RHODOCOCCUS-EQUI INFECTION IN HIV-INFECTED PATIENTS

Objective: To report clinical and microbiological features and respons e to treatment in HIV patients with Rhodococcus equi infection. Design : Retrospective study. Setting: Inpatients admitted to two Infectious Diseases Departments in a community-based hospital. Patients: A total of 12 HIV-positive patients with R. equi infection. Main outcome measu res: Clinical status, radiological finding, microbiological, haematoch emical and immunological tests, and response to treatment. Results: Tw elve patients (11 men, six injecting drug users) were diagnosed with R . equi infection. Fever and cough were the principal clinical signs on presentation. Mean CD4+ count at the time of diagnosis was 47.67x10(6 )/l (SD, 49.2x10(6)/l). In 58.3% of the cases the diagnosis of R. equi infection followed the appearance of an AIDS-defining illness. The mo st frequent radiological findings were cavitary lesions (41.7%) and lu ng consolidation (33.3%). In 83% of cases, R. equi was isolated from b lood and in 33.3% cases from sputum. Test of chemosensitivity showed s ensitivity to vancomycin (100%), teicoplanin (100%), ceftriaxone (80%) , erythromycin (71%) and ciprofloxacin (66%). Clinical response alone with the disappearance of the presenting signs was observed in nine of the 12 cases (75%); complete response was observed in two cases. Seve n patients died with a mortality rate of 58.3% and a mean survival of 5.75 months (SD, 6.48x10(6)/l). Conclusions: R. equi should be conside red in the differential diagnosis of pulmonary or disseminated infecti ons in patients with HIV infection. Blood culture may be the most sens itive means of diagnosis. Other studies are needed to determine the mo st effective choice and duration of antibiotic therapy.