10/1/2002 through 08/31/2010. Associations between the VACS Index and CAP outcomes were assessed in multivariable models. RESULTS Among 117 557 Veterans (36 922 HIV-infected and 80 635 uninfected), 1203 met our eligibility criteria. The 30-day mortality rate was 5.3%, the mean LOS was 7.3 days, and 13.2% were readmitted within 30 days of discharge. In unadjusted analyses, there were no significant differences between HIV-infected and uninfected participants regarding the three CAP outcomes (P > 0.2). A higher VACS Index was associated with increased 30-day mortality, readmission, and LOS in both HIV-infected and uninfected groups. Generic organ system components of the VACS Index were associated with adverse CAP outcomes; HIV-specific components were not. Among HIV-infected participants, those not on antiretroviral therapy (ART) had a higher 30-day mortality (HR 2.94 [95% CI 1.51, 5.72]; P = 0.002) and a longer LOS (slope 2.69 days [95% CI 0.65, 4.73]; P = 0.008), after accounting for VACS Index. Readmission was not associated with ART use (OR 1.12 [95% CI 0.62, 2.00] P = 0.714). CONCLUSION Among HIV-infected and uninfected older adults hospitalized for CAP, organ system components of the VACS Index were associated with adverse CAP outcomes. Among HIV-infected individuals, ART was associated with decreased 30-day mortality and LOS.
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Affiliation(s)
- L A Barakat
- Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - M Juthani-Mehta
- Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - H Allore
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - M Trentalange
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - J Tate
- Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - D Rimland
- Infectious Disease, VA Medical Center, Decatur, GA, USA
| | - M Pisani
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Pulmonary Disease and Critical Care, Yale University School of Medicine, New Haven, CT, USA
| | - K M Akgün
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.,Pulmonary Disease and Critical Care, Yale University School of Medicine, New Haven, CT, USA
| | - M B Goetz
- Infectious Disease, VA Greater Los Angles Healthcare System, Los Angelos, CA, USA
| | - A A Butt
- Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Rodriguez-Barradas
- Infectious Diseases (MS 111G), Michael E. Debakey VA Medical Center, Houston, TX, USA
| | - M Duggal
- Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - K Crothers
- Pulmonary Disease and Critical Care, University of Washington, Seattle, WA, USA
| | - A C Justice
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - V J Quagliarello
- Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.,Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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10
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Choi HW, Miele K, Dowdy D, Shah M. Cost-effectiveness of Xpert® MTB/RIF for diagnosing pulmonary tuberculosis in the United States. Int J Tuberc Lung Dis 2014; 17:1328-35. [PMID: 24025386 DOI: 10.5588/ijtld.13.0095] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Conventional approaches to tuberculosis (TB) diagnosis and resistance testing are slow. The Xpert® MTB/RIF assay is an emerging molecular diagnostic assay for rapid TB diagnosis, offering results within 2 hours. However, the cost-effectiveness of implementing Xpert in settings with low TB prevalence, such as the United States, is unknown. OBJECTIVE We evaluated the cost-effectiveness of incorporating Xpert into TB diagnostic algorithms in the United States compared to existing diagnostics. DESIGN A decision-analysis model compared current TB diagnostic algorithms in the United States to algorithms incorporating Xpert. Primary outcomes were the costs and quality-adjusted life years (QALYs) accrued with each strategy; cost-effectiveness was represented using incremental cost-effectiveness ratios (ICER). RESULTS Xpert testing of a single sputum sample from TB suspects is expected to result in lower total health care costs per patient (US2673) compared to diagnostic algorithms using only sputum microscopy and culture (US2728) and improved health outcomes (6.32 QALYs gained per 1000 TB suspects). Compared to existing molecular assays, implementation of Xpert in the United States would be considered highly cost-effective (ICER US39992 per QALY gained). CONCLUSION TB diagnostic algorithms incorporating Xpert in the United States are highly cost-effective.
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Affiliation(s)
- H W Choi
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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11
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Pisani M. Lung Disease in Older Patients with HIV. AGING AND LUNG DISEASE 2012. [PMCID: PMC7120014 DOI: 10.1007/978-1-60761-727-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Successful treatment of HIV with combination antiretroviral therapy (ART) has resulted in an aging HIV-infected population. As HIV-infected patients are living longer, noninfectious pulmonary diseases are becoming increasingly prevalent with a proportional decline in the incidence of opportunistic infections (OIs). Pulmonary OIs such as Pneumocystis jirovecii pneumonia (PCP) and tuberculosis are still responsible for a significant proportion of pulmonary diseases in HIV-infected patients. However, bacterial pneumonia (BP) and noninfectious pulmonary diseases such as chronic obstructive pulmonary disease (COPD), lung cancer, pulmonary arterial hypertension (PAH), and interstitial lung disease (ILD) account for a growing number of pulmonary diseases in aging HIV-infected patients. The purpose of this chapter is to discuss the spectrum and management of pulmonary diseases in aging HIV-infected patients, although limited data exists to guide management of many noninfectious pulmonary diseases in HIV-infected patients. In the absence of such data, treatment of lung diseases in HIV-infected patients should generally follow guidelines for management established in HIV-uninfected patients.
