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[Not Available].

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
PubMed
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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.

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  • 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.