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Community-acquired lung respiratory infections in HIV-infected patients: microbial aetiology and outcome

Catia Cilloniz, Antoni Torres, Eva Polverino, Albert Gabarrus, Rosanel Amaro, Encarnacion Moreno, Santiago Villegas, Mar Ortega, Josep Mensa, Maria Angeles Marcos, Asuncion Moreno, Jose M. Miro
European Respiratory Journal 2014; DOI: 10.1183/09031936.00155813
Catia Cilloniz
Dept of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERes), Barcelona,
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Antoni Torres
Dept of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERes), Barcelona,
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Eva Polverino
Dept of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERes), Barcelona,
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Albert Gabarrus
Dept of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERes), Barcelona,
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Rosanel Amaro
Dept of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERes), Barcelona,
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Encarnacion Moreno
Dept of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERes), Barcelona,
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Santiago Villegas
Departamento de Medicina Crítica y Cuidados Intensivos, Universidad CES, Medellin Colombia,
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Mar Ortega
Infectious Disease Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona,
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Josep Mensa
Infectious Disease Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona,
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Maria Angeles Marcos
Dept of Microbiology, Barcelona Centre for International Health Research, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Asuncion Moreno
Infectious Disease Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona,
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Jose M. Miro
Infectious Disease Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona,
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Abstract

We describe the aetiology of community-acquired pneumonia (CAP) in HIV-infected patients, risk factors for bacterial or Pneumocystis jirovecii CAP and prognostic factors of 30-day mortality.

This was a prospective observational study of 331 consecutive adult CAP cases in HIV-infected patients (January 2007 to July 2012).

128 (39%) patients had CD4+ cell counts <200 per mm3 and 99 (43%) ha HIV RNA levels <200 copies per mL on antiretroviral therapy. Streptococcus pneumoniae was the most frequent microorganism in the group with CD4+ cell counts ≥200 per mm3; P. jirovecii was the most frequent microorganism in the group with CD4+ cell counts <200 per mm3 and in patients with HIV RNA ≥200 copies per mL. Predictors of bacterial CAP were: time with symptoms ≤5 days (OR 2.6, 95% CI 1.5–4.4), C-reactive protein level ≥22 mg·dL−1 (OR 4.3, 95% CI 2.3–8.2) and hepatitis C virus co-infection (OR 2.3, 95% CI 1.4–3.9). White blood cell count ≤4×1012 per L (OR 3.7, 95% CI 1.2–11.5), lactate dehydrogenase (LDH) level ≥598 U·L−1 (OR 12.9, 95% CI 4.2–39.7) and multilobar infiltration (OR 5.8, 95% CI 1.9–19.5) were predictors of P. jirovecii. Overall 30-day mortality was 7%. Appropriate antibiotic treatment (OR 0.1, 95% CI 0.03–0.4), LDH ≥598 U·L−1 (OR 6.2, 95% CI 1.8–21.8) and mechanical ventilation (OR 22.0, 95% CI 6.2–78.6) were the variables independently associated with 30-day mortality.

The described predictors may help clinicians to distinguish between bacterial and P. jirovecii pneumonia in patients with suspected or confirmed HIV infection.

Abstract

Clinical risk factors in HIV patients to distinguish between bacterial and Pneumocystis jirovecii pneumonia http://ow.ly/sV2hf

  • Received September 5, 2013.
  • Accepted January 2, 2014.
  • © ERS
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Community-acquired lung respiratory infections in HIV-infected patients: microbial aetiology and outcome
Catia Cilloniz, Antoni Torres, Eva Polverino, Albert Gabarrus, Rosanel Amaro, Encarnacion Moreno, Santiago Villegas, Mar Ortega, Josep Mensa, Maria Angeles Marcos, Asuncion Moreno, Jose M. Miro
European Respiratory Journal Jan 2014, erj01558-2013; DOI: 10.1183/09031936.00155813

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Community-acquired lung respiratory infections in HIV-infected patients: microbial aetiology and outcome
Catia Cilloniz, Antoni Torres, Eva Polverino, Albert Gabarrus, Rosanel Amaro, Encarnacion Moreno, Santiago Villegas, Mar Ortega, Josep Mensa, Maria Angeles Marcos, Asuncion Moreno, Jose M. Miro
European Respiratory Journal Jan 2014, erj01558-2013; DOI: 10.1183/09031936.00155813
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