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Affiliation(s)
- Margaret Pisani
- School of Medicine, Pulmonary and Critical Care Medicine, Yale University, Cedar Street 330, New Haven, 06520-8057 Connecticut USA
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12
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Albrich WC, Madhi SA, Adrian PV, van Niekerk N, Mareletsi T, Cutland C, Wong M, Khoosal M, Karstaedt A, Zhao P, Deatly A, Sidhu M, Jansen KU, Klugman KP. Use of a rapid test of pneumococcal colonization density to diagnose pneumococcal pneumonia. Clin Infect Dis 2011; 54:601-9. [PMID: 22156852 DOI: 10.1093/cid/cir859] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is major need for a more sensitive assay for the diagnosis of pneumococcal community-acquired pneumonia (CAP). We hypothesized that pneumococcal nasopharyngeal (NP) proliferation may lead to microaspiration followed by pneumonia. We therefore tested a quantitative lytA real-time polymerase chain reaction (rtPCR) on NP swab samples from patients with pneumonia and controls. METHODS In the absence of a sensitive reference standard, a composite diagnostic standard for pneumococcal pneumonia was considered positive in South African human immunodeficiency virus (HIV)-infected adults hospitalized with radiographically confirmed CAP, if blood culture, induced good-quality sputum culture, Gram stain, or urinary Binax demonstrated pneumococci. Results of quantitative lytA rtPCR in NP swab samples were compared with quantitative colony counts in patients with CAP and 300 HIV-infected asymptomatic controls. RESULTS Pneumococci were the leading pathogen identified in 76 of 280 patients with CAP (27.1%) using the composite diagnostic standard. NP colonization density measured by lytA rtPCR correlated with quantitative cultures (r = 0.67; P < .001). The mean lytA rtPCR copy number in patients with pneumococcal pneumonia was 6.0 log(10) copies/mL, compared with patients with CAP outside the composite standard (2.7 log(10) copies/mL; P < .001) and asymptomatic controls (0.8 log(10) copies/mL; P < .001). A lytA rtPCR density ≥8000 copies/mL had a sensitivity of 82.2% and a specificity of 92.0% for distinguishing pneumococcal CAP from asymptomatic colonization. The proportion of CAP cases attributable to pneumococcus increased from 27.1% to 52.5% using that cutoff. CONCLUSIONS A rapid molecular assay of NP pneumococcal density performed on an easily available specimen may significantly increase pneumococcal pneumonia diagnoses in adults.
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Affiliation(s)
- W C Albrich
- Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
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13
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Daneshvar C, Smith NC, Waghorn DJ, Luzzi GA, Wathen CG. Community-acquired pneumonia due to Panton-Valentine leukocidin-producing Staphylococcus aureus in an HIV-2-infected patient. Int J STD AIDS 2011; 22:610-2. [PMID: 21998186 DOI: 10.1258/ijsa.2009.009372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pneumonia caused by Panton-Valentine leukocidin-producing Staphylococcus aureus is associated with a high fatality rate. There have been few reported cases in HIV-1-co-infected patients. Here we report a fatal case of severe community-acquired pneumonia caused by Panton-Valentine leukocidin-producing S. aureus in a 45-year-old woman with HIV-2 infection.
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Affiliation(s)
- C Daneshvar
- Department of Thoracic Medicine,Wycombe Hospital, High Wycombe, UK.
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14
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Allen CM, Al-Jahdali HH, Irion KL, Al Ghanem S, Gouda A, Khan AN. Imaging lung manifestations of HIV/AIDS. Ann Thorac Med 2011; 5:201-16. [PMID: 20981180 PMCID: PMC2954374 DOI: 10.4103/1817-1737.69106] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/16/2010] [Accepted: 04/15/2010] [Indexed: 01/10/2023] Open
Abstract
Advances in our understanding of human immunodeficiency virus (HIV) infection have led to improved care and incremental increases in survival. However, the pulmonary manifestations of HIV/acquired immunodeficiency syndrome (AIDS) remain a major cause of morbidity and mortality. Respiratory complaints are not infrequent in patients who are HIV positive. The great majority of lung complications of HIV/AIDS are of infectious etiology but neoplasm, interstitial pneumonias, Kaposi sarcoma and lymphomas add significantly to patient morbidity and mortality. Imaging plays a vital role in the diagnosis and management of lung of complications associated with HIV. Accurate diagnosis is based on an understanding of the pathogenesis of the processes involved and their imaging findings. Imaging also plays an important role in selection of the most appropriate site for tissue sampling, staging of disease and follow-ups. We present images of lung manifestations of HIV/AIDS, describing the salient features and the differential diagnosis.
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Affiliation(s)
- Carolyn M Allen
- North Manchester General Hospital, Pennine Acute NHS Trust, Manchester, UK
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15
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Djawe K, Huang L, Daly KR, Levin L, Koch J, Schwartzman A, Fong S, Roth B, Subramanian A, Grieco K, Jarlsberg L, Walzer PD. Serum antibody levels to the Pneumocystis jirovecii major surface glycoprotein in the diagnosis of P. jirovecii pneumonia in HIV+ patients. PLoS One 2010; 5:e14259. [PMID: 21151564 PMCID: PMC3000336 DOI: 10.1371/journal.pone.0014259] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 11/10/2010] [Indexed: 12/27/2022] Open
Abstract
Background Pneumocystis jirovecii remains an important cause of fatal pneumonia (Pneumocystis pneumonia or PcP) in HIV+ patients and other immunocompromised hosts. Despite many previous attempts, a clinically useful serologic test for P. jirovecii infection has never been developed. Methods/Principal Findings We analyzed serum antibody responses to the P. jirovecii major surface glycoprotein recombinant fragment C1 (MsgC1) in 110 HIV+ patients with active PcP (cases) and 63 HIV+ patients with pneumonia due to other causes (controls) by an enzyme-linked immunosorbent assay (ELISA). The cases had significantly higher IgG and IgM antibody levels to MsgC1 than the controls at hospital admission (week 0) and intervals up to at least 1 month thereafter. The sensitivity, specificity and positive predictive value (PPV) of IgG antibody levels increased from 57.2%, 61.7% and 71.5% at week 0 to 63.4%, 100%, and 100%, respectively, at weeks 3–4. The sensitivity, specificity and PPV of IgM antibody levels rose from 59.7%, 61.3%, and 79.3% at week 0 to 74.6%, 73.7%, and 89.8%, respectively, at weeks 3–4. Multivariate analysis revealed that a diagnosis of PcP was the only independent predictor of high IgG and IgM antibody levels to MsgC1. A high LDH level, a nonspecific marker of lung damage, was an independent predictor of low IgG antibody levels to MsgC1. Conclusions/Significance The results suggest that the ELISA shows promise as an aid to the diagnosis of PCP in situations where diagnostic procedures cannot be performed. Further studies in other patient populations are needed to better define the usefulness of this serologic test.
