Lung cavitation in patients with human immunodeficiency virus infection: analysis in 78 cases

BACKGROUND: TO assess the clinical, radiologic and microbiological features of lung cavitation and HIV infection. Evaluation of the differences relate d to this disease in the last years. PATIENTS AND METHODS: Retrospective review of all patients with lung cavita tion and HIV infection admitted at our hospital from January 1989 until Dec ember 1994 and prospective study of all patients with the same characterist ics during 1995 and 1996. Lung cavitation was defined as any parenchymal le sion, with air content, visible in a simple X-ray and greater than 1 cm of diameter. Criteria for confirmed, probable or possible diagnosis were defin ed. RESULTS: 78 cases of lung cavitation have been identified in 73 patients. T he radiologic patterns included unilobar and multilobular involvement in 31 and 47 cases, respectively. Cavities were multiple and single in 40 and 38 cases respectively, Findings with fine needle aspiration biopsy (FNAB) wer e diagnostic in 11 out of 14 cases. A clinical diagnosis was performed in a ll 78 cases, with microbiological results in 69 cases (88,5%): Mycobacteriu m tuberculosis in 20, Pneumocystis carinii in nine, Pseudomonas aeruginosa in nine, Staphylococcus aureus in eight (5 endocarditis with cavitary septi c emboli), Rhodococcus equi in six, P. aeruginosa and S. aureus in three, S almonella enteritidis in three, Cryptococcus neoformans in two, Aspergillus fumigatus in two and others in 7 cases. Confirmed, probable and possible d iagnosis was considered in 54, 15 and 9 cases, respectively. Thirteen episo des of spontaneous pneumothorax were found. CONCLUSIONS: The lung cavitation rate is tow, compared with the number of a dmissions related to HIV infection; nervertheless, many of them are in clos e relationship with HIV infection, and most of them are caused by treatable infections. It is important to know the clinical and radiological characte ristics, in order to establish an early diagnosis and an appropiate therapy . Pseudomonas aeruginosa is becoming an important cause of lung cavitation. In our series, spontaneous pneumo-thorax was not related to Pneumocystis c arinii pneumonia in 61.5% of cases.