0071643192.pdf

INFECTIOUS DISEASE

Pulmonary Complications

See Table 8.3 for CXR differential diagnosis.

COMMUNITYACQUIREDPNEUMONIA(NONOPPORTUNISTIC)

■ This is the #1 cause of pulmonary infection in HIV+patients (S. pneumoniae,
H. influenzae, P. aeruginosa).

P. cariniipneumonia (newly named Pneumocystis jiroveci) is the #1 cause of
AIDS-associated mortality.

SYMPTOMS/EXAM

■ Fever
■ Cough (nonproductive)
■ Dyspnea

When treating for PCP,

steroids should be given prior

to starting antibiotics if the A-a

gradient is >35 or PaO 2 is

<70 mm Hg.

TABLE 8.3. Differential Diagnosis for AIDS-Associated CXR Findings

CXR DIFFERENTIALDIAGNOSIS

Normal Histoplasmosis (40%)

PCP (20%)

TB

Cryptococcosis

Focal consolidation Bacterial pneumonia

Mycoplasma pneumoniae

PCP

TB

Mycoplasma avium

Nodular lesions Kaposi’s sarcoma

TB

M. avium

Fungal lesions

Toxoplasmosis

Cavitary lesions PCP

TB

Bacterial abscess

Fungal abscess

Diffuse interstitial infiltrates PCP

CMV

TB

M. avium

Histoplasmosis

Coccidioidomycosis

Lymphoid interstitial pneumonitis

M. pneumoniae