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D Scevola1, E Seminari, P Marone
1Istituto di Clinica delle Malattie Infettive, IRCCS Policlinico S. Matteo, Università di Pavia, 27100 Pavia, Italy.
Le Infezioni in Medicina
|March 1, 1995
Summary
Rhodococcus equi causes severe pneumonia in advanced HIV patients. Treatment challenges include drug resistance and uncertain surgical roles, with only two survivors in this case series.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pulmonology
Context:
- Rhodococcus equi is a Gram-positive pathogen causing pneumonia in immunocompromised individuals.
- This study focuses on eight cases of Rhodococcus equi pneumonia in patients with advanced HIV infection (CD4 < 100/mm³).
Purpose:
- To describe the clinical presentation, diagnosis, treatment, and outcomes of Rhodococcus equi pneumonia in patients with advanced HIV.
- To highlight diagnostic challenges and therapeutic considerations for this opportunistic infection.
Summary:
- Eight patients with advanced HIV presented with symptoms including fever, dyspnea, cough, and hemoptysis. Chest X-rays revealed consolidation and cavitation.
- Diagnosis was often delayed, relying on blood cultures, bronchoalveolar lavage, sputum, or lung biopsy.
- Prolonged antibiotic therapy was administered, with frequent use of trimethoprim-sulfamethoxazole (TMP/SMX), vancomycin, imipenem, rifampin, aminoglycosides, macrolides, and quinolones.
- Drug-resistant mutants emerged during therapy.
- Five patients underwent pulmonary lobectomy.
- Outcomes were poor, with only two patients surviving.
Impact:
- This case series underscores the severity of Rhodococcus equi pneumonia in advanced HIV.
- It highlights the challenges in achieving timely diagnosis and effective treatment, including the emergence of antimicrobial resistance.
- The uncertain role of surgery and the overall poor prognosis emphasize the need for improved management strategies for this infection.