Kaufmann P, Opravil M, Hauser M, Gaspert A, Laube I, Jenni R, Speich R
Department Innere Medizin, Universitätsspital Zürich.
Schweiz Med Wochenschr. 1999 Jan 30;129(4):120-30.
Bacterial pneumonias are the most common pulmonary complication in HIV-infected patients. Up to now, H. influenzae and S. pneumoniae have been described as the most important germs. Within a period of 4 years we diagnosed 15 cases of pneumonia caused by P. aeruginosa. All patients were in HIV stage C3; 3F, 12M; median age 34 (24-54) years; median CD4 count 10 (0-130) microliters. Except for 3 nosocomial pneumonias, all others were community-acquired. Only 3 patients had neutropenia < 1000/microliter; 7 were intravenous drug abusers. Morphologically there were 6 cases of abscess pneumonia, in 3 of which pleural drainage was necessary because of pyopneumothorax. 4 patients showed bilateral infiltrates that could not be differentiated from those of P. carinii pneumonia. Our diagnosis was based on quantitative cultures of broncho-alveolar lavage fluid (9 cases, two of them with concurrent positive blood cultures/positive cultures of the pleural fluid), pleural puncture (one case), sputum in pneumonias responding only to antipseudomonas therapy (3 cases), and autopsy (2 cases). 8 patients died of pseudomonas pneumonia within 1-3 months despite therapy. 7 patients received pseudomonas-specific combination therapy, but all died after median 9 (4-15) months of the underlying illness. In 3 cases recurrent pseudomonas pneumonia could be documented bacteriologically. We conclude that in HIV-infected patients pneumonia caused by P. aeruginosa is a significant and severe pulmonary complication.
细菌性肺炎是HIV感染患者最常见的肺部并发症。到目前为止，流感嗜血杆菌和肺炎链球菌被认为是最重要的病菌。在4年的时间里，我们诊断出15例由铜绿假单胞菌引起的肺炎。所有患者均处于HIV C3期；3名女性，12名男性；中位年龄34（24 - 54）岁；中位CD4细胞计数为10（0 - 130）微升。除3例医院获得性肺炎外，其余均为社区获得性肺炎。只有3例患者中性粒细胞减少<1000/微升；7例为静脉吸毒者。形态学上有6例脓肿性肺炎，其中3例因脓气胸需要进行胸腔引流。4例患者表现为双侧浸润，无法与卡氏肺孢子虫肺炎相鉴别。我们的诊断基于支气管肺泡灌洗液体的定量培养（9例，其中2例同时血培养阳性/胸腔积液培养阳性）、胸腔穿刺（1例）、仅对抗假单胞菌治疗有反应的肺炎患者的痰液（3例）以及尸检（2例）。尽管进行了治疗，仍有8例患者在1 - 3个月内死于假单胞菌肺炎。7例患者接受了针对假单胞菌的联合治疗，但在基础疾病发病后中位9（4 - 15）个月全部死亡。在3例患者中，可通过细菌学方法记录到复发性假单胞菌肺炎。我们得出结论，在HIV感染患者中，由铜绿假单胞菌引起的肺炎是一种严重的肺部并发症。
