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Pneumonia in the acquired immune deficiency syndrome.


 To data there have been 130 cases of the acquired immune deficiency syndrome (AIDS) in Britain. AIDS is though to be caused by the retrovirus human T cell lymphotropic virus III/lymphadenopathy associated virus (HTLV-III/LAV). The presenting feature of AIDS may be and acute pneumonic illness with cough, breathlessness, and fever. Nearly always, however, there is a preceding history of several months' ill health characterized by loss of weight, intermittent of prolonged fever, and malaise. The organism most commonly responsible for AIDS related pneumonia is the multiflagellate protozoa Pneumocystis carinii. Pneumonia caused by this organism is usually associated with an insidious but progressive dry cough and increasing breathlessness. Other organisms associated with AIDS related pneumonia in the US include Mycobacterium avium intracellulare and cytomegalovirus. In patients suspected of having AIDS the diagnosis may not be possible until an opportunistic organism has been identified. P carinii may be identified morphologically only in stained specimens of bronchoalveolar lavage or of alveolar tissue obtained by transbronchial, percutaneous needle, or open lung biopsy. Clinicians disagree as to whether agressive investigation is really necessary. Most will probably choose the most likely pathogen on clinical and radiological grounds and treat accordingly, reserving transbronchial biopsy and bronchoalveolar lavage for patients who fail to respond. The initial choice of antibiotics is likely to be difficult since many patients may have multiple infecting organisms. Conventional pneumonia should be treated with oxygen, physiotherapy, and broad spectrum antibiotics. The mortality from a 1st attack of P carinni pneumonia is about 1/3.
