HIV related bronchiectasis.

HIV related bronchiectasis In their review of new developments in pulmonary diseases affecting HIV infected individuals (March 1995;50:294-302) Mitchell and Miller do not discuss bronchiectasis. They mention indolent bronchopulmonary Pseudomonas aeruginosa infection comparable to that seen in cystic fibrosis, but do not comment on bronchiectasis which is now well described in adults and children with HIV infection. Bronchiectasis in a series of HIV infected adults was first reported from Oxford in 1992,' and the association has subsequently been confirmed in reports from the USA.23 The incidence of bronchiectasis in the HIV infected population remains to be established; it is frequently undiagnosed because of a low index of suspicion and because chest radiographs may be normal or non-specific. High resolution computed tomographic (CT) scanning is the investigation of choice.2 The aetiology is likely to be multifactorial, but recurrent bronchopulmonary infection is probably one of the most important contributing factors. Some cases have been seen following Pneumocystis carinii infection alone, while other cases have been related to various endobronchial lesions. Most cases of bron-chiectasis in HIV infected adults are seen following recurrent episodes of pyogenic infection with common pathogens such as Strep-tococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus au-reus. In paediatric practice bronchiectasis has emerged as a complication of lymphocytic interstitial pneumonitis. A report of the isolation of Burkholderia (formerly Pseudomonas) cepacia from one case of bronchiectasis in an adult with AIDS gives cause for concern.3 This organism has a predilection for the lungs of patients with cystic fibrosis and has caused several epidemics associated with cystic fib-rosis. The potential exists for B cepacia to pose a similar threat to HIV patients with chronic lung disease. At Boston City Hospital in the past year we have diagnosed bronchiectasis in three patients, aged 7, 10, and 16 years, out of 60 children with AIDS. All were boys and had congenitally acquired HIV infection. Each had experienced many previous episodes of pneumonia, and the two younger patients had previously experienced lymphocytic inter-stitial pneumonitis, based on chest radio-graphic findings or histopathological examination. Symptoms of chronic productive cough, exercise limitation, and persistent bas-ilar pulmonary infiltrates suggested bron-chiectasis, which in each case was confirmed by a chest CT scan. Sputum culture yielded S pneumoniae, H influenzae, non-typable, beta-lactamase negative, and normal flora in the three patients, respectively. We conclude that bronchiectasis has become a significant problem in HIV infected patients, and has the potential to cause …