Management and Outcome of Pneumothoraces in Patients Infected with Human Immunodeficiency Virus

Ingram, R. J. H.; Call, Stephanie; Andrade, Adriana Ribas; White, Charles; Wheeler, D. M.

doi:10.1093/clinids/23.3.624

Cited by 21 publications

(18 citation statements)

References 11 publications

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“…2 deaths. Increased association with PCP, 9.7% of PCP pts had pneumothoraxSmall N, retrospective Ingram RJ et al 1996 [26]Retrospective chart review39 pts, 60 pneumothoraces total. 32 pneumothoraces from traumaMortality.…”

Section: Resultsmentioning

confidence: 99%

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An argument for the conservative management of small traumatic pneumathoraces in populations with high prevalence of HIV and tuberculosis: an evidence-based review of the literature

et al. 2010

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BackgroundTraumatic pneumothoraces are common. Many are managed with tube thoracostomy. However, there is a high complication rate from chest tube placement, particularly in patients with HIV, TB, or both.AimsWe sought to investigate the literature on the conservative management of traumatic pneumothorax in patients with HIV and/or TB.MethodsThe literature search was broken into two parts. In the first part, we searched for articles comparing tube thoracostomy versus conservative management in traumatic pneumothorax. In the second part, we sought articles describing the incidence and outcome of pneumothoraces in patients with pre-existing HIV or tuberculosis. In both, relevant articles were reviewed, and citations were hand-searched.ResultsFor the first portion, we identified 384 papers. From these, six studies were relevant. For the second portion, we identified 327 articles. A total of four unique articles were selected. The heterogeneity of the studies did not allow any pooled analysis. The studies of conservative management demonstrated a low percentage of patients with small pneumothoraces (most often <1.5 cm or less than 10%) later required tube thoracostomy for clinical deterioration (range 6–25%). No studies focused exclusively on pneumothoraces in patients with TB. In patients with HIV, there were no prospective trials of conservative management. Mortality for all HIV-infected patients with pneumothorax was high (25–50%), and the rate of complications from tube thoracostomy was also high. Pneumocystits carinii pneumonia (PCP) independently increased mortality.ConclusionsA review of the literature suggests that selected small pneumothoraces may be managed conservatively and that there is a high rate of complications related to tube thoracostomy in HIV patients. We propose a trial of the safety of conservative management of traumatic pneumothoraces in an area with a high prevalence of HIV and TB.

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Section: Resultsmentioning

confidence: 99%

“…Ingram et al reviewed cases of HIV-infected patients diagnosed with pneumothorax over a 6-year period [26]. In 1,836 HIV infected patients, 60 pneumothoraces were identified in 39 patients.…”

Section: Resultsmentioning

confidence: 99%

An argument for the conservative management of small traumatic pneumathoraces in populations with high prevalence of HIV and tuberculosis: an evidence-based review of the literature

et al. 2010

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“…Cuando la presión alveolar excede la presión del intersticio pulmonar, como ocurre en pacientes con EPOC y la inflamación de las vías aéreas después de toser, el aire que sale de la rotura alveolar se dirige a través del paquete broncovascular al hilio ipsilateral, produciendo un neumomediastino; si el aire se dirige hacia el espacio pleural, se produce neumotórax. Un mecanismo alternativo para neumotórax espontáneo secundario es la rotura alveolar como resultado de necrosis pulmonar, como ocurre en la neumonía por Pneumocistis jerovecci (2,12,17) .…”

Section: Discussionunclassified

Neumotórax espontáneo secundario a tuberculosis pulmonar activa de reciente diagnóstico

2011

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Se presenta el caso de un paciente varón de 17 años de edad, estudiante, procedente de Lima, sin antecedente de contacto tuberculoso, con Elisa para HIV no reactivo, quien fue diagnosticado, 21 días antes de su ingreso, de tuberculosis pulmonar activa con baciloscopia en esputo 3 +, por lo que inició tratamiento específico con esquema I. Fue hospitalizado por presentar dolor torácico tipo punzada de inicio súbito y disnea moderada, encontrándose en el examen físico abolición de las vibraciones vocales, ausencia de murmullo vesicular e hipersonoridad en hemitórax derecho, compatible con neumotórax de dicho lado. En la radiografía de tórax se evidenció importante colapso pulmonar en hemotórax derecho. Se colocó tubo de drenaje toráxico con sello de agua y se continuó con tratamiento específico. Su evolución fue tórpida, habiéndose complicado con empiema piógeno, siendo necesaria la realización de una toracostomia, lo que motivó una hospitalización prolongada. El neumotórax espontáneo secundario se presenta con mayor frecuencia en la fase de fibrosis de la tuberculosis. Se trata, por tanto, de complicación muy infrecuente de la tuberculosis pulmonar activa recientemente diagnosticada, motivo por el cual presentamos el caso.

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“…La aparición de neumotórax está relacionada en forma creciente al uso de drogas intravenosas, con invasión del espacio pleural por inyecciones cervicales y drogas inhalatorias, que actúan como factores obstructivos; existe también una relación directa con el hábito tabáquico 7,8 . El uso de ventilación mecánica es otra causa que se relaciona con aparición de neumotórax, en este caso iatrogénica, así como la colocación de vías centrales y la toracocentesis 9,10 . El trauma también se menciona como causa de esta complicación.…”

Section: Discussionunclassified

Presentación inhabitual de un caso de neumonía bulosa aguda bilateral por Pneumocystis jiroveci complicada con neumotórax

P¹,

H²,

C³

2007

Rev. chil. infectol.

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Unusual presentation of bilateral bullous Pneumocystis jiroveci pneumonia complicated with pneumothorax In patients with human immunodeficiency virus infection, pneumothorax overcomes in advanced stages of the illness, associated with infections by Mycobacterium tuberculosis or Pneumocystis jiroveci, in smokers and intravenous drug users. We present a case with this unusual complication: homosexual man, 30 years of age, with a history of one month of cough, progressive dyspnea, weight loss and diarrhea. He was hospitalized with the diagnosis of atypical pneumonia, respiratory failure and a presumptive HIV infection. His clinical course was complicated by the presence of bullae and pneumothorax by day 15 of hospitalization. The existence of Pneumocystis jiroveci in sputum was confirmed by a direct immunofluorescence test. The patient was treated with sulpha-trimethoprim, steroids, oxygen, but he died 21 days after admittance. The strategies recommended for treatment of pneumothorax appeared during P. jiroveci pneumonia in HIV positive patients are summarized.

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Management and Outcome of Pneumothoraces in Patients Infected with Human Immunodeficiency Virus

Cited by 21 publications

References 11 publications

An argument for the conservative management of small traumatic pneumathoraces in populations with high prevalence of HIV and tuberculosis: an evidence-based review of the literature

An argument for the conservative management of small traumatic pneumathoraces in populations with high prevalence of HIV and tuberculosis: an evidence-based review of the literature

Neumotórax espontáneo secundario a tuberculosis pulmonar activa de reciente diagnóstico

Presentación inhabitual de un caso de neumonía bulosa aguda bilateral por Pneumocystis jiroveci complicada con neumotórax

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