Parapneumonic effusions secondary to community-acquired bacterial pneumonia in human immunodeficiency virus-infected patients

Abstract

The purpose of this study was to determine whether the clinical and microbiological characteristics of parapneumonic effusions in patients with community-acquired pneumonia (CAP) infected with the human immunodeficiency virus (HIV) were different from those observed in patients without HIV infection. One hundred and thirty seven patients with parapneumonic effusions were included and divided into two groups depending on whether they had HIV infection or not. The parapneumonic effusion rate was significantly higher in HIV-positive than in noninfected patients (21 vs 13%). Their clinical course was more severe, presenting a higher rate of bacteraemias (58 vs 18%). Pleural fluid in patients infected with HIV had significantly lower glucose levels than that of patients without HIV infection. Chest tube drainage was more frequent in parapneumonic effusions of patients infected with HIV than in those without HIV infection (71 vs 44%). Staphylococcus aureus was the most common microorganism found in the bacteriological samples of patients with CAP infected with HIV (53 vs 12%). We conclude that patients with community-acquired pneumonia and HIV infection have a higher rate of parapneumonic effusions and a more severe clinical course than non-HIV patients, and that Staphylococcus aureus predominates in their bacteriological samples.

Evaluation of Respiratory Disease

“…The typical chest radiographic appearance includes unilateral, lobar or segmental consolidation; however, as immune function deteriorates, multilobar and bilateral radiographic disease become more common. Pleural effusions are present in 12% to 47% of patients with bacterial pneumonia (45, 46) and empyemas develop in 2% to 6% (47, 48). …”