Chave J P, Bille J, Glauser M P, Francioli P
Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Eur J Clin Microbiol Infect Dis. 1989 Feb;8(2):123-6. doi: 10.1007/BF01963894.
Over a three-year period, 54 episodes of pneumonia were diagnosed in 45 adults infected with the human immunodeficiency virus (HIV). These episodes were reviewed in order to assess the distribution of pathogens and their clinical presentation. Thirty-six episodes were due to an opportunistic pathogen (Pneumocystis carinii in 31, Mycobacterium avium complex in 3, Mycobacterium tuberculosis in 2), and 18 were caused by non-opportunistic pathogens (11 Streptococcus pneumoniae, 2 Haemophilus influenzae, 5 unknown pathogens that responded to broad-spectrum antibiotics). Non-opportunistic pneumonias were characterized by an abrupt onset (18/18 had pulmonary symptoms of less than 7 days duration), high fever (13/18), and focal lung infiltrates (17/18). In contrast, opportunistic infections infrequently presented with pulmonary symptoms of less than 7 days duration (3/36) or high fever (7/36), and most of the chest radiograms (34/36) disclosed a diffuse lung infiltrate. In HIV-infected patients presenting with pneumonia, simple clinical and radiological data may point to bacterial pathogens. Such data could be used in selected cases to spare invasive procedures and to start empirical antibiotic therapy.
在三年时间里，45名感染人类免疫缺陷病毒（HIV）的成年人被诊断出54次肺炎发作。对这些发作情况进行了回顾，以评估病原体的分布及其临床表现。36次发作是由机会性病原体引起的（31次为卡氏肺孢子菌，3次为鸟分枝杆菌复合体，2次为结核分枝杆菌），18次是由非机会性病原体引起的（11次为肺炎链球菌，2次为流感嗜血杆菌，5次为对广谱抗生素有反应的未知病原体）。非机会性肺炎的特点是起病急骤（18例中有18例肺部症状持续时间少于7天）、高热（18例中有13例）和肺部局灶性浸润（18例中有17例）。相比之下，机会性感染很少出现持续时间少于7天的肺部症状（36例中有3例）或高热（36例中有7例），并且大多数胸部X光片（36例中有34例）显示为弥漫性肺部浸润。在患有肺炎的HIV感染患者中，简单的临床和放射学数据可能指向细菌病原体。这些数据可用于某些病例，以避免进行侵入性检查并开始经验性抗生素治疗。
