Lung Abscess in Patients with AIDS

Abstract

We identified 31 patients with human immunodeficiency virus (HIV) infection and lung abscess. All patients had advanced HIV disease, and the mean CD4 cell count was 17/mm3 (range, 2-50/mm3). Twenty-two patients (71%) had previous opportunistic infections, and 24 (77%) had previous pulmonary infections. Symptoms at the time of presentation included fever (90% of patients), cough (87%), dyspnea (35%), pleuritic chest pain (26%), and hemoptysis (10%). The microbiological etiology was established for 28 patients, and the pathogens recovered were bacteria (65%), Pneumocystis carinii (6%), fungi (3%), and mixed microorganisms (16%). The pathogens included Pseudomonas aeruginosa (11), Streptococcus pneumoniae (6), P. carinii (5), Klebsiella pneumoniae (5), Staphylococcus aureus (4), Aspergillus species (3), viridans streptococcus (2), Haemophilus influenzae (1), Streptococcus milleri (1), Proteus mirabilis (1), and Cryptococcus neoformans (1). Mycobacterium tuberculosis was not isolated; two patients for whom a microbiological etiology was not established responded to antituberculous therapy. Patients were treated for 2-12 weeks; 25% of the patients received > 4 weeks of therapy. The outcome was poor: 36% of the patients had recurrences, and 19% died. In patients with AIDS, lung abscess is associated with advanced HIV infection, is due to a broad spectrum of pathogens, responds poorly to antibiotics, and has a poor prognosis.

Pyogenic bacterial lower respiratory tract infection in human immunodeficiency virus-infected patients

“…In the cohort study of GILKS et al [10], a first episode of bacterial pneumonia was observed in 54 patients during a 36-month follow-up. During this relatively short follow-up period, a first recurrence of bacterial pneumonia occurred in 24% of cases, which is the very high recurrence rate usually reported for HIV-infected patients [22,28,69,76]. The recurrence might be due to the same or a new pathogen [80].…”

“…The third situation with subacute or moderate progression of the condition, fever, weight loss, nodules [75] or alveolar infiltrates, with or without cavitation [76], in a patient with a CD4 T-cell count of v100 cells?mm -3 , usually indicates an opportunistic infection due to mycobacteria, fungus, Nocardia spp. or R. equi, but S. aureus, members of the Enterobacteriaceae family or P. aeruginosa might also be responsible.…”

Uncommon mycosis in a patient with diabetes

“…Although cavitating lung nodules have been described in pulmonary cryptococcosis, presentation with lung abscesses due to Cryptococcus is extremely rare. We came across only four cases of cryptococcal lung abscess reported in the published literature 2 3 22 23. Empyema due to Cryptococcus infection is also rare, with only a few reports both in HIV-infected and non-HIV-infected patients with other immunocompromising conditions 24 25.…”

“…Pulmonary cryptococcosis can present as nodules or mass-like lesions. There have been few reports of cryptococcal lung abscess 2 3. We describe an apparently immunocompetent patient who presented to us initially with a lung mass that progressed to lung abscess and empyema, and was diagnosed as disseminated cryptococcal disease.…”

Persistence of Pseudomonas aeruginosa in a pulmonary nodule with late relapse

“…Pseudomonas aeruginosa is a known cause of lung abscess in immune compromised hosts and other special populations such as injection drug users . However, the ability of this organism to persist in an otherwise quiescent lung nodule and recrudesce into an active infection is not generally appreciated or well documented.…”