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Affiliation(s)
- Kpandja Djawe
- Veterans Affairs Medical Center, Cincinnati, Ohio, United States of America
- Division of Epidemiology and Biostatistics, Department of Environmental Health, University College of Medicine, Cincinnati, Ohio, United States of America
| | - Laurence Huang
- Division of Pulmonary and Critical Care Medicine and HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Kieran R. Daly
- Veterans Affairs Medical Center, Cincinnati, Ohio, United States of America
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Linda Levin
- Division of Epidemiology and Biostatistics, Department of Environmental Health, University College of Medicine, Cincinnati, Ohio, United States of America
| | - Judy Koch
- Veterans Affairs Medical Center, Cincinnati, Ohio, United States of America
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Alexandra Schwartzman
- Division of Pulmonary and Critical Care Medicine and HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Serena Fong
- Division of Pulmonary and Critical Care Medicine and HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Brenna Roth
- Division of Pulmonary and Critical Care Medicine and HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Anuradha Subramanian
- Division of Pulmonary and Critical Care Medicine and HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Katherine Grieco
- Division of Pulmonary and Critical Care Medicine and HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Leah Jarlsberg
- Division of Pulmonary and Critical Care Medicine and HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Peter D. Walzer
- Veterans Affairs Medical Center, Cincinnati, Ohio, United States of America
- Division of Epidemiology and Biostatistics, Department of Environmental Health, University College of Medicine, Cincinnati, Ohio, United States of America
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- * E-mail:
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Murinello A, Manuel Figeiredo A, Semedo J, Damásio H, Carrilho Ribeiro N, Peres H. Empiema torácico – Revisão baseada em três casos clínicos. REVISTA PORTUGUESA DE PNEUMOLOGIA 2009. [DOI: 10.1016/s0873-2159(15)30149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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17
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Hull MW, Phillips P, Montaner JSG. Changing global epidemiology of pulmonary manifestations of HIV/AIDS. Chest 2009; 134:1287-1298. [PMID: 19059959 DOI: 10.1378/chest.08-0364] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Tremendous advances have occurred in the care of patients with HIV/AIDS resulting from the advent of highly active antiretroviral therapy (HAART). This has led to differences in the presentations of HIV-related pulmonary disease. Infections such as bacterial pneumonias, particularly Streptococcus pneumoniae, remain commonplace, while opportunistic agents such as Pneumocystis jirovecii remain a concern in patients without adequate access to optimal medical care. The tuberculosis epidemic, once thought to be slowing, has been re-energized by the spread of HIV, particularly in sub-Saharan Africa. Unusual inflammatory responses due to a phenomenon of immune reconstitution, are now recognized as a consequence of HAART, with a reported incidence of IRIS in this setting ranges from 7 to 45% in retrospective reviews. Noninfectious pulmonary conditions such as chronic obstructive lung disease and pulmonary malignancies are gaining prominence as patients are accessing antiretroviral care and enjoying significantly extended survival.
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Affiliation(s)
- Mark W Hull
- Canadian HIV Trials Network, University of British Columbia, Vancouver, BC, Canada
| | - Peter Phillips
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julio S G Montaner
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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[Treatment of opportunistic infections in adolescent and adult patients infected with the human immunodeficiency virus during the era of highly active antiretroviral therapy. AIDS Study Group (GESIDA) and National AIDS Plan Expert Committee]. Enferm Infecc Microbiol Clin 2008; 26:356-79. [PMID: 18588819 DOI: 10.1157/13123842] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite the huge advance that highly active antiretroviral therapy has represented for the prognosis of infection by human immunodeficiency virus (HIV), opportunistic infections continue to be a cause of morbidity and mortality in HIV-infected patients. This is often the case because of severe immunodepression, poor adherence to antiretroviral therapy, failure of therapy, or the fact that patients are unaware of their HIV-positive status and debut with an opportunistic infection. This article updates the guidelines on treatment of acute episodes of various opportunistic infections in HIV-infected patients, including infections due to parasites, fungi, viruses, mycobacteria, and bacteria. This edition has a new chapter on imported parasite infections as well as additional information on endemic mycoses in the chapter on fungal infections, taking into account the growing number of immigrants in our setting. Lastly, the chapter on the immune reconstitution syndrome has also been updated, providing relevant data on a phenomenon that has clinical and diagnostic repercussions in patients who start antiretroviral therapy while they are severely immunodepressed (English version available at http://www.gesida.seimc.org).
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Gordin FM, Roediger MP, Girard PM, Lundgren JD, Miro JM, Palfreeman A, Rodriguez-Barradas MC, Wolff MJ, Easterbrook PJ, Clezy K, Slater LN. Pneumonia in HIV-infected persons: increased risk with cigarette smoking and treatment interruption. Am J Respir Crit Care Med 2008; 178:630-6. [PMID: 18617640 DOI: 10.1164/rccm.200804-617oc] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Bacterial pneumonia is a major cause of morbidity for HIV-infected persons and contributes to excess mortality in this population. OBJECTIVES To evaluate the frequency and risk factors for occurrence of bacterial pneumonia in the present era of potent antiretroviral therapy. METHODS We evaluated data from a randomized trial of episodic antiretroviral therapy. The study, Strategies for Management of Antiretroviral Therapy, enrolled 5,472 participants at 318 sites in 33 countries. Study patients had more than 350 CD4 cells at baseline. Diagnosis of bacterial pneumonia was confirmed by a blinded clinical-events committee. MEASUREMENTS AND MAIN RESULTS During a mean follow-up of 16 months, 116 participants (2.2%) developed at least one episode of bacterial pneumonia. Patients randomized to receive episodic antiretroviral therapy were significantly more likely to develop pneumonia than patients randomized to receive continuous antiretroviral therapy (hazard ratio, 1.55; 95% confidence interval, 1.07-2.25; P = 0.02). Cigarette smoking was a major risk factor: Current-smokers had more than an 80% higher risk of pneumonia compared with never-smokers (hazard ratio, 1.82; 95% confidence interval, 1.09-3.04; P = 0.02). Participants who were on continuous HIV treatment and were current smokers were three times more likely to develop bacterial pneumonia than nonsmokers. Current smoking status was significant, but a past history of smoking was not. CONCLUSIONS Bacterial pneumonia is a major source of morbidity, even for persons on potent antiretroviral therapy, including those with high CD4 cells. Efforts to reduce this illness should stress the importance of uninterrupted antiretroviral therapy and attainment and/or maintenance of nonsmoking status.
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Affiliation(s)
- Fred M Gordin
- Infectious Diseases (151B), Veterans Affairs Medical Center, 50 Irving Street, NW, Washington, DC 20422, USA.
