Die Pseudomonas-Pneumonie – eine wichtige Differentialdiagnose pulmonaler Infiltrate bei Aids

Bacterial pneumonias are the most common pulmonary complication in HIV-infected patients. Up to now, H. influenzae and S. pneumoniae have been described as the most important germs. Within a period of 4 years we diagnosed 15 cases of pneumonia caused by P. aeruginosa. All patients were in HIV stage C3; 3F, 12M; median age 34 (24-54) years; median CD4 count 10 (0-130) microliters. Except for 3 nosocomial pneumonias, all others were community-acquired. Only 3 patients had neutropenia < 1000/microliter; 7 were intravenous drug abusers. Morphologically there were 6 cases of abscess pneumonia, in 3 of which pleural drainage was necessary because of pyopneumothorax. 4 patients showed bilateral infiltrates that could not be differentiated from those of P. carinii pneumonia. Our diagnosis was based on quantitative cultures of broncho-alveolar lavage fluid (9 cases, two of them with concurrent positive blood cultures/positive cultures of the pleural fluid), pleural puncture (one case), sputum in pneumonias responding only to antipseudomonas therapy (3 cases), and autopsy (2 cases). 8 patients died of pseudomonas pneumonia within 1-3 months despite therapy. 7 patients received pseudomonas-specific combination therapy, but all died after median 9 (4-15) months of the underlying illness. In 3 cases recurrent pseudomonas pneumonia could be documented bacteriologically. We conclude that in HIVinfected patients pneumonia caused by P. aeruginosa is a significant and severe pulmonary complication. Other titles: Pseudomonas pneumonia–an important differential pulmonary infiltration diagnosis in AIDS Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-103433 Originally published at: Kaufmann, P; Opravil, M; Hauser, M; Gaspert, A; Laube, I; Jenni, R; Speich, R (1999). Die PseudomonasPneumonie – eine wichtige Differentialdiagnose pulmonaler Infiltrate bei Aids. Swiss Medical Weekly, 129(4):120-130. Originalarbeit Schweiz Med Wochenschr 1999;129:120–30 Peer reviewed article 120 Pseudomonas pneumonia: an important differential diagnosis of pulmonary infiltrates in AIDS Bacterial pneumonias are the most common pulmonary complication in HIV-infected patients. Up to now, H. influenzae and S. pneumoniae have been described as the most important germs. Within a period of 4 years we diagnosed 15 cases of pneumonia caused by P. aeruginosa. All patients were in HIV stage C3: 3F, 12M; median age 34 (24–54) years; median CD4 count 10 (0–130) μl. Except for 3 nosocomial pneumonias, all others were community-acquired. Only 3 patients had neutropenia <1000/μl; 7 were intravenous drug abusers. Morphologically there were 6 cases of abscess pneumonia, in 3 of which pleural drainage was necessary because of pyopneumothorax. 4 patients showed bilateral infiltrates that could not be differentiated from those of P. carinii pneumonia. Our diagnosis was based on quantitative cultures of bronchoalveolar lavage fluid (9 cases, two of them with concurrent positive blood cultures/positive cultures of the pleural fluid), pleural puncture (one case), sputum in pneumonias responding only to antipseudomonas therapy (3 cases), and autopsy (2 cases). 8 patients died of pseudomonas pneumonia within 1–3 months despite therapy. 7 patients received pseudomonas-specific combination therapy, but all died after median 9 (4–15) months of the underlying illness. In 3 cases recurrent pseudomonas pneumonia could be documented bacteriologically. We conclude that in HIV-infected patients pneumonia caused by P. aeruginosa is a significant and severe pulmonary complication.