The significance of Pneumocystis carinii pneumonia(PCP) in AIDS is well established. However it has been reported to be simultaneously associated with other opportunistic infections. The aim of this study was to investigate the prevalence of Mycobacterium tuberculosis(MTB) in patients diagnosed by bronchoscopy with PCP in an inner city hospital with high prevalence rates of HIV infection and Tuberculosis.
Retrospective review of Bronchoscopy results obtained between 7/99 and 3/04.
A total of 500 bronchoscopies were performed during this period. PCP was detected in 75 patients (15%). All these patients were HIV infected. Five PCP patients were co-infected with MTB and 1 patient with histoplasma. Their clinical, radiological, microbiological and pathological characteristics are shown in Table 1 and Table 2.
Table 1.PatientCoinfectionCD4VLClinical SuspicionSuggestive X RaySuggestive CT1MTB11021.9K+++Interstitial infiltrate, R hilar calcified noduleN/A2MTB271405K+++MiliaryN/A3MTB72>100K+/−Diffuse reticulonodularDiffuse nodules4MTB163>750K+/−Diffuse reticulonodularDiffuse Nodules5MTB46494K−Diff. Air space consolidationN/A6Histoplasma16653K+/−Alveolar/nodular infiltrateAlveolar/nodular infiltrate
+ suspicious − not suspiciousTable 2.PatientSputum AFB Smear/CultureBAL Fungal CultureBAL AFB Smear/CultureLung Biopsy AFB Stain/Culture1−/−−−/−Caseating granuloma+/not done2−/+−−/+Caseating granuloma−/+3−/+Yeast−/+Non-caseous granuloma−/+4−/+Candida−/+Necrotizing pneumonia+/−5+/+−−/+Not done6−/−Histoplasma−/−Histoplasmosis−/−
+ positive − negative
Patients with advanced AIDS may have an increased incidence of coexisting opportunistic lung infections. The presence of PCP in BAL can mask other opportunistic infections such as TB and fungal diseases.
In AIDS patients presenting with pulmonary manifestations an aggressive diagnostic approach by bronchoscopy including transbronchial lung biopsy, as well as prompt initiation of empiric treatment is essential even when the suspicion for other co-morbidities is low and diagnosis of PCP has been established.
V.E. Coelho-D’Costa, None.