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20
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Saindou M, Chidiac C, Miailhes P, Voirin N, Baratin D, Amiri M, Livrozet JM, Touraine JL, Trepo C, Peyramond D, Vanhems P. Pneumococcal pneumonia in HIV-infected patients by antiretroviral therapy periods. HIV Med 2008; 9:203-7. [PMID: 18298578 DOI: 10.1111/j.1468-1293.2008.00546.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To ascertain the relationship between periods of various antiretroviral therapies and the incidence of first community-acquired pneumococcal pneumonia (CAPP) among HIV-1 infected patients. METHODS We analysed 4075 patients enrolled prospectively in the Lyon section of the French Hospital Database on HIV between 1993 and 2004, stratified into three groups. The first group (G1) included patients for whom enrolment and last follow-up were before the highly active antiretroviral therapy (HAART) period (beginning 1 July 1996); the second group (G2) comprised patients who were enrolled before HAART but had last follow-up in the HAART period; the third group (G3) included patients for whom both enrolment and last follow-up took place in the HAART period. RESULTS Fifty-five CAPP episodes were identified. The incidence of CAPP per 1000 patient-years declined over time, from 10.6 to 1.5 and 2.5 in calendar periods G1, G2 and G3, respectively (P=0.004 for linear trend). Factors associated with a decreased risk of CAPP were lower age, baseline CD4 count >or=200 cells/microL and more recent years of enrolment, when HAART use became extensive (P<0.001). The use of intravenous drugs increased the risk of CAPP (P<0.001). CONCLUSIONS There has been a significant reduction in the incidence of CAPP in HIV-1 infected patients since the advent of HAART.
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Affiliation(s)
- M Saindou
- Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Epidémiologie et Santé Publique, 8 avenue Rockefeller, Lyon F-69373, France
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Rizzi EB, Schininá V, Rovighi L, Cristofaro M, Bordi E, Narciso P, Bibbolino C. HIV-related pneumococcal lung disease: does highly active antiretroviral therapy or bacteremia modify radiologic appearance? AIDS Patient Care STDS 2008; 22:105-11. [PMID: 18260801 DOI: 10.1089/apc.2007.0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We reviewed chest radiographs of 57 HIV-infected patients with pulmonary diseases in whom Streptococcus pneumoniae was the sole respiratory pathogen isolated to evaluate whether highly active antiretroviral therapy (HAART) or bacteremia modify radiographic appearance. Pneumococcal lung disease presented as lobar pneumonia in 40% of the cases, 54% of whom were on HAART; as bronchopneumonia in 42%, 58% on HAART; as interstitial infiltrates in 17%, 60% on HAART. Bacteremia was observed 38 times in 23 patients with CD4 less than 200/mm(3), and in 15 with CD4 greater than 200/mm(3) (p > 0.05). HAART does not significantly influences radiographic appearances of lung disease caused by Streptococcus pneumoniae (p > 0.05). Immunosuppression induced by HIV infection was a major risk factor for development of pneumococcal lung disease (p = 0.04) and influences radiographic appearance; bronchopneumonia (p = 0.006), in particular multifocal (p = 0.008), which was more frequent in subjects with CD4 less than 200/mm(3). Bacteremia influences radiographic appearance of pneumococcal lung disease; lobar pneumonia was more frequent (p = 0.003), and considering CD4 cell count, was more frequent if CD4 cell count was above 200/mm(3). An original finding of this study was the frequency of interstitial changes. This pattern of pneumonia, found in 17% of our patients, could represent a difference between HIV-seropositive and -seronegative subject in displaying pneumococcal lung disease.
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Affiliation(s)
- Elisa Busi Rizzi
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
| | - Vincenzo Schininá
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
| | - Laura Rovighi
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
| | - Massimo Cristofaro
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
| | - Eugenio Bordi
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
| | - Pasquale Narciso
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
| | - Corrado Bibbolino
- Department of Radiology, L Spallanzani National institute for infectious diseases, Rome, Italy
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Simkins J, Corrales-Medina V, Symes S, Dickinson G. Pulmonary embolism in patients with acquired immunodeficiency syndrome presenting with clinical picture of Pneumocystis jiroveci pneumonia: report of two cases. ACTA ACUST UNITED AC 2007; 39:634-6. [PMID: 17577835 DOI: 10.1080/00365540601148509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jacques Simkins
- Department of Internal Medicine, Jackson Memorial Hospital-University of Miami Miller School of Medicine, Miami, Florida, USA.
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Klein MB, Lu Y, DelBalso L, Coté S, Boivin G. Influenzavirus infection is a primary cause of febrile respiratory illness in HIV-infected adults, despite vaccination. Clin Infect Dis 2007; 45:234-40. [PMID: 17578785 DOI: 10.1086/518986] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 04/01/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There are, to our knowledge, no prospective studies of respiratory tract infections in human immunodeficiency virus (HIV)-infected adults in the highly active antiretroviral therapy (HAART) era. We performed a surveillance study of outpatients who presented with fever and respiratory symptoms to examine the role of viral pathogens in these patients. METHODS Consecutive patients with a temperature of >38.0 degrees C and respiratory symptoms were recruited from a tertiary care HIV clinic during the period 2003-2006. Nasal pharyngeal samples were tested for influenzavirus A and B, respiratory syncytial virus, and human metapneumovirus using real-time multiplex polymerase chain reaction assays. Paired acute- and convalescent-phase serum samples were tested for respiratory viruses by complement fixation. RESULTS Fifty patients (90% of whom were receiving HAART) were included in the study (median CD4(+) T cell count, 325 cells/microL; median HIV RNA level, <50 copies/mL). A causative pathogen was identified in 25 patients (50%). Even though 76% of subjects had received influenza vaccine, viral infections were diagnosed in 21 patients (42%), as follows: influenza A, 10 patients; influenza B, 10; and parainfluenza virus type 3 infection, 1. Patients with and those without viral infection had similar demographic characteristics and HIV statuses. No patients with influenza and 23% of patients with other conditions had radiography-confirmed pneumonia (P=.07). Antibiotic prescriptions were common: 70% of patients received antibiotics. No patients with influenza required hospitalization, compared with 21% of other patients (P=.03). CONCLUSIONS Although illness was mild, influenza accounted for a large proportion of unscheduled visits to a health care provider for respiratory illness and was associated with unnecessary antibiotic prescriptions that may contribute to antimicrobial resistance. Vaccination alone was insufficient to prevent infection. Thus, specific identification and management of influenza should be performed in HIV-infected outpatients who present with fever and respiratory symptoms.
