SALMONELLA LUNG INVOLVEMENT IN PATIENTS WITH HIV-INFECTION

Study objective: To determine the frequency, clinical features, and ou tcome of lung involvement in HIV-infected patients having nontyphoid s trains of Salmonella bacteremia, Design: A retrospective clinical stud y, Patients and setting: We studied the records of all HIV-infected pa tients with Salmonella bacteremia diagnosed at a university tertiary h ospital from January 1987 to December 1995, Results: Lung involvement was found in 18 (35.3%) of 51 HIV-infected individuals with Salmonella bacteremia, Six of 18 (33.3%) were diagnosed as having definite Salmo nella pulmonary infection by isolation of Salmonella from respiratory specimens, while probable Salmonella lung disease was considered in tw o patients who developed lung abscesses without the identification of any pathogen, Predisposing factors for focal disease, such as prior lu ng disease or Salmonella serotype, were equally prevalent regardless o f the presence of Salmonella pulmonary involvement. Cavitary infiltrat es or abscess formation were seen in five of the eight patients, With the exception of one patient coinfected with Nocardia asteroides who d ied 1 month later, all patients were cured with antibiotic treatment, Superinfection with other pulmonary pathogens (10 cases, 56%) was more frequent than Salmonella pneumonia; the most frequent alternative dia gnosis was Pneumocystis carinii pneumonia (5 cases, 28%), pyogenic bac terial infection (17%), and tuberculosis (11%). Conclusions: In HIV-in fected patients with Salmonella bacteremia, lung involvement is freque nt, although there were no significant factors to explain this associa tion. Cavitary disease was the most common radiologic pattern, and foc al lung disease due to Salmonella does not seem to be prognosis. Coinf ection and superinfection with other respiratory pathogens are more co mmon than isolated Salmonella lung disease, and therefore, additional diagnostic procedures must be considered in the evaluation of these pa tients.