Aetiology of cavitary lung lesions in patients with HIV infection
Background 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. Methods HIV‐infected patients enrolled in a cohort study who presented with cavitary lung lesions by radiograph...
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Published in | HIV medicine Vol. 10; no. 3; pp. 191 - 198 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Oxford, UK
Blackwell Publishing Ltd
01.03.2009
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Subjects | |
Online Access | Get full text |
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Summary: | Background
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.
Methods
HIV‐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.
Results
During 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/μL (range 1–575 cells/μL). 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 (P<0.0001). The median CD4 count of patients with cavitary lung lesions resulting from tuberculosis (115 cells/μL) was significantly higher than that of patients with cavitary lung lesions resulting from penicilliosis (4 cells/μL) and cryptococcosis (29.5 cells/μL).
Conclusions
Our 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. |
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Bibliography: | † Preliminary analyses of these data were presented as Abstract 1733_140 at the 17th European Congress of Clinical Microbiology and Infectious Diseases held in Munich, Germany, 31 March to 3 April 2007. * Drs C. Y. Lin and H. Y. Sun contributed equally to the paper. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1464-2662 1468-1293 |
DOI: | 10.1111/j.1468-1293.2008.00674.x |