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Processing of Bronchoalveolar Lavage Fluid and Matched Blood for Alveolar Macrophage and CD4+ T-cell Immunophenotyping and HIV Reservoir Assessment
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Concurrent PCP and TB pneumonia in HIV infected patients

Jose G Castro1, Gabriel Manzi, Luis Espinoza

  • 1Division of Infectious Diseases, University of Miami Miller School of Medicine, Florida, USA. Jcastro2@med.miami.edu

Scandinavian Journal of Infectious Diseases
|September 14, 2007
PubMed

Insights

Concurrent tuberculosis (TB) and Pneumocystis pneumonia (PCP) in HIV patients were common in Miami. Diagnosis was challenging, with many unaware of their HIV status and presenting with low CD4 counts.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Immunology

Background:

  • HIV infection significantly increases susceptibility to opportunistic infections.
  • Pneumocystis pneumonia (PCP) and tuberculosis (TB) are common opportunistic infections in advanced HIV disease.
  • Co-infection with PCP and TB presents diagnostic and therapeutic challenges.

Purpose of the Study:

  • To determine the incidence and clinical features of HIV-infected patients with concurrent PCP and TB.
  • To highlight diagnostic challenges associated with co-infection.

Main Methods:

  • Retrospective record review of HIV-infected patients admitted with pulmonary TB and PCP.
  • Study period: 1995-2004 at a large county hospital in Miami, Florida.
  • Identification of patients with concurrent diagnosis of TB and PCP.

Main Results:

  • 17 patients had a new, concurrent diagnosis of pulmonary TB and PCP.
  • Half of these patients were unaware of their HIV infection.
  • Most presented with CD4 counts < 100 cells/mm(3) and bilateral infiltrates on chest X-ray.
  • Sputum Acid-Fast Bacilli (AFB) smears were negative in half of the cases.
  • High survival rate (all but 2) during hospital admission.

Conclusions:

  • Concurrent TB and PCP in HIV-infected patients were not uncommon in this setting during the study period.
  • Diagnosis of co-infection is challenging due to overlapping symptoms and potential for negative initial diagnostic tests.
  • Early recognition and prompt management are crucial for improving outcomes in HIV patients with co-infection.

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