From the early stage of HIV infection, patients are particularly vulnerable to common pathogens of the respiratory tract. As the immune system continues to deteriorate, they become increasingly susceptible to tuberculosis, non-specific mycobacterial infections, and systemic mycoses. Pneumonia due to Pneumocystis carinii is relatively common, in industrialized countries. Pulmonary tuberculosis is particularly common in developing countries.
Bacterial infection: |
Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus |
Mycobacterial infection: |
M. tuberculosis, M. avium-intracellulare, M. kansasii, M. xenopi. |
Fungal infection: |
Pneumocystis carinii pneumonia Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, Aspergillus species Penicillium marnefii. |
Viral infection: |
Cytomegalovirus. |
Non-infectious disorders: |
Non-Hodgkin’ s lymphoma, Kaposi’s sarcoma, lymphoid interstitial pneumonitis, non-specific interstitial pneumonitis. |
Summary of main respiratory infections
| |
Symptoms & signs |
Laboratory investigations |
Radiological changes |
1st line treatment |
Bacterial pneumonia |
fever cough, dyspnoea sputum production increased respiratory rate |
leucocytosis blood cultures may be positive |
consolidation (may be lobar) |
amoxicillin or according to national guidelines & local sensitivities |
PCP |
dyspnoea (esp. on exertion) fever dry cough normal auscultation |
haemo-gas analysis: hypoxia bronchial lavage (if available) |
peri-hilar shadowing (ground glass haze) interstitial infiltrates |
high dose SMZ/TMP 2-3 weeks then continual maintenance |
Tuberculosis |
general malaise weight loss night sweats fever cough sputum production (may be blood- stained) lymphadenopathy |
sputum examination for AFBs lymph node aspiration for AFBs culture, where possible |
upper lobe consolidation +/- cavities mediastinal lymphadenopathy pleural effusion (Xray often atypical) |
according to national TB guidelines or 2RHEZ/4RH* (for new cases, recurrences require longer and more aggressive treatment**) |
* Rifampicin and isoniazid for 6 months supplemented in the first 2 months by pyrazinamide and ethambutol
** Treatment is based on a five drug regime
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