Prognosis and Clinical Evaluation of Infection Caused by Rhodococcus equi in HIV-Infected Patientsa
| Autor: | Elisa Peérez-Cecilia, Juan Flores, Joseé L. Villanueva, M. Eulalia Valencia, Mariéa Leyes, Joseé M. Pen˜a, Manuel Torres-Tortosa, Juan Gaélvez, Carmen Quereda, Julio Arrizabalaga |
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| Rok vydání: | 2003 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty education.field_of_study biology business.industry Population Cavitary pneumonia Critical Care and Intensive Care Medicine biology.organism_classification medicine.disease Pneumonia Acquired immunodeficiency syndrome (AIDS) Internal medicine Bacteremia Immunology medicine Sputum Rhodococcus equi medicine.symptom Cardiology and Cardiovascular Medicine Complication business education |
| Zdroj: | Chest. 123:1970-1976 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.123.6.1970 |
| Popis: | Objective To assess the clinical characteristics and the factors that influenced the prognosis of patients with HIV and infection caused by Rhodococcus equi . Design Observational, multicenter study in 29 Spanish general hospitals. Setting These hospitals comprised a total of 20,250 beds for acute patients and served a population of 9,716,880 inhabitants. Patients All patients with HIV and diagnosed R equi infection until September 1998. Results During the study period, 19,374 cases of AIDS were diagnosed. Sixty-seven patients were included (55 male patients; mean ± SD age, 31.7 ± 5.8 years). At the time of diagnosis of R equi infection, the mean CD4+ lymphocyte count was 35/μL (range, 1 to 183/μL) and the stage of HIV infection was A3 in 10.4% of patients, B3 in 31.3%, C3 in 56.7%, and unknown in 1.5%. R equi was most commonly isolated in sputum (52.2%), blood cultures (50.7%), and samples from bronchoscopy (31.3%). Chest radiographic findings were abnormal in 65 patients (97%). Infiltrates were observed in all of them, with cavitations in 45 patients. The most active antibiotics against the strains isolated were vancomycin, amikacin, rifampicin, imipenem, ciprofloxacin, and erythromycin. After a mean follow-up of 10.7 ± 12.8 months, 23 patients (34.3%) died due to causes related to R equi infection and 6 other patients showed evidence of progression of the infection. The absence of highly active antiretroviral therapy (HAART) was independently associated with mortality related to R equi infection (relative risk, 53.4; 95% confidence interval, 1.7 to 1,699). Survival of patients treated with HAART was much higher than that of patients who did not receive this therapy. Conclusions Infection by R equi is an infrequent, opportunistic complication of HIV infection and occurs during advanced stages of immunodepression. In these patients, it leads to a severe illness that usually causes a bacteremic, cavitary pneumonia, although HAART can improve the prognosis. |
| Databáze: | OpenAIRE |
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