Chapter 7 : Community-Acquired Pneumonia in Human Immunodeficiency Virus-Infected Patients: Comparative Study of Streptococcus pneumoniae and Legionella pneumophilaSerogroup 1

Abstract:

Bacterial pneumonia continues to be the most frequent pulmonary complication in human immunodeficiency virus (HIV)-infected patients, although its prevalence has decreased with the use of highly active antiretroviral therapy. The most common etiologic agent of community-acquired pneumonia (CAP) in infected and uninfected patients is Streptococcus pneumoniae. Legionella is at present one of the leading causes of CAP in the general population. This chapter compares the epidemiological data, clinical features, outcome, and mortality of pneumonia by S. pneumoniae and by Legionella spp. in HIV-infected patients. An observational, comparative study was performed in 15 HIV patients with CAP by Legionella (group 1) and 46 by S. pneumoniae (group 2). No statistically significant differences were observed between the two groups in either the use of an appropriate antibiotic treatment in the emergency department or in the delay from the presentation of the symptoms until the initiation of an appropriate antibiotic therapy. Legionella pneumonia (LP) should be considered as an opportunistic infection in HIV-infected patients, and the Legionella urinary antigen test should be mandatory whenever we are faced with CAP in an HIV-positive patient.