Torres-Tortosa Manuel, Arrizabalaga Julio, Villanueva José L, Gálvez Juan, Leyes María, Valencia M Eulalia, Flores Juan, Peña José M, Pérez-Cecilia Elisa, Quereda Carmen
hospital Punta de Europa, Algeciras, Spain.
Chest. 2003 Jun;123(6):1970-6. doi: 10.1378/chest.123.6.1970.
To assess the clinical characteristics and the factors that influenced the prognosis of patients with HIV and infection caused by Rhodococcus equi.
Observational, multicenter study in 29 Spanish general hospitals.
These hospitals comprised a total of 20,250 beds for acute patients and served a population of 9,716,880 inhabitants.
All patients with HIV and diagnosed R equi infection until September 1998.
During the study period, 19,374 cases of AIDS were diagnosed. Sixty-seven patients were included (55 male patients; mean +/- SD age, 31.7 +/- 5.8 years). At the time of diagnosis of R equi infection, the mean CD4+ lymphocyte count was 35/ micro L (range, 1 to 183/ micro L) and the stage of HIV infection was A3 in 10.4% of patients, B3 in 31.3%, C3 in 56.7%, and unknown in 1.5%. R equi was most commonly isolated in sputum (52.2%), blood cultures (50.7%), and samples from bronchoscopy (31.3%). Chest radiographic findings were abnormal in 65 patients (97%). Infiltrates were observed in all of them, with cavitations in 45 patients. The most active antibiotics against the strains isolated were vancomycin, amikacin, rifampicin, imipenem, ciprofloxacin, and erythromycin. After a mean follow-up of 10.7 +/- 12.8 months, 23 patients (34.3%) died due to causes related to R equi infection and 6 other patients showed evidence of progression of the infection. The absence of highly active antiretroviral therapy (HAART) was independently associated with mortality related to R equi infection (relative risk, 53.4; 95% confidence interval, 1.7 to 1,699). Survival of patients treated with HAART was much higher than that of patients who did not receive this therapy.
Infection by R equi is an infrequent, opportunistic complication of HIV infection and occurs during advanced stages of immunodepression. In these patients, it leads to a severe illness that usually causes a bacteremic, cavitary pneumonia, although HAART can improve the prognosis.
评估感染马红球菌的HIV患者的临床特征及影响预后的因素。
在西班牙29家综合医院开展的观察性多中心研究。
这些医院共有20250张急性病床位，服务于9716880名居民。
截至1998年9月所有诊断为感染马红球菌的HIV患者。
在研究期间，共诊断出19374例艾滋病病例。纳入67例患者（55例男性患者；平均年龄±标准差为31.7±5.8岁）。在诊断马红球菌感染时，CD4+淋巴细胞平均计数为35/μL（范围为1至183/μL），10.4%的患者处于HIV感染A3期，31.3%处于B3期，56.7%处于C3期，1.5%情况不明。马红球菌最常从痰液（52.2%）、血培养（50.7%）和支气管镜检查样本（31.3%）中分离出来。65例患者（97%）胸部X线检查结果异常。所有患者均有浸润影，45例有空洞形成。对分离出的菌株最有效的抗生素是万古霉素、阿米卡星、利福平、亚胺培南、环丙沙星和红霉素。平均随访10.7±12.8个月后，23例患者（34.3%）因与马红球菌感染相关的原因死亡，另外6例患者有感染进展的证据。未接受高效抗逆转录病毒治疗（HAART）与马红球菌感染相关的死亡率独立相关（相对风险为53.4；95%置信区间为1.7至1699）。接受HAART治疗的患者生存率远高于未接受该治疗的患者。
马红球菌感染是HIV感染罕见的机会性并发症，发生于免疫抑制晚期。在这些患者中，它会导致严重疾病，通常引起菌血症性空洞性肺炎，不过HAART可改善预后。
