Bacterial respiratory tract infections in AIDS

The common bacterial infections are:

• chronic sinus disease:
  • 15% of HIV-infected patients have chronic sinusitis
  • most common when the CD4 count falls below 200/microl
    
    
• bronchiectasis:
  • found increasingly commonly in AIDS patients
  • probably due to recurrent bacterial infection
  • Strep. pneumoniae and H. influenzae most common
    
    
• bacterial pneumonia:
  • Strep. pneumoniae and H. influenzae most common (1)
  • Staph. aureus more common in advanced disease
  • clinical features similar to general population
  • chest radiograph may look unusual, often with diffuse infiltrates resembling P. carinii pneumonia (1)
  • complications such as cavitation, empyema and death are more common than in the normal population
    
    
• tuberculosis and other atypical mycobacterial disease
  • common and important presenting disease in UK
  • may be seen in patients with a CD4 count of more than 200
  • less commonly atypical mycobacterial diseases (e.g. - mycobacterium avium intracellulare) is seen in late stage HIV (2)
    
    
• nocardia pneumonia

Reference:

• (1) The Medical Foundation for AIDS & Sexual Health (MedFASH) 2008. HIV for non-HIV specialists, diagnosing the undiagnosed: A practical guide for healthcare professionals secondary care to support improved detection and diagnosis of HIV in the UK
• (2) The Medical Foundation for AIDS & Sexual Health (MedFASH) 2005. HIV in primary care: an essential guide to HIV for GPs, practice nurses and other members of the primary healthcare team