BACTERIAL BRONCHITIS AND BRONCHIECTASIS IN HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Background: Bacterial pneumonia and sinusitis are important causes of morbidity in patients with human immunodeficiency virus (HIV) infectio n. We noted an increased incidence of bacterial bronchitis and bronchi ectasis in our patients with HIV infection. Methods: This study was co nducted on persons with HIV infection at a county hospital and clinic. Bronchiectasis was diagnosed by bronchogram and computed tomography i n one patient and by computed tomography alone in two others. Bacteria l bronchitis was defined by a Gram's stain showing an abundance of neu trophils with a predominance of one or more bacteria and by a confirma tory sputum culture. Bronchoscopy with bronchoalveolar lavage was perf ormed in patients with bronchitis to eliminate other causes of bronchi al inflammation. Results: Eighteen episodes of bacterial bronchitis in 10 patients are described. The mean CD4 lymphocyte counts for these p atients was 0.061 X 10(9)/L (range, 0.001 to 0.203 x 10(9)/L). The mos t common pathogens in 18 episodes of bacterial bronchitis were Haemoph ilus influenzae and Streptococcus pneumoniae (five episodes each) and Pseudomonas aeruginosa (four episodes). Response to antibiotic therapy was usually rewarding though recurrences were frequent. Three patient s with well-defined bronchiectasis who appeared to have developed, or who became symptomatic during the course of, HIV infection are describ ed. Their mean CD4 cell count was 0.03 X 10(9)/L. (range, 0.024 to 0.0 37 X 10(9)/L). Haemophilus influenzae, Staphylococcus aureus, Pseudomo nas cepacia, and P aeruginosa were recovered from these patients; the P aeruginosa was a mucoid strain. Conclusions: Recurrent bacterial bro nchitis should be added to the list of bacterial infections that occur with increased frequency with HIV infection. Repeated bacterial bronc hitis may lead to bronchiectasis, which may be more common in HIV infe ction than generally appreciated.