Pulmonary infections in HIV infected patients.

We retrospectively reviewed causes, clinical presentations and chest radiographs of pulmonary infections in symptomatic HIV infected patients diagnosed in Srinagarind Hospital from February 1992 to 1994. We found 95 episodes of pulmonary infections in 88 HIV infected patients enrolled in our review. The three most common pathogens were Mycobacterium tuberculosis (37.2%), Pneumocystis carinii (23.8%), and Cryptococcus (15.2%). Coexistent pulmonary infections were seen in 10.5 per cent, mostly due to P. carinii and Cryptococcus neoformans. Extrapulmonary infections were also common, particularly with M. tuberculosis (49%) and C. neoformans (100%). The common clinical presentations were fever, dyspnea, and cough which frequency varied among the organisms. Chest radiographs were nonspecific, the most common finding was bilateral pulmonary infiltrates except that bacterial pneumonia usually presented with unilateral infiltrates. All patients wit PC had significant hypoxia (PaO2 < 70 mmHg). Due to nonspecific clinical and chest film presentations as well as frequent coinfections, definite diagnosis should be carried out in all HIV infected patients with pulmonary infections.In Thailand, the opportunistic infections experienced with AIDS differ by region. To determine the prevalence of infectious pathogens and characteristics which can be found with each type of pathogen, all medical records of HIV-infected patients who presented at Srinagarind Hospital from February 1992 through February 1994 were retrospectively reviewed. 88 symptomatic HIV-infected patients of mean age 29 years (range 20-67) were diagnosed as having pneumonia. The subject sample had a 1.37:1.0 male-to-female ratio and 98% of patients' risk behavior was heterosexual contact. 95 episodes of pulmonary infection were diagnosed. The most common pathogen was M. tuberculosis (37.2%), followed by P. carinii (28%) and C. neoformans (16%). Bacterial infections were common, including Streptococcus pneumoniae, anaerobes, nocardia, and unspecified gram negative pathogens, while fungal lung infection was found in 20 cases, mainly C. neoformans (15.2%). All pulmonary fungal infections had concomitant extrapulmonary involvement. Cytomegalovirus infection was diagnosed by lung biopsy in a patient who failed to respond to antipneumocystic treatment and died. Strongyloides stercoralis was found in three cases.