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Affiliation(s)
- Marina B Klein
- Department of Medicine, Division of Infectious Diseases, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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Aviram G, Fishman JE, Boiselle PM. Thoracic Infections in Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome. Semin Roentgenol 2007; 42:23-36. [PMID: 17174172 DOI: 10.1053/j.ro.2006.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Galit Aviram
- Department of Radiology at Tel Aviv Sourasky Medical Center and Tel Aviv University, Tel-Aviv, Israel
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25
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Benito Hernández N, Moreno Camacho A, Gatell Artigas JM. [Infectious pulmonary complications in HIV-infected patients in the high by active antiretroviral therapy era in Spain]. Med Clin (Barc) 2005; 125:548-55. [PMID: 16266640 DOI: 10.1157/13080461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pulmonary complications in HIV-infected patients are at present a first-rate problem. They are the main cause of hospital admission of these patients in our country. Most HIV-patients have a pulmonary complication during the evolution of the infection. The main etiologic diagnosis is bacterial pneumonia, especially pneumococcal pneumonia; the second most frequent cause is Pneumocystis jiroveci (previously named P. carinii) pneumonia and the third cause is mycobacteriosis, particularly Mycobacterium tuberculosis. From early studies, important changes in the epidemiology of HIV-related pulmonary complications have occurred. General prescription of P. jiroveci primary prophylaxis is probably one of the main causes, and, more recently, the use of highly active antiretroviral therapy may also be an underlying explanation. In this review, epidemiology, diagnosis and outcome of HIV-related pulmonary complications in our country are update.
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Siripattanapipong S, Worapong J, Mungthin M, Leelayoova S, Tan-ariya P. Genotypic study of Pneumocystis jirovecii in human immunodeficiency virus-positive patients in Thailand. J Clin Microbiol 2005; 43:2104-10. [PMID: 15872228 PMCID: PMC1153780 DOI: 10.1128/jcm.43.5.2104-2110.2005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Pneumocystis jirovecii is one of the common opportunistic infections in human immunodeficiency virus (HIV)-infected patients in Thailand. Information regarding genotypic and epidemiological of this organism in Thai patients is not available. We analyzed the genotypes of 28 P. jirovecii-positive specimens from bronchoalveolar lavage and sputum samples from HIV-infected Thai patients based on nucleotide variations of the internal transcribed spacer regions 1 and 2 of the rRNA gene. Thirteen genotypes were the same as previously reported outside Thailand. Ten genotypes, which included Bp, Er, Eq, Ic, Ir, Ip, Rc, Rp, Qb, and Qq, were new. Ir and Rp were unique and dominant types observed in HIV-infected Thai patients. Thirteen specimens (46.4%) were infected with a single type of P. jirovecii, and fifteen (53.6%) were mixed infections. These differences may be used as genotypic markers for studying the epidemiology and transmission of P. jirovecii in the Thai population.
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Affiliation(s)
- Suradej Siripattanapipong
- Department of Microbiology, Faculty of Science, Mahidol University, Rama VI Rd., Phayathai, Bangkok 10400, Thailand
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Robberts FJL, Chalkley LJ, Weyer K, Goussard P, Liebowitz LD. Dihydropteroate synthase and novel dihydrofolate reductase gene mutations in strains of Pneumocystis jirovecii from South Africa. J Clin Microbiol 2005; 43:1443-4. [PMID: 15750128 PMCID: PMC1081295 DOI: 10.1128/jcm.43.3.1443-1444.2005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dihydropteroate synthase (DHPS) gene mutations have raised concerns about emerging sulfonamide resistance in Pneumocystis jirovecii. DHPS and dihydrofolate reductase (DHFR) gene products were amplified in clinical specimens from South African patients. One of 53 DHPS genes sequenced contained the double mutation Thr55Ala Pro57Ser. DHFR gene mutations detected were Ala67Val and the new mutations Arg59Gly and C278T.
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Affiliation(s)
- F J L Robberts
- Department of Medical Microbiology, University of Stellenbosch, Tygerberg 7500, South Africa.
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Benson CA, Kaplan JE, Masur H, Pau A, Holmes KK. Treating Opportunistic Infections among HIV-Infected Adults and Adolescents: Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. Clin Infect Dis 2005. [DOI: 10.1086/427906] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Álvarez-Rocha L, Alós J, Blanquer J, Álvarez-Lerma F, Garau J, Guerrero A, Torres A, Cobo J, Jordá R, Menéndez R, Olaechea P, Rodríguez de castro F. [Guidelines for the management of community pneumonia in adult who needs hospitalization]. Med Intensiva 2005; 29:21-62. [PMID: 38620135 PMCID: PMC7131443 DOI: 10.1016/s0210-5691(05)74199-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2004] [Indexed: 11/01/2022]
Abstract
Community acquired pneumonia is still an important health problem. In Spain the year incidence is 162 cases per 100,000 inhabitants with 53,000 hospital admission costing 115 millions of euros per year. In the last years there have been significant advances in the knowledge of: aetiology, diagnostic tools, treatment alternatives and antibiotic resistance. The Spanish Societies of Intensive and Critical Care (SEMICYUC), Infectious Diseases and Clinical Microbiology (SEIMC) and Pulmonology and Thoracic Surgery (SEPAR) have produced these evidence-based Guidelines for the management of community acquired pneumonia in Adults. The main objective is to help physicians to make decisions about this disease. The different points that have been developed are: aetiology, diagnosis, treatment and prevention.
