Lung abscess in patients with AIDS
Lung abscess in patients with AIDS
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DOI：
10.1093/clinids/22.1.81
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发表时间：
1996-01-01
影响因子：
11.8
通讯作者：
Sepkowitz, KA
中科院分区：
文献类型：
--
作者：
Furman, AC;Jacobs, J;Sepkowitz, KA
我们确定了31例人类免疫缺陷病毒（HIV）感染和肺脓肿。所有患者均为晚期HIV疾病，平均CD4细胞计数为17/mm(3)（范围2-50/mm(3)）。22例（71%）患者既往有机会性感染，24例（77%）患者既往有肺部感染。出现时的症状包括发热（90%的患者）、咳嗽（87%）、呼吸困难（35%）、胸膜炎性胸痛（26%）和咯血（10%）。28例患者确定病原微生物学，检出病原菌为细菌（65%）、卡氏肺囊虫（6%）、真菌（3%）和混合微生物（16%）。病原菌包括铜绿假单胞菌（11种）、肺炎链球菌（6种）、卡氏假单胞菌（5种）、肺炎克雷伯菌（5种）、金黄色葡萄球菌（4种）、曲霉属（3种）、翠绿链球菌（2种）、流感嗜血杆菌（1种）、milleri链球菌（1种）、神奇变形杆菌（1种）和新型隐球菌（1种）。未分离结核分枝杆菌；两名微生物病因尚未确定的患者对抗结核治疗有反应。患者治疗2-12周；25%的患者接受了4周的治疗。结果很糟糕：36%的患者复发，19%的患者死亡。在艾滋病患者中，肺脓肿与晚期艾滋病毒感染有关，是由于广泛的病原体，对抗生素反应差，预后差。
We identified 31 patients with human immunodeficiency virus (HIV) infection and lung abscess. All patients had advanced HIV disease, and the mean CD4 cell count was 17/mm(3) (range, 2-50/mm(3)). Twenty-two patients (71%) had previous opportunistic infections, and 24 (77%) had previous pulmonary infections. Symptoms at the time of presentation included fever (90% of patients), cough (87%), dyspnea (35%), pleuritic chest pain (26%), and hemoptysis (10%). The microbiological etiology was established for 28 patients, and the pathogens recovered were bacteria (65%), Pneumocystis carinii (6%), fungi (3%), and mixed microorganisms (16%). The pathogens included Pseudomonas aeruginosa (11), Streptococcus pneumoniae (6), P. carinii (5), Klebsiella pneumoniae (5), Staphylococcus aureus (4), Aspergillus species (3), viridans streptococcus (2), Haemophilus influenzae (1), Streptococcus milleri (1), Proteus mirabilis (1), and Cryptococcus neoformans (1). Mycobacterium tuberculosis was not isolated; two patients for whom a microbiological etiology was not established responded to antituberculous therapy. Patients were treated for 2-12 weeks; 25% of the patients received >4 weeks of therapy. The outcome was poor: 36% of the patients had recurrences, and 19% died. In patients with AIDS, lung abscess is associated with advanced HIV infection, is due to a broad spectrum of pathogens, responds poorly to antibiotics, and has a poor prognosis.