Aetiology of cavitary lung lesions in patients with HIV infection^*

Abstract

Although many studies have been carried out on pulmonary diseases in HIV-infected patients, studies specifically investigating the aetiologies of cavitary lung lesions are rare. MethodsHIV-infected patients enrolled in a cohort study who presented with cavitary lung lesions by radiography were identified between June 1994 and March 2008. Medical records and radiological and microbiological data for these patients were retrospectively reviewed using a standardized case collection form. ResultsDuring the 14-year study period, 73 episodes of cavitary lung lesions were diagnosed in 66 of 1790 (3.7%) HIV-infected patients. At the diagnosis of cavitary lung lesions, the median CD4 count was 25 cells/mL (range 1-575 cells/mL). Eighty-one pathogens were considered causative, with fungi being the most common aetiology (42.0%), followed by bacteria (29.6%) and mycobacteria (25.9%). Of the fungal pneumonias, 19 (55.9%) were caused by Penicillium marneffei, 11 (32.4%) by Cryptococcus neoformans, two (5.9%) by Pneumocystis jirovecii, and two (5.9%) by Aspergillus species. During the study period, 11 of 205 patients (5.4%) who were diagnosed as having tuberculosis presented with cavitary lung lesions, compared with 19 of 36 patients (52.8%) with penicilliosis and 11 of 64 patients (17.2%) with cryptococcosis (Po0.0001). The median CD4 count of patients with cavitary lung lesions resulting from tuberculosis (115 cells/mL) was significantly higher than that of patients with cavitary lung lesions resulting from penicilliosis (4 cells/mL) and cryptococcosis (29.5 cells/mL). ConclusionsOur findings suggest that invasive infections attributable to endemic fungi were the leading cause of cavitary lung lesions among patients in the late stage of HIV infection, and were more common than infections attributable to bacteria and mycobacteria.

Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients

“…Nevertheless, pulmonary nodular lesions with or without cavitation, although reported in other studies, were not recognized as common manifestations of HIV-associated PC [6, 7, 10]. More recently, Lin et al reported that PC contributed to about 17% of the cavitary pulmonary lesions in HIV-infected patients [11]. …”

“…Also, penicilliosis was unlikely considered because our patients were not from an endemic area and did not have skin lesions or blood culture results consistent with penicilliosis. Aside from fungal infections, pulmonary nodules could also be caused by many other reasons, such as mycobacteria infection and malignancy [11, 13, 20–22], and those etiologies should be included in the differential diagnosis.…”

Clinical characteristics and outcome of Penicillium marneffei infection among HIV-infected patients in northern Vietnam

“…Of the 11 patients with dyspnea 5 also had lung lesions, of these one was diagnosed with Pneumocystis jiroveci and non with tuberculosis. Lung involvement of P. marneffei has been shown in Taiwan where it was found to be the most common cause of cavities in the lungs of immunosuppressed HIV infected patients [10]. The majority of patients with dyspnea did not have lung lesions, hence the dyspnea might be due to the severe condition with multi-organ involvement and acute respiratory distress syndrome (ARDS).…”

HIV and Tuberculosis: a Deadly Human Syndemic

“…on May 12, 2018 by guest http://cmr.asm.org/ cells/l should prompt a search for other etiologies (33,102,161,210). Although pulmonary TB is the most common presentation regardless of the stage of HIV infection, persons with advanced immune suppression are more likely to have extrapulmonary TB than are HIV-infected persons with relatively intact immunity or persons without HIV (15,33,83,136).…”