Features of systemic inflammation in patients with severe community-acquired (CAP) pneumonia of different etiology in HIV-infected patients

Abstract

Aim: to determine features of severe CAP in HIV-infected individuals.

Materials and methods: 62 patients with severe CAP were observed, after rapid testing the main group include 11 (17.7%) persons with severe CAP and identified HIV-infection. Pathogens identification, serum procalcitonin (PCT) and C-reactive protein (CRP)), CD₄, CD₈).

Results: causative agent in the study group was Pneumocystis jirivecii (9 (81.8%)), whereas at other 2 (18.2%) patients were identified Streptococcus pneumonia. Clinical features of severe CAP in HIV infected patients is nonmanifestal atypical clinical symptoms with predominance of respiratory distress syndrome on general intoxication (BR was 37,5±0,1 per 1 min, SaO2 79,2±3,0%).

Maximum level of PCT in patients with Pneumocystis pneumonia was 0.555 ng/ml, whereas in patients with Streptococcus pneumonia it was 1,75 ng/mland 26,92 ng/ml.

CD₄ count at main group was on 65% less than in healthy men and did not depend from etiology.

Conclusions: 1) in cases of suspected severe CAP in HIV-infected patients sputum PCR method allows you to quickly detect atypical respiratory pathogens (including Pneumocystis); 2) determination of serum levels of biomarkers allows to orient according to the reason for the severity of patients with severe CAP, and the need for antibiotic therapy; 3) in patients with severe CAP on the background of HIV there are no systemic inflammation but the risk of septic complications is still present at pneumococcal etiology of severe CAP.