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Affiliation(s)
- L. Álvarez-Rocha
- Grupo de Trabajo de Enfermedades Infecciosas. Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (GTEI de la SEMICYUC)
| | - J.I. Alós
- Grupo de Estudio de la Infección en Atención Primaria. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIAP de la SEIMC)
| | - J. Blanquer
- Área de Tuberculosis e Infección Respiratoria. Sociedad Española de Neumología y Cirugía Torácica (Area TIR de la SEPAR)
| | - F. Álvarez-Lerma
- Grupo de Estudio de la Infección en el Paciente Crítico. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIPC de la SEIMC)
| | - J. Garau
- Grupo de Estudio de la Infección en Atención Primaria. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIAP de la SEIMC)
| | - A. Guerrero
- Grupo de Estudio de la Infección en Atención Primaria. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIAP de la SEIMC)
| | - A. Torres
- Área de Tuberculosis e Infección Respiratoria. Sociedad Española de Neumología y Cirugía Torácica (Area TIR de la SEPAR)
| | - J. Cobo
- Grupo de Estudio de la Infección en Atención Primaria. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIAP de la SEIMC)
| | - R. Jordá
- Grupo de Trabajo de Enfermedades Infecciosas. Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (GTEI de la SEMICYUC)
| | - R. Menéndez
- Área de Tuberculosis e Infección Respiratoria. Sociedad Española de Neumología y Cirugía Torácica (Area TIR de la SEPAR)
| | - P. Olaechea
- Grupo de Trabajo de Enfermedades Infecciosas. Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (GTEI de la SEMICYUC)
| | - F. Rodríguez de castro
- Área de Tuberculosis e Infección Respiratoria. Sociedad Española de Neumología y Cirugía Torácica (Area TIR de la SEPAR)
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Hung CC, Chang SC. Impact of highly active antiretroviral therapy on incidence and management of human immunodeficiency virus-related opportunistic infections. J Antimicrob Chemother 2004; 54:849-53. [PMID: 15456733 DOI: 10.1093/jac/dkh438] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We review the changes in incidences of HIV-related opportunistic infections and the safety of discontinuation of primary and secondary prophylaxis for HIV-related opportunistic infections in patients achieving immune restoration after the introduction of highly active antiretroviral therapy (HAART). HIV-related opportunistic infections continue to occur in patients who are newly diagnosed with HIV infection, those in the early course of HAART or non-adherent to HIV care and HAART, and those in whom non-HIV-related infections have emerged as a significant cause of morbidity and mortality in the post-HAART era. Clinical studies of patients with tuberculosis and HIV co-infection are reviewed to provide appropriate regimen combinations of rifamycins and antiretrovirals, which have varying degrees of drug-drug interactions that have posed challenges in the management of tuberculosis as well as HIV infection.
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Affiliation(s)
- Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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31
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Pedro-Botet ML, García Cruz A, Sopena N, Domínguez MJ, Sarroca O, Rey Joly C, Sabrià M. Legionelosis e infección por el virus de la inmunodeficiencia humana: ¿infección oportunista? Med Clin (Barc) 2004; 123:582-4. [PMID: 15535942 DOI: 10.1016/s0025-7753(04)74604-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Legionella infections are not frequent in HIV-infected patients, although clinical manifestations and outcome are particularly severe in this subset. This manuscript analyzes the clinical features and immunological situation of HIV-infected patients with Legionnaires' disease (LD). PATIENTS AND METHOD The clinical files of HIV-infected patients diagnosed with LD from 1983 to December 2003 were reviewed. The incidence of hospital-acquired Legionella pneumonia (HALP) from 1997-2000 in HIV-infected patients was compared with that of non infected patients. RESULTS Eighteen patients were included. 72.2% were diagnosed by the Legionella urinary antigen assay. The incidence of HALP in HIV-infected and non infected patients was 0.3 and 0.25/1000 admissions/year, respectively (p = 0.42). 83.3% received appropriate antibiotic treatment at the Emergency department. The mean lymphocyte CD4 count was 348.1/microl, 53.8% had an undetectable viral load and 64.7% were on antiretroviral therapy. 72.2% were smokers, 38.8% had cancer and 16.7% were on chemotherapy. 93.8% had cough, 75% dyspnea, 62.5% extrarespiratory symptoms, 76.5% increased AST, 50% increased CK and 56.3% hyponatremia. Moreover, 50% developed bilateral pulmonary infiltrates, 83.3% respiratory failure and 22.2% died. CONCLUSIONS Although LD is not more frequent in HIV-infected than in non infected patients, its clinical severity suggests that it is an opportunistic infection.
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Affiliation(s)
- María Luisa Pedro-Botet
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
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32
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Silva RMD, Teixeira PJZ, Moreira JDS. O escarro induzido no diagnóstico das doenças pulmonares em pacientes positivos ao vírus da imunodeficiência humana. J Bras Pneumol 2004. [DOI: 10.1590/s1806-37132004000500009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O escarro induzido é utilizado para monitorar a inflamação de vias aéreas, porém seu papel como ferramenta diagnóstica de doenças pulmonares em pacientes imunocomprometidos ainda necessita de melhor definição. OBJETIVOS: Determinar o rendimento do escarro induzido no diagnóstico das doenças pulmonares em pacientes positivos ao virus da imunodeficiência humana (HIV). MÉTODO: No período de janeiro de 2001 a setembro de 2002, foram avaliados todos os pacientes com idade superior a 14 anos, infectados com o HIV, admitidos em Hospital de Referência. Foram incluídos aqueles indivíduos que apresentavam manifestações clínicas do aparelho respiratório há pelo menos 7 dias, associadas, ou não, a alterações radiológicas, bem como indivíduos assintomáticos do ponto de vista respiratório, com alterações no radiograma de tórax. Os pacientes foram submetidos à avaliação clínica, radiológica e laboratorial e realizaram a indução de escarro, seguida pela broncofibroscopia, lavado broncoalveolar e biópsia pulmonar transbrônquica. As amostras foram processadas para bacterioscopia pelo método de Gram e Ziehl-Neelsen, cultura quantitativa para bactérias, exame micológico direto, cultura para micobactérias e fungos, pesquisa de citomegalovírus e Pneumocystis jiroveci, bem como celularidade total e diferencial. RESULTADOS: 54 pacientes foram incluídos no estudo. A pesquisa de agente etiológico resultou negativa em 7 pacientes, sendo que nos casos restantes foram isolados 60 agentes. Dentre os agentes isolados, 46,7% foram P. jiroveci; 33,5% bactérias piogênicas e 16,7% Mycobacterium tuberculosis. O escarro induzido apresentou sensibilidade de 57,5%, especificidade de 42,9%, valor preditivo positivo de 87,1%, valor preditivo negativo de 13% e acurácia de 55,6%. CONCLUSÕES: Nesta população, a análise do escarro induzido é um procedimento simples, seguro e com bom rendimento diagnóstico.
