Pneumococcal Pneumonia in Adult Hospitalized Patients Infected With the Human Immunodeficiency Virus

Abstract

The HIV-infected patient is at increased risk for pneumococcal pneumonia and bacteremia. Patients younger than 40 years of age who present with pneumococcal pneumonia should be considered for HIV testing, since it may be the first manifestation of HIV infection. Specific antimicrobial therapy is curative in the majority of HIV-infected patients.

Impact of Penicillin Susceptibility on Medical Outcomes for Adult Patients with Bacteremic Pneumococcal Pneumonia

“…Indeed, this proportion may be an underestimate because we assumed that patients without medical-record documentation of HIV infection were HIV-uninfected. Prior work has demonstrated that HIV-infected patients are at a significantly higher risk of developing bacteremic pneumococcal pneumonia than is the general population [34][35][36]. However, in this study, HIV infection was not a risk factor for infection with a penicillin-nonsusceptible isolate (table 1).…”

Bacteremic Pneumococcal Pneumonia in HIV-Seropositive and HIV-Seronegative Adults

“…In particular, there were lower levels of initial WBC count and serum albumin in the HIV-seropositive patients. Although these two parameters have previously been noted by some investigators 16,17,19,22,24,25 to be important negative prognostic factors in pneumococcal bacteremia (being present more commonly in patients who require ICU admission or in patients who died), their presence in the HIV-seropositive patients in our study was not associated with a worse outcome. This may simply reflect a statistical analysis that was performed with a small number of patients; however, it is important to note that although the overall WBC count in our HIV-seropositive group was lower than that of the HIV-seronegative group, only three patients actually had leukopenia, one of whom died.…”

“…There appeared to be more multilobar consolidation among our HIV-seropositive patients, but this difference did not quite reach statistical significance. While some investigators 16 have noted a difference in the radiologic appearance of AIDS patients with bacteremic pneumococcal pneumonia compared with HIV-seropositive patients without AIDS and HIV-seronegative individuals (such patients being more likely to have bilateral infiltrates), other investigators 9,16,24 have found no differences when comparing the radiologic findings in HIV-seropositive and HIV-seronegative patients alone.…”

Bacteraemic pneumococcal pneumonia: Impact of HIV on clinical presentation and outcome

“…This finding has also been noted in U.S. and Spain and for this reason, we agree that young patients presenting with an episode of invasive pneumococcal infection should be screened for co-existing HIV infection. 12,28 The pneumococci isolated from HIV patients demonstrated significantly less antibiotic resistance than isolates from the non-HIV patients (Table 4). This may be due to the fact that fewer South African patients had been diagnosed as having pneumonia previously and/or received antibiotics in the past 3 months, known risk factors for pneumococcal antibiotic resistance.…”