pulmonary infiltrate in patients with AIDS
Jump to navigation
Jump to search
Etiology
Epidemiology
- almost 50% of patients with AIDS initially present with pulmonary disease
Laboratory
- induced sputum samples for
- Pneumocystis jirovecii (P carinii)
- Mycobacteria
- fungi
- bacteria
- fiberoptic bronchoscopy
- open lung biopsy in patients in whom
- BAL is negative
- transbronchial biopsy is contraindicated
- chest radiographs
- Pneumocystis jirovecii
- diffuse interstitial or alveolar infiltrates
- upper lobe infiltrates in patients receiving aerosolized pentamidine
- Pneumocystis jirovecii
- arterial blood gas exchange abnormalities
Differential diagnosis
- opportunistic infections (majority of cases)
- Pneumocystis jirovecii is the most common pulmonary infection in patients with AIDS
- prophylaxis has reduced incidence
- non-productive cough
- dyspnea
- Mycobacterium avium intracellulare (MAI)
- cytomegalovirus (CMV)
- Cryptococcus neoformans
- Histoplasma capsulatum
- Toxoplasma gondii
- Coccidioides immitis
- Blastomyces dermatitidis
- Herpes simplex virus
- Pneumocystis jirovecii is the most common pulmonary infection in patients with AIDS
- non-opportunistic infections
- neoplasms
- lymphocytic & non-specific interstitial pneumonitis
- IV drug abuse may produce similar abnormalities
Management
- Empiric therapy for Pneumocystis pneumonia (PCP)
- Glucocorticoids for PCP with paO2 < 75 mm Hg on RA
- Specific therapy for documented
- Pneumocystis jirovecii
- fungus
- bacteria
- Mycobacterium tuberculosis
- Mycobacterium avium intracellulare (MAI) may be resistant to therapy
- radiotherapy for symptomatic airway obstruction or hemoptysis secondary to neoplasm.
More general terms
Additional terms
- Acquired Immuno-Deficiency Syndrome (HIV infection stage 3, AIDS)
- HIV1 infection; human immunodeficiency virus-1 infection
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 250