Clinical features and etiology of pneumonia in acid-fast bacillus sputum smear-negative HIV-infected patients hospitalized in Asia and Africa

Abstract

In South-east Asia, acid-fast bacillus smear-negative pneumonia is caused by a wide variety of pathogens. When possible, fiberoptic bronchoscopy must be performed rapidly if clinical data are not highly suggestive of bacterial pneumonia, Pneumocystis jiroveci pneumonia or tuberculosis. In contrast, in Africa, bacterial pneumonia and tuberculosis are responsible for the large majority of cases. Fiberoptic bronchoscopy should be restricted to patients with clinical and/or radiological findings not suggestive of bacterial pneumonia or tuberculosis, antibiotic failure, and three consecutive negative sputum smears.

Pneumocystis jiroveciipneumonia in developing countries

“…Recent reports have described an increased rate of PcP in Africa, Asia and South America (Worodria et al , 2003; Aderaye et al , 2007; Le Minor et al , 2008; Panizo et al , 2008; Vray et al , 2008). In this study, we review published studies that have reported the frequency of PcP in developing countries, focusing mainly on more recent data.…”

Étiologie des pneumonies BAAR négatives chez les patients infectés par le VIH hospitalisés à Dakar (étude ANRS 1260)

“…Les critères suivants ont été utilisés pour classer les patients en quatre catégories de diagnostic. Ces critères sont décrits en détail par ailleurs [10] :…”

TB/AIDS Coinfection: An Integrated Clinical and Research Response

“…For example, TB was diagnosed in 43% of adults presenting to primary health care clinics with cough for three weeks or longer (chronic cough) in Harare, Zimbabwe [82], and in 48% and 70%, respectively, of patients attending chest clinics with chronic cough in Kenya and Malawi [83][84][85]. Furthermore, TB was the leading cause of pneumonia in immune-suppressed AIDS patients in South-east Asia [86,87].…”

“…Respiratory symptoms and cough are, however, among the most common manifestations of HIV infection, with a wide spectrum of differential diagnoses including nontuberculous bacterial pneumonias and lower respiratory tract infections (LRTIs), bronchiectasis (often post-tuberculous) and, in Africa, Kaposis sarcoma [86,87,89,90]. In many parts of the world, HIV-positive people are also more likely to be smokers than are uninfected individuals, thus also putting them at risk of smoking-related diseases [91].…”

“…For example, M. tuberculosis was isolated from 9% of adults with acute pneumonia in Kenya [94], from 35% of chest clinic attendees with cough for less than three weeks in Malawi [95], and from 13% of HIV-infected patients with chronic diarrhea in Kenya [96]. In a series from Cambodia, 17% of smear-negative HIV-positive patients with pneumonia with a median CD4 T-cell count of 25 ml À1 were proven to have TB by fiber optic bronchoscopy [87]. In another series from Asia and Africa, following ART initiation, 253 of 496 patients were diagnosed with TB, with 145 extrapulmonary cases [86].…”