Magnenat J L, Nicod L P, Auckenthaler R, Junod A F
Department of Medicine, Geneva University Hospital, Switzerland.
Am Rev Respir Dis. 1991 Oct;144(4):917-22. doi: 10.1164/ajrccm/144.4.917.
Bacterial pneumonia (BP) has recently been reported to be more frequent in human immunodeficiency virus (HIV)-infected patients than in normal hosts. This study reviews the clinical and radiologic manifestations of BP in 132 consecutive pulmonary episodes over a 15-month period. BP was defined on a clinical basis as a pulmonary infiltrate accompanied by fever and improving in a few days with conventional antibiotics (trimethoprim-sulfamethoxazole excluded). In patients undergoing bronchoscopy (97 procedures), semiquantitative cultures and cell differentials of bronchoalveolar lavage (BAL) were performed, in addition to conventional staining and cultures for opportunistic infections. BP were frequent (45%), and the usual community-acquired pathogens were found. The radiologic manifestations of BP were often unusual, however, and 47% were indistinguishable from the typical appearance of Pneumocystis carinii pneumonia. BAL cultures had a sensitivity of 83 or 23%, depending on whether antibiotics were administered before bronchoscopy, using a cutoff value of greater than or equal to 10(4) bacteria/ml. The specificity of BAL culture was of 80.5% if patients with P. carinii pneumonia were taken as a control group. We conclude that BP is frequently encountered in HIV-infected patients. The clinical and radiologic presentation of BP may be indistinguishable from that of opportunistic infections. Semiquantitative cultures of BAL appear a valuable diagnostic tool to avoid unnecessary invasive diagnostic procedures or treatments.
据报道，细菌性肺炎（BP）在人类免疫缺陷病毒（HIV）感染患者中比在正常宿主中更为常见。本研究回顾了15个月内连续132例肺部发作的BP的临床和放射学表现。BP在临床上定义为伴有发热的肺部浸润，并在数天内使用传统抗生素（不包括甲氧苄啶-磺胺甲恶唑）后病情改善。在接受支气管镜检查的患者（97例）中，除了进行机会性感染的常规染色和培养外，还进行了支气管肺泡灌洗（BAL）的半定量培养和细胞分类。BP很常见（45%），并发现了常见的社区获得性病原体。然而，BP的放射学表现通常不寻常，47%与卡氏肺孢子虫肺炎的典型表现难以区分。根据支气管镜检查前是否使用抗生素，BAL培养的敏感性为83%或23%，临界值为大于或等于10⁴个细菌/毫升。如果以卡氏肺孢子虫肺炎患者作为对照组，BAL培养的特异性为80.5%。我们得出结论，BP在HIV感染患者中经常出现。BP的临床和放射学表现可能与机会性感染难以区分。BAL的半定量培养似乎是一种有价值的诊断工具，可避免不必要的侵入性诊断程序或治疗。