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33
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Robberts FJL, Liebowitz LD, Chalkley LJ. Genotyping and coalescent phylogenetic analysis of Pneumocystis jiroveci from South Africa. J Clin Microbiol 2004; 42:1505-10. [PMID: 15070996 PMCID: PMC387607 DOI: 10.1128/jcm.42.4.1505-1510.2004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Sequence analysis of Pneumocystis jiroveci internal transcribed spacer (ITS) regions has become an important epidemiological tool. The objectives of the present study were to investigate sequence variations in the ITS1-5.8S ribosomal DNA (rDNA)-ITS2 regions; determine the P. jiroveci genotypes present in Cape Town, South Africa; and resolve the lineage evolution of the types by use of the coalescent theory. ITS regions were amplified from samples collected from 19 patients. PCR products were cloned, and four to five clones were sequenced from each specimen. Statistical parsimony was applied for coalescence-based network genotype analysis. The most prevalent type was Eg (14 of 19 patients, 33 of 83 clones), followed by Gg (4 of 19 patients, 7 of 83 clones), Eu (3 of 19 patients, 5 of 83 clones), and Gh (2 of 19 patients, 2 of 83 clones). Four new combinations (Eo, Je, Ge, and No), 11 new ITS1 sequences, and 13 new ITS2 sequences were identified. A new ITS2 type was detected in three patients and was designated type u. Coinfection appeared to be common, with 15 of 19 patients harboring more than one type and with up to six types per specimen. The resultant parsimony network identified Eg as the most probable ancestral haplotype and supported the occurrence of recombinational events within the population studied. Although the 5.8S rDNA region revealed only 13 clones containing one to two nucleotide polymorphisms, it may assist in defining types. Coalescent theory proposed that Eg is an ancestral type from which microevolutionary subtypes radiate.
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Affiliation(s)
- Frans J L Robberts
- Department of Medical Microbiology, School for Basic and Applied Health Sciences, University of Stellenbosch, Tygerberg, South Africa.
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34
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Abstract
PURPOSE OF REVIEW Although an emphasis has historically been placed on nonbacterial, opportunistic respiratory infections in HIV-infected individuals, it is increasingly important for clinicians to be familiar with the spectrum of bacterial respiratory infections that may occur in this population. RECENT FINDINGS Bacterial pneumonia and acute bronchitis are currently the most common causes of respiratory disease in HIV-infected individuals in developed countries. Moreover, these infections are frequently the first clinical manifestation of HIV infection. Among patients with sustained CD4 cell count >200 cells/microL, the discontinuation of Pneumocystis carinii pneumonia prophylaxis is not associated with an increased risk of bacterial pneumonia. The most common radiographic pattern of bacterial pneumonia is focal consolidation, which typically presents in either a segmental or lobar distribution. In cases in which the chest radiograph is inconclusive, high-resolution chest CT has a very high accuracy for detecting pyogenic small airways disease and for distinguishing between P. carinii pneumonia and other lung infections including bacterial infection. SUMMARY Knowledge of the characteristic imaging and clinical features of bacterial respiratory infections can enhance their timely diagnosis and treatment.
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Affiliation(s)
- Galit Aviram
- Department of Radiology, Tel Aviv Sourasky Medical Center and Tel Aviv University, Tel Aviv, Israel
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35
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Abstract
The lungs are at considerable risk from the use of injected or inhaled illicit drugs. The extent and clinical significance of illicit drug induced lung damage is not known completely. Drug use leads to an increase in infectious pulmonary disease, historically in relation to nonsterile injection techniques, and, more recently, in relation to HIV infection and its pulmonary manifestations. Barotrauma related to "smoking topography" or errant injections also represents a real risk of drug use. Although granulomatous disease that involves the pulmonary vasculature and interstitium is probably common in injection drug users, the clinical consequence of such is difficult to estimate. What effect smoked or injected illicit drugs have on short- and long-term pulmonary function also is hard to ascertain. The ubiquitous use of tobacco among users of illicit drugs certainly has confounding effects. Given that illicit drug use is common and that the "popular" drugs of abuse change from generation to generation, the pulmonary physician must remain informed about, and alert for, the effects of drugs of abuse.
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Affiliation(s)
- Armand J Wolff
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Hospital, 3800 Reservoir Road, Northwest, Washington, DC 20007, USA
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36
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Viale P, Scudeller L, Petrosillo N, Girardi E, Cadeo B, Signorini L, Pagani L, Carosi G. Clinical Stability in Human Immunodeficiency Virus–Infected Patients with Community‐Acquired Pneumonia. Clin Infect Dis 2004; 38:271-9. [PMID: 14699461 DOI: 10.1086/380788] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2003] [Accepted: 09/05/2003] [Indexed: 11/03/2022] Open
Abstract
Clinical stability (CS), defined as normalization of vital signs, is often used to manage inpatients with community-acquired pneumonia (CAP). The main objective of our study was to identify a reliable definition of CS for human immunodeficiency virus (HIV)-positive patients with CAP. During an 18-month period, 437 HIV-positive Italian inpatients with CAP were enrolled in the study. We used 3 definitions of CS (from a less conservative [definition 1] to a more conservative [definition 3] definition) based on combinations of different thresholds for vital signs. Assessments were performed at admission and daily during the hospital stay. For the 3 definitions, 14.9%, 8.0%, and 4.8% of patients were stable at baseline, with deterioration after reaching CS in 7.16%, 4.76%, and 2.05%, respectively. The 8 patients whose conditions deteriorated after reaching CS definition 3 (systolic blood pressure, >90 mm Hg; pulse, <90 beats/min; respiratory rate, <20 breaths/min; oxygen saturation, >90%; temperature, <37 degrees C; ability to eat; and normal mental status) survived and were discharged from the hospital. The more conservative definition of CS appears to be reliable for the management of HIV-infected patients with CAP.
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Affiliation(s)
- P Viale
- Clinic of Infectious Disease, Department of Clinical and Morphological Research, School of Medicine, University of Udine, Udine, Italy.
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37
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Abstract
Antimicrobial prophylaxis and highly active antiretroviral therapy have changed the epidemiology and impact of pulmonary infection in patients infected with the human immunodeficiency virus (HIV). However, pulmonary infection remains a significant contributor to the morbidity and mortality of such patients. Bacterial pneumonia and tuberculosis remain common lung infections in this setting, especially where appropriate prophylaxis is unavailable or when compliance with such therapy is poor. Pneumonia related to Pneumocystis carinii also remains a significant problem, especially as a presenting illness in patients not yet known to be infected with HIV. Recrudescence of "treated" infection as a manifestation of the immune reconstitution syndrome may become more commonly encountered as more patients are treated with highly active therapy.
