Bacterial Pneumonia in Patients with the Acquired Immunodeficiency Syndrome

TLDR

The study aims to emphasize that bacteria linked to B‑cell defects should be considered when empirically treating pulmonary infiltrates in AIDS patients. The authors reviewed bacterial isolates from AIDS patients with community‑acquired pneumonia to identify pathogens associated with B‑cell defects. Among 336 AIDS patients, 18 episodes of community‑acquired bacterial pneumonia were diagnosed in 13 individuals, mainly caused by Haemophilus influenzae and Streptococcus pneumoniae, with 16 of 18 episodes cured by specific antibiotics, 2 deaths, and an incidence of 17.9 per 1000—significantly exceeding the general population rate.

Abstract

Eighteen episodes of community-acquired bacterial pneumonia were diagnosed in 13 patients among 336 with the acquired immunodeficiency syndrome (AIDS) cared for at Memorial Sloan-Kettering Cancer Center since 1979. Bacterial pathogens isolated in 16 of 18 episodes were Haemophilus influenzae in 8, Streptococcus pneumoniae in 6, group B streptococcus in 1, and Branhamella catarrhalis in 1. Eight episodes were presumed Pneumocystis carinii pneumonia until cultures obtained at bronchoscopy confirmed a bacterial cause. Specific antibacterial therapy was curative in 16 of 18 episodes; 2 patients died. Given an estimated yearly incidence of pneumococcal pneumonia in the general population of 2.6/1000, 1.09 cases were expected in our patients with AIDS; we saw 6 (p = 0.001), for an attack rate of 17.9/1000. Bacteria associated with B-cell defects should be anticipated when formulating empiric antibiotic therapy, pending a definitive diagnosis, for pulmonary infiltrates in patients with AIDS.