Dual Pulmonary Infection with Mycobacterium tuberculosis and Pneumocystis carinii in Patients Infected with Human Immunodeficiency Virus

Abstract

During a 22-month period, we identified 39 patients with human immunodeficiency virus (HIV) infection (mean CD4(+) count, 90 cells/mm(3)) who were hospitalized with pneumonia and who had sputum and/or other specimens that tested concurrently positive for both Mycobacterium tuberculosis and Pneumocystis carinii. The most common chest x-ray abnormality was a reticulonodular pattern or bilateral infiltrates (n=26). Serum lactate dehydrogenase levels were elevated in 17 (85%) of 20 of patients tested (mean value, 2208 U/L). Mean O(2) saturation and PO(2) were 89% and 64 mm Hg, respectively. A majority (24 patients [62%]) received both antituberculous and anti-PCP therapy (17 with steroids), and 22 improved. All ten patients who received no treatment for PCP improved and were discharged from the hospital, whereas 4 (80%) of the 5 persons who received no antituberculous treatment had a poor outcome (P<.001; OR=43). Patients with HIV or acquired immune deficiency syndrome may present with both TB and PCP; of the 2, TB seems to account for the most severe features of disease.

Ineffectiveness of Trimethoprim‐Sulfamethoxazole Prophylaxis and the Importance of Bacterial and Viral Coinfections in African Children withPneumocystis cariniiPneumonia

“…Although the use of steroids did not affect mortality among children with PCP in our study, the result may have been different had mechanical ventilation been available [23,24]. Some children with PCP survived, despite having received either inadequate treatment (16 [84%] of 19 children) or no treatment at all (3 [75%] of 4 children), which has been reported elsewhere for HIV-1-infected adults [20]. The isolation of P. carinii cysts is rare among asymptomatic immunocompromised individuals [25], but we cannot exclude the coincidental shedding of these cysts among these children [26].…”

“…Gastric washings for the investigation of Mycobacterium species were requested at the discretion of the attending physician and were evaluated using the Bactec method coupled with a PCR amplification test and conventional culture that used a Lowenstein-Jensen agar, as described elsewhere [20].…”

“…carinii identification was performed using a direct monoclonal antibody immunofluorescent stain (Merifluor Pneumocystis). A test result was considered to be positive if у2 typical cysts characteristic of P. carinii morphology were observed at a magnification of 100ϫ by use of dark-field microscopy [20].…”

Risk factors for Pneumocystis carinii pneumonia in kidney transplant recipients: a case–control study

“…Patients with TB and non‐selective CD4 lymphocytopenia at diagnosis have been shown to normalize CD4 count after treatment for TB, suggesting that TB itself was causing non‐selective CD4 lymphocytopenia (20, 23, 24). The occurrence of PCP in a previously healthy patient in the setting of miliary TB and acquired CD4+ lymphocytopenia (24) and the occurrence of 39 cases of dual infections caused by P. carinii and M. tuberculosis in HIV‐positive patients have been reported (25). The authors report that 10 patients treated for TB who received no treatment for PCP improved and were discharged from hospital (25).…”

Evaluation of Sensitivity of Multiplex PCR for Detection of Mycobacterium tuberculosis and Pneumocystis jirovecii in Clinical Samples

“…Pulmonary tuberculosis (TB) and Pneumocystis jirovecii pneumonia are two of the most common opportunistic infections found in association with AIDS worldwide (4), including Thailand (2,3,6,10). About one-third of the world's population and one-third of people infected with HIV are infected with Mycobacterium tuberculosis.…”