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MESH Headings
- AIDS-Related Opportunistic Infections/diagnosis
- AIDS-Related Opportunistic Infections/drug therapy
- AIDS-Related Opportunistic Infections/epidemiology
- Anti-Bacterial Agents
- Antiretroviral Therapy, Highly Active/methods
- Antitubercular Agents/administration & dosage
- Drug Therapy, Combination
- Female
- Humans
- Incidence
- Male
- Pneumonia, Mycoplasma/diagnosis
- Pneumonia, Mycoplasma/drug therapy
- Pneumonia, Mycoplasma/epidemiology
- Pneumonia, Pneumocystis/diagnosis
- Pneumonia, Pneumocystis/drug therapy
- Pneumonia, Pneumocystis/epidemiology
- Prognosis
- Risk Assessment
- Severity of Illness Index
- Survival Analysis
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/epidemiology
- United States/epidemiology
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Affiliation(s)
- Armand J Wolff
- Division of Pulmonary, Critical Care, and Sleep Medicine Georgetown University Medical Center Washington, DC 20007, USA
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38
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Brecher CW, Aviram G, Boiselle PM. CT and radiography of bacterial respiratory infections in AIDS patients. AJR Am J Roentgenol 2003; 180:1203-9. [PMID: 12704024 DOI: 10.2214/ajr.180.5.1801203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Chad W Brecher
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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39
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Lubis N, Baylis D, Short A, Stebbing J, Teague A, Portsmouth S, Bower M, Nelson M, Gazzard B. Prospective cohort study showing changes in the monthly incidence of Pneumocystis carinii pneumonia. Postgrad Med J 2003; 79:164-6. [PMID: 12697918 PMCID: PMC1742624 DOI: 10.1136/pmj.79.929.164] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pneumocystis carinii pneumonia (PCP) remains a serious opportunistic infection in HIV infected individuals. Seasonal changes in climate are associated with changes within individual susceptibility to infection. The possibility of monthly variability in the incidence of PCP was therefore examined by means of a cohort study of a database of 8640 HIV infected individuals attending the Chelsea and Westminster Hospital. There were 792 cases of PCP diagnosed since 1985. A marked decline was observed in the incidence of PCP in mid-1992 coincident with the introduction of PCP prophylaxis. There was a further decline in 1996 after the introduction of highly active antiretroviral therapy. Despite no significant monthly variation in the mean attendance to clinic and CD4 count, both new and all cases of PCP were higher in January than in other months (15.9% and 14.5% of all cases, respectively). A correlation with low rainfall in January and new cases of PCP was observed. These data are consistent with an influence of climatic conditions on the presentation of PCP. The diagnosis of PCP is more common in winter months suggesting that this is a transmissible infection.
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Affiliation(s)
- N Lubis
- Imperial College School of Medicine, London
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40
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Qureshi MH, Harmsen AG, Garvy BA. IL-10 modulates host responses and lung damage induced by Pneumocystis carinii infection. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2003; 170:1002-9. [PMID: 12517967 DOI: 10.4049/jimmunol.170.2.1002] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Host responses to Pneumocystis carinii infection mediate impairment of pulmonary function and contribute to the pathogenesis of pneumonia. IL-10 is known to inhibit inflammation and reduce the severity of pathology caused by a number of infectious organisms. In the present studies, IL-10-deficient (IL-10 knockout (KO)) mice were infected with P. carinii to determine whether the severity of pathogenesis and the efficiency of clearance of the organisms could be altered in the absence of IL-10. The clearance kinetics of P. carinii from IL-10 KO mice was significantly enhanced compared with that of wild-type (WT) mice. This corresponded to a more intense CD4(+) and CD8(+) T cell response as well as an earlier neutrophil response in the lungs of IL-10 KO mice. Furthermore, IL-12, IL-18, and IFN-gamma were found in the bronchoalveolar lavage fluids at earlier time points in IL-10 KO mice suggesting that alveolar macrophages were activated earlier than in WT mice. However, when CD4(+) cells were depleted from P. carinii-infected IL-10 KO mice, the ability to enhance clearance was lost. Furthermore, CD4-depleted IL-10 KO mice had significantly more lung injury than CD4-depleted WT mice even though the intensity of the inflammatory responses was similar. This was characterized by increased vascular leakage, decreased oxygenation, and decreased arterial pH. These data indicate that IL-10 down-regulates the immune response to P. carinii in WT mice; however, in the absence of CD4(+) T cells, IL-10 plays a critical role in controlling lung damage independent of modulating the inflammatory response.
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MESH Headings
- Adjuvants, Immunologic/deficiency
- Adjuvants, Immunologic/genetics
- Adjuvants, Immunologic/physiology
- Animals
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/parasitology
- Carbon Dioxide/blood
- Cell Movement/genetics
- Cell Movement/immunology
- Chemokines/biosynthesis
- Chemokines/genetics
- Cytokines/biosynthesis
- Host-Parasite Interactions/genetics
- Host-Parasite Interactions/immunology
- Interleukin-10/deficiency
- Interleukin-10/genetics
- Interleukin-10/physiology
- Lung/immunology
- Lung/parasitology
- Lung/pathology
- Lymphocyte Depletion
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, SCID
- Oxygen/blood
- Pneumocystis/immunology
- Pneumocystis/pathogenicity
- Pneumonia, Pneumocystis/genetics
- Pneumonia, Pneumocystis/immunology
- Pneumonia, Pneumocystis/parasitology
- Pneumonia, Pneumocystis/physiopathology
- RNA, Messenger/biosynthesis
- Respiratory Function Tests
- Up-Regulation/genetics
- Up-Regulation/immunology
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Affiliation(s)
- Mahboob H Qureshi
- Department of Internal Medicine and Microbiology, University of Kentucky, Lexington 40536, USA
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41
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Viale P, Scudeller L, Signorini L, Cadeo B, Petrosillo N, Pagani L, Carosi G. HIV-associated community-acquired pneumonia in the highly active antiretroviral therapy era. AIDS 2002; 16:2361-2. [PMID: 12441819 DOI: 10.1097/00002030-200211220-00027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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