Pneumothorax in AIDS

Article Abstract:

The acquired immunodeficiency syndrome (AIDS) is characterized by frequent infections, and the most common of which is pneumonia caused by Pneumocystis carinii. Some patients with P. carinii pneumonia develop a complication known as pneumothorax, in which air collects within the chest cavity, causing at least partial collapse of the lung. A study of AIDS patients with P. carinii pneumonia was performed to assess the frequency of pneumothorax and the predisposing factors to this condition. Of 1,030 AIDS patients with probable P. carinii pneumonia, 20 (2 percent) developed pneumothorax spontaneously. Patients who had experienced previous episodes of P. carinii pneumonia had a significantly increased risk of developing pneumothorax compared with patients experiencing their first bout of pneumonia. Additionally, those patients who were receiving an aerosolized form of pentamidine, an anti-Pneumocystis drug, were also found to have a greater risk for pneumothorax. Pneumothorax carries greater morbidity for AIDS patients than for others. Typically, the AIDS patients required chest tubes to correct the pneumothorax for 20 days, rather than the average three to four days. Chest tube therapy was adequate for only 4 of the 20; 5 needed surgical correction, and 11 underwent sclerotherapy, in which drugs are injected into the chest cavity to form scar tissue and seal the air leaks that caused the pneumothorax. Of the 20 patients who developed spontaneous pneumothorax, 19 had clear evidence of ongoing P. carinii pneumonia, despite the use of pentamidine by 18 of these patients. Interestingly, patients who developed pneumothorax tended to survive AIDS approximately 150 days longer than average AIDS patients, suggesting that their extended survival permitted them the opportunity to develop this complication. Based on these data, treating any AIDS patient who develops a spontaneous pneumothorax as if he had P. carinii pneumonia is prudent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Pneumothorax

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Aerosolized pentamidine: effect on diagnosis and presentation of Pneumocystis carinii pneumonia

Article Abstract:

A common complication of human immunodeficiency virus (HIV) infection is infection of the lungs with the microorganism Pneumocystis carinii. Transbronchial biopsy (tissue sampling of the airways) is used to diagnose P. carinii pneumonia, but may be associated with a small risk of bleeding and pneumothorax, the collection of air within the lung cavity. Some studies suggest that bronchoalveolar lavage (BAL), the washing out of the airways and alveoli (gas-exchanging units of the lungs), may be used without transbronchial biopsy to diagnose P. carinii pneumonia. However, previous use of aerosolized pentamidine, a drug used to treat P. carinii pneumonia, may decrease the yield of BAL for diagnosis of P. carinii pneumonia. The effect of previous pentamidine treatment on the diagnosis and characteristics of P. carinii pneumonia was assessed in 52 patients with P. carinii pneumonia and HIV infection, including 21 patients previously treated with aerosolized pentamidine. The yield of BAL for P. carinii pneumonia was 62 percent for pentamidine-treated patients and 100 percent for untreated patients, whereas the yield of transbronchial biopsy was similar in both groups. Accumulation of abnormal substances, collection of air, and formation of cysts within the lungs were detected more often in pentamidine-treated patients, although the severity of the disease was similar in both groups of patients. BAL should be combined with other diagnostic methods to optimize diagnosis of P. carinii pneumonia in HIV-infected patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Bronchoalveolar lavage

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Pneumocystis carinii pneumonia among patients without AIDS at a cancer hospital

Article Abstract:

Patients with lymphoma, leukemia and primary or metastatic brain cancer may be at risk of developing Pneumocystis carinii pneumonia (PCP), especially if they are taking corticosteroids. Although PCP is common in AIDS patients, it can occur in other individuals whose immune system is weak. A review of medical records at Memorial Sloan-Kettering Cancer Center from 1978 to 1989 found 142 cases of PCP. Forty-seven percent had lymphoma or leukemia, 31% had a solid tumor and 18% had received a bone marrow transplant. Although patients with solid tumors accounted for only 3.6% of PCP cases in the 1970s, that percentage rose to 31% by the 1980s. Most of this increase was in patients with primary or metastatic brain cancer, and most were taking corticosteroids. Corticosteroid use was the major risk factor for PCP in 87% of the 134 patients for whom a risk factor could be determined. Physicians should suspect PCP in any cancer patient on long-term corticosteroid therapy who develops symptoms of lung disease.

Corticosteroids, Adrenocortical hormones, Cancer

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