Prospective study on clinical features and etiologic agents of community-acquired pneumonia in HIV-infected patients

• Grant number: 12/03834-7
• Support Opportunities: Regular Research Grants
• Start date: August 01, 2012
• End date: July 31, 2014
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Anna Sara Shafferman Levin
• Grantee: Anna Sara Shafferman Levin
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

The lungs of patients infected with human immunodeficiency virus are frequently involved, in an autopsy study approximately 90% of investigated patients had some pulmonary involvement related to acquired immunodeficiency syndrome. Few studies have examined systematically the etiology of pneumonia in patients infected with HIV, as the majority of researchers focused their work in specific etiologies, such as bacterial pneumonias or pneumocystis pneumonia. Studies of the general population shows a reduction in mortality of hospitalized patients treated with a combination of beta-lactams and macrolides when compared to other regimes, but a recent Brazilian study showed no benefits of this association in a group of HIV-infected patients. Given that there is no consensus on a diagnostic algorithm for patients with HIV who have a pneumonia, that the frequency of each etiologic agent may vary according to geographic region, that there is a controversy about the presence of atypical agents and therefore about the benefit of therapy with macrolides for the treatment of bacterial pneumonia in this population, this study was designed to better characterize the episodes of pneumonia in our environment. Primary objective: To study HIV-infected patients admitted to the hospital because of pneumonia through various laboratory tests to determine the microbiological diagnosis. Methods: This is a prospective study of HIV-infected adults hospitalized with a community-acquired pneumonia in the "Emilio Ribas Institute of Infectious Diseases". Clinical data of the patients will be collected and these patients will undergo various examinations looking for a specific diagnosis. Blood sampling will be conducted at admission to perform hemogram, biochemical tests, blood cultures, latex agglutination test for antigen of Cryptococcus spp., and serology for Mycoplasma pneumoniae and Chlamydophila pneumoniae. There will also attempt to collect sputum (simple or induced) or other respiratory specimens (tracheal aspirate and bronchoalveolar lavage) as indicated by the physician to perform gram stain, direct search for Pneumocystis jirovecii and acid-resistant bacilli (AFB) and cultures. The first respiratory specimen obtained will be subjected to PCR (Polymerase Chain Reaction) to search for Chlamydophila pneumoniae, Legionella and Mycoplasma pneumoniae pneumophilla, adenovirus and influenza A (including H1N1). An urine sample will be also collected and tested for antigens of Legionella pneumophila serogroup 1. Other tests for diagnosis or follow-up may be required in conformation with the discretion of the attending physician. (AU)

Scientific publications

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

FIGUEIREDO-MELLO, CLAUDIA; NAUCLER, PONTUS; NEGRA, MARINELLA D.; LEVIN, ANNA S.. Prospective etiological investigation of community-acquired pulmonary infections in hospitalized people living with HIV. MEDICINE, v. 96, n. 4, JAN 2017. (12/03834-7)

FIGUEIREDO-MELLO, C.; NAUCLER, P.; NEGRA, M. D.; LEVIN, A. S.. Ceftriaxone versus ceftriaxone plus a macrolide for community-acquired pneumonia in hospitalized patients with HIV/AIDS: a randomized controlled trial. Clinical Microbiology and Infection, v. 24, n. 2, p. 146-151, FEB 2018. (12/03834-7)