[The spectrum of bronchopulmonary infection caused by Pseudomonas aeruginosa in patients infected with the human immunodeficiency virus].

OBJECTIVE

To describe the clinical spectrum of bronchopulmonary infections caused by Pseudomonas aeruginosa in patients infected with HIV.

METHODS

A retrospective study of cases with P. aeruginosa pneumonia and tracheo-bronchitis in patients infected with HIV, diagnosed over a 5-year period (January 1990-December 1994) in a third level university hospital.

RESULTS

Seven patients with pneumonia and 15 with tracheobronchitis were identified, with a mean age of 33 years. All patients were in an advanced stage of immunosuppression (median CD4 count 11/mm3) and 21 (95%) had AIDS. In 6 cases (86%) pneumonia was acquired in the community and no patient had severe neutropenia. Clinical presentation ranged from severe pneumonia with respiratory insufficiency and shock to subacute less severe disease. Two patients (29%) died in the first episode as a result of pneumonia. The combination of cough, purulent expectoration and fever was the usual presenting form of tracheo-bronchitis. Nine out of the 15 patients (60%) had been treated previously because of tracheo-bronchitis and/or bacterial pneumonia episodes not caused by P. aeruginosa. Twelve patients required hospital admission; ten patients (83%) because of tracheo-bronchitis symptoms. The initial response to therapy was satisfactory, but 12 (80%) relapsed, with 2.6 relapses per patient after a mean follow-up of 7.4 months.

CONCLUSIONS

P. aeruginosa bronchopulmonary infections emerge in late stages of HIV disease. P. aeruginosa should be considered in the differential diagnosis of every patient with pneumonia and advanced AIDS, even in the absence of the traditionally reported risk factors. Initially, tracheo-bronchitis responds well to therapy, but its management is difficult because of the frequent relapses and the development of antibiotic resistance.