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Pseudomonas aeruginosa bronchopulmonary infection in patients with advanced human immunodeficiency virus disease
Z C Traill1, R F Miller, N Ali
1Department of Radiology, John Radcliffe Hospital, Oxford, UK.
Abstract:
Pseudomonas aeruginosa is increasingly reported as a respiratory pathogen in patients with advanced human immunodeficiency virus (HIV) disease. We retrospectively reviewed the chest radiographic appearances of 29 HIV-infected adults with bronchopulmonary infection in whom Pseudomonas aeruginosa was the sole respiratory pathogen isolated. The commonest radiographic abnormality was a diffuse reticular (11 patients) or reticulonodular (9 patients) infiltrate in the pulmonary interstitium. Alveolar opacification was seen in seven patients. Cavitation was rare (2 patients), as was ground-glass opacification (2 patients). Five patients had pleural effusions. No patient had mediastinal or hilar lymphadenopathy. Normal chest radiographs were seen in eight patients. Although the radiographic appearances of Pseudomonas bronchopulmonary infection in HIV-infected patients are non-specific, an interstitial infiltrate is a common finding. Pseudomonas aeruginosa should be considered along with the commoner pathogen Pneumocystis carinii in the differential diagnosis of an interstitial infiltrate in this group of patients.
Insights
Pseudomonas aeruginosa is a growing respiratory threat in advanced human immunodeficiency virus (HIV) patients. Chest X-rays often show interstitial infiltrates, suggesting this pathogen in HIV-related lung infections.
Area of Science:
- Infectious Diseases
- Radiology
- Pulmonology
Background:
- Pseudomonas aeruginosa is an emerging respiratory pathogen in individuals with advanced human immunodeficiency virus (HIV).
- Bronchopulmonary infections in HIV patients present diagnostic challenges due to varied etiologies.
Purpose of the Study:
- To describe the chest radiographic findings of bronchopulmonary infection caused solely by Pseudomonas aeruginosa in HIV-infected adults.
- To determine the utility of chest radiography in diagnosing Pseudomonas aeruginosa pneumonia in this patient population.
Main Methods:
- Retrospective review of chest radiographs from 29 HIV-infected adults.
- Analysis of radiographic findings where Pseudomonas aeruginosa was the only identified respiratory pathogen.
- Correlation of imaging features with clinical presentation.
Main Results:
- Diffuse reticular or reticulonodular interstitial infiltrates were the most common findings (20/29 patients).
- Alveolar opacification occurred in seven patients; cavitation and ground-glass opacities were rare.
- Pleural effusions were present in five patients; mediastinal or hilar lymphadenopathy was absent.
- Eight patients (8/29) had normal chest radiographs.
Conclusions:
- The radiographic presentation of Pseudomonas aeruginosa bronchopulmonary infection in HIV patients is often non-specific.
- Interstitial infiltrates are a common radiographic finding, warranting consideration of Pseudomonas aeruginosa in the differential diagnosis.
- Pseudomonas aeruginosa should be considered alongside Pneumocystis carinii in patients with interstitial infiltrates and advanced HIV.