Thoracic Empyema in HIV-Infected Patients
Microbiology, Management, and Outcome
Thoracic empyema seems rare in adult HIV-related diseases, despite the increased incidence of respiratory infections, although there are no available data (to our knowledge) to estimate true incidence. In the general population, empyema is most common as a consequence of community-acquired pneumonia. Bacterial pneumonia is common in patients with AIDS, but most clinical reviews of infections associated with HIV are notable for the lack of empyema documentation. The reasons for this are not clear.
Pneumococcal pneumonia occurs in 1-2.6 cases/ 1,000 per year for the general population, compared with 18-46 cases/1,000 per year in AIDS patients. Furthermore, the rate of pneumococcal bacteremia among these patients may be more than 100 times higher than that found in an age-matched population. In about 2% of cases, associated parapneumonic effusions fulfill empyema criteria in the HIV-seronegative population with pneumococcal pneumonia; however, there are few cases of clearly documented HIV-associated pneumococcal empyema, despite both an increased incidence and severity of infections. cialis professional online
Bacteria other than pneumococcus, which commonly causes empyema in the general population, include Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas species, other Gram-negative organisms and anaerobes. There are, however, few accounts of empyema in HIV-infected individuals due to any of these organisms.
The aim of this study was to analyze, retrospectively, our experience with thoracic empyema in HIV-infected patients throughout a 9-year period in a 500-bed hospital teaching center, giving special attention to HIV infection risk factors, stage of the infection (as reflected by CD4 counts), and the microbiological diagnosis. Likewise, we evaluated the procedures, length of hospitalization, and outcome.