Pneumothorax in HIV-infected patients: role of Pneumocystis carinii pneumonia and pulmonary tuberculosis

Tumbarello, Mario; Tacconelli, Evelina; Pirronti, Tommaso; Cauda, Roberto; Ortona, L

doi:10.1183/09031936.97.10061332

Cited by 32 publications

(19 citation statements)

References 20 publications

(37 reference statements)

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“…It has also been reported to complicate interstitial pneumonitis secondary to systemic lupus erythematosus [14] and bronchiolitis obliterans organising pneumonia [15]. In HIV infection, SP is reported in association with Pneumocystis carinii pneumonia in 9.5% and with tuberculosis in 6.8% of cases [16]. SP is also reported to complicate cytomegalovirus pneumonitis in patients with haematological malignancies [17] and idiopathic pneumonia syndrome after bone marrow transplantation [18].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome

Chu¹,

Leung²,

Hui³

et al. 2004

Eur Respir J

126

170

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Spontaneous pneumomediastinum (SP) unrelated to assisted ventilation is a newly recognised complication of severe acute respiratory syndrome (SARS). The objective of the present study was to examine the incidence, risk factors and the outcomes of SP in a cohort of SARS victims from a community outbreak.Data were retrieved from a prospectively collected database of virologically confirmed SARS patients. One hundred and twelve cases were analysable, with 13 patients developing SP (11.6%) at a mean ¡ SD of 19.6 ¡ 4.6 days from symptom onset.Peak lactate dehydrogenase level was associated with the development of SP. SP was associated with increased intubation and a trend towards death. Drainage was required in five cases. For patients who survived, the SP and/or the associated pneumothoraces took a median of 28 days (interquartile range: 15-45 days) to resolve completely.In conclusion, spontaneous pneumomediastinum appeared to be a frequent complication of severe acute respiratory syndrome. Further research is needed to investigate its pathogenesis. Severe acute respiratory syndrome (SARS) has been documented to be caused by a novel coronavirus (SARS-CoV) [1][2][3], which satisfied the Koch's postulations for causation [4,5]. At the time of writing, the numbers of probable SARS cases has reached 8,422 globally [6]. Two previous studies have noted the occurrence of spontaneous pneumomediastinum (SP) occasionally in patients with SARS, unrelated to assisted ventilation [7,8]. However, SP in SARS has not been systematically studied. In the present study the incidence, risk factors and the implications of the development of SP in SARS sufferers were examined. MethodsThe present study examined SP in SARS patients by retrospective analysis of a prospectively collected SARS database. Patients included in the study were consecutive SARS patients admitted to the United Christian Hospital (Hong Kong, SAR, China) during a community outbreak from March 24 to April 28, 2003. Patients met a modified WHO definition of SARS, which included fever (o38uC), cough or shortness of breath, new pulmonary infiltrates on radiological examination, in the absence of an alternative diagnosis, together with virological documentation of SARS-CoV infection (paired serology and/or positive RT-PCR for SARS-CoV from clinical specimens). All patients were treated with a standard protocol of broad spectrum antibiotics, ribavirin and a tailing regimen of corticosteroids [9]. The clinical, haematological, biochemical, radiological and virological findings were prospectively entered into a preset database, according to previous publications [1,7].Chest radiographs were taken at intervals of 1 to 3 days, depending on clinical need. SP was defined as the presence of gas in the mediastinum, occurring before assisted ventilation. For equivocal cases, high resolution computed tomography (HRCT) of the thorax would be utilised to detect this complication. All chest radiographs and HRCT were interpreted by thoracic radiologists. Results were expressed ...

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Section: Discussionmentioning

confidence: 99%

Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome

Chu¹,

Leung²,

Hui³

et al. 2004

Eur Respir J

126

170

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“…As recently stated, air enters the pleural space through ruptured alveoli as a result of peripheral lung necrosis, as in P. carinii pneumonia [31]. However, not only P. carinii pneumonia but also pulmonary tuberculosis enhance the risk of pneumothorax in AIDS patients [32]. …”

Section: Secondary Spontaneous Pneumothoraxmentioning

confidence: 99%

Management of spontaneous pneumothorax: state of the art

Jm¹,

Rami–Porta²,

Noppen³

et al. 2006

Eur Respir J

191

141

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Spontaneous pneumothorax remains a significant health problem. However, with time, there have been improvements in pathogenesis, diagnostic procedures and both medical and surgical approaches to treatment.Owing to better imaging techniques, it is now clear that there is almost no normal visceral pleura in the case of spontaneous pneumothorax, and that blebs and bullae are not always the cause of pneumothorax. In first episodes of primary spontaneous pneumothorax, observation and simple aspiration are established first-line therapies, as proven by randomised controlled trials. Aspiration should be better promoted in daily medical practice. In the case of recurrent or persistent pneumothorax, simple talc poudrage under thoracoscopy has been shown to be safe, cost-effective and no more painful than a conservative treatment using a chest tube. There are also new experimental data showing that talc poudrage, as used in Europe, does not lead to serious side-effects and is currently the best available pleural sclerosing agent.Alternatively, surgical techniques have considerably improved, and are now less invasive, especially due to the development of video-assisted thoracoscopic surgery. Studies suggest that video-assisted thoracoscopic surgery may be more cost-effective than chest tube drainage in spontaneous pneumothorax requiring chest tube drainage, although it is more expensive than simple thoracoscopy and requires general anaesthesia, double-lumen tube intubation and ventilation.Recommendations are made regarding the treatment of pneumothorax. In secondary or complicated primary pneumothorax, i.e. recurrent or persistent pneumothorax, some diffuse treatment of the visceral pleura should be offered, either by talc poudrage under thoracoscopy or by video-assisted thoracoscopic surgery. Moreover, all of these new techniques should be better standardised to permit comparison in randomised controlled studies.

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“…2). 16 Adjunctive testing may support the diagnosis of PCP but, by themselves, do not establish a diagnosis. This infection is unlikely in a patient who had a CD4+ cell count of >200 cells/µL in the preceding 2 months, in the absence of other HIV‐associated symptoms.…”

Section: Pneumocystis Jiroveci Pneumoniamentioning

confidence: 99%

Pulmonary complications of HIV infection

Rosen

2007

Respirology

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The AIDS epidemic has had a devastating global impact in the last two decades; although prevalence rates are low in Asia and the Pacific, their enormous population is associated with an estimated 1 million people infected with HIV in 2006 alone. Survival from what had been a uniformly fatal illness has improved markedly with combination antiretroviral therapy and restoration of the immune system, but these treatments are expensive and difficult to distribute to the millions who need them around the world. In addition, millions more do not know they are infected with HIV until they develop an opportunistic infection. The lungs are the most frequent sites of these infections, and in different geographic regions, tuberculosis, bacterial pneumonia and Pneumocystis jiroveci are the dominant pathogens. The incidences of lung cancer and HIV-associated pulmonary arterial hypertension are also increasing in patients with HIV infection, and with the use of antiretrovirals, inflammatory disorders associated with immune restoration are being recognized.

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Pneumothorax in HIV-infected patients: role of Pneumocystis carinii pneumonia and pulmonary tuberculosis

Cited by 32 publications

References 20 publications

Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome

Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome

Management of spontaneous pneumothorax: state of the art

Pulmonary complications of HIV infection

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