RHODOCOCCUS-EQUI PNEUMONIA IN PATIENTS INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS - REPORT OF 2 CASES AND REVIEW OF THE LITERATURE

Rhodococcus equi is a cause of lung infection in immunosuppressed host s. Since the start of the HIV epidemic, 76 cases of R. equi lung infec tion (MEDLINE 1985-96) affecting this population have been described. We report 2 additional cases and review the clinical data, radiologica l findings, treatment and outcome of these 78 patients. The mean age o f these patients was 33 y; 69 were male. 71 met the criteria for AIDS (CDC 1993). Fever and cough were the presenting complaints in the majo rity of patients (84.3%). A single cavitary lung lesion in the upper r obes was the most common radiological finding (57.7%), although multip le cavitations, alveolar infiltrates and pleural effusion were also fo und, Treatment usually was based on synergistic antibiotic combination s for a long period of time determined on an individual basis. Surgery was performed only in 11 patients. Death attributable directly to R. equi infection is low (15.4%), however only half of the patients (53.8 %) were completely cured. We conclude that R. equi infection should be strongly considered in any HIV patient who presents with cavitary les ions in the lung, especially if mycobacteria are not identified. Treat ment must be based on synergistic antibiotic combinations, and surgery relegated to cases of chronic single cavitary lesions not responding to antibiotics.