Lung Infections in HIV - Differential Diagnosis Framework Disease by CD4 Count: Any CD4 Count: • Mycobacterium tuberculosis, Bacterial pneumonia • Seasonal influenza CD4 <200: • Pneumocystis jirovecii pneumonia (PJP), MAI, Cryptococcal pneumonia, Extrapulmonary tuberculosis, Blastomycosis CD4 <50-100: • Toxoplasmosis • Histoplasmosis, Coccidioidomycosis, CMV, Mycobacterium avium, Mycobacterium kansasii, Invasive aspergillosis, Rhodococcus equi, Pseudomonas FUNGAL PNEUMONIAS: • Weight loss, lethargy, fever • Disseminated • Pleuritic CP • Cough, dyspnea • (Less common since cART) Aspergillus Pneumonia: • 3 syndromes: ABPA, Mycetoma, Invasive Aspergillosis • High fever, cough, and dyspnea, wheezing • Pleuritic chest pain may be present. Hemoptysis (occasionally massive) - angioinvasive disease. • CT: Halo sign Coccidioides Immitis Pneumonia: • "Flu-like", Valley fever • Fever, weight loss, Lymphadenopathy, Chest pain, cough • Polymorphic skin lesions (papules, pustules, erythematous nodules, plaques) Cryptococcus Neoformans Pneumonia: • Cough and dyspnea • Lobar consolidation or nodular infiltrates PJP Pneumonia: • Risk: Can produce significant depression of the phagocytic function of alveolar macrophages in HIV • Lung Exam: Can be normal • Fever (It's usually low if you have HIV), Chills, Dry cough or wheezing, Shortness of breath, Fatigue, Chest pain or tightness when you breathe, Weight loss Histoplasma Capsulatum Pneumonia: • (Fever, weight loss), Lymphadenopathy, dry cough or dyspnea, hepatomegaly, • Oral mucosal ulcers, erythema nodosum or erythema multiforme, • Multiple skin lesions (pustules, crusted papules), • Cytopenias VIRAL PNEUMONIAS: Influenza: • Rapid onset of a "flu-like syndrome" consisting of dry cough, myalgias, headache and high fever CMV: • 2-4 week subacute course • Nonproductive cough, dyspnea, and fever BACTERIAL PNEUMONIAS: Most Common: • Streptococcus pneumoniae - 20% of pneumonias • Haemophilus influenzae - 10-15% of pneumonias • Staphylococcus aureus Nocardia Pneumonia: • Chest pain, cough, bloody sputum, sweats, chills, weakness, lack of appetite, weight loss • Imaging: Irregular nodules or infiltrates-necrotizing • Lung most commonly infected M. Tuberculosis Pneumonia: • Upper lung zone infiltrates • Cavities • Fever, chills, night sweats, anorexia, productive cough, and occasional hemoptysis • Lymphadenopathy, CNS involvement MAI Pneumonia: • Constitutional symptoms (fever, weight loss, anorexia) Hepatosplenomegaly, lymphadenopathy, • Abdominal pain, chronic diarrhea, cytopenias M. Kansasii Legionella: • Nausea, vomiting, and diarrhea • Hyponatremia • Elevated hepatic transaminases • C-reactive protein levels >100 mg/L • Rhabdomyolysis (rare) Co-MRSA Pneumonia: • PVL virulence factor • May cause rapidly progressive necrotizing pneumonia Rhodococcus Equi Pneumonia: • Indolent course with fever, cough and cavitary infiltrates, mimicking TB Chlamydia Pneumoniae: • Focal pneumonia, pleural effusion, or bronchitis Mycoplasma Pneumoniae: • Cough (reported in 100% of cases), anemia, arthralgia, dyspnea, sore throat along with fever, rales, interstitial infiltrates or lobar pneumonia Coxiella Burnetii: • Fever, headache, non-productive cough, myalgia • Lung nodules possible in HIV PARASITIC PNEUMONIAS: • Toxoplasma gondii - Fever, nonproductive cough, and dyspnea • Strongyloides stercoralis - Worms in lungs • Cryptosporidium, and Microsporidium #Lung #Infections #HIV #AIDS #pulmonary #differential #diagnosis #infectiousdiseases
