Findings from fibre optic bronchoscopy in HIV-positive patients in eastern London
Abstract number: P1210
Papineni P., Ahmed Y., Limb S., Noble H., O'Shaughnessy T., Packe G., Thomas G.
Objectives: Respiratory disease is a common complication of HIV infection. Definitive diagnosis can be elusive with non-invasive testing. We aimed to characterise the diagnoses made in HIV positive patients following fibre optic bronchoscopy (FOB) and assess the hypothesis that FOB remains useful in the diagnosis of respiratory disease in HIV.
Methods: A retrospective observational analysis of FOB in HIV positive patients at Newham University Hospital in East London between March 2005 and August 2008.
Results: 63 FOBs were performed on 58 HIV positive patients. There were 64 diagnoses of which FOB supported or proved 26 (41%). The most common diagnosis (30%) was Pneumocystis jirovecii pneumonia (PJP) with 19 cases of which 12 were proven, all on bronchial washing cytology. Of these 12 patients, 25% had CD4 counts >200×106/L. The second most common diagnosis (27%) was tuberculosis with 17 cases of which 15 were primarily pulmonary in focus. Culture of bronchial washings was positive in 10 of these cases. Of the 15 cases of pulmonary tuberculosis, 13 were sputum smear negative. Of these, 3 (23%) were afforded early diagnosis by FOB with positive microscopy whilst 8 (62%) were culture positive, confirming the diagnosis and providing sensitivities. The rate of FOB proven PJP appears to have decreased over time whilst that of pulmonary tuberculosis appears to have grown. Average CD4 counts did not change consistently over this period.
Other diagnoses made at FOB include Cryptococcal pneumonitis, pulmonary strongyloidiasis, interstial lung disease and lymphoma. Other organisms isolated at FOB include Staphylococcus aureus (11%), Haemophilus influenza, Pseudomonas spp. and Coliforms (each 5%) and Aspergillus spp. (3%). The significance of these organisms in the patient's illness was uncertain. Candida albicans was isolated following 18% of FOBs, nearly 3 times the rate found in our HIV negative patients. No significant association was found between organism isolated and CD4 count (student's t test), perhaps due to limitations in sample size.
Conclusions: PJP and pulmonary tuberculosis are the most common diagnoses following FOB in our HIV+ patients. FOB is useful in the diagnosis of PJP and smear negative TB in HIV.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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