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Table 34.3

Diagnostic Clues in the HIV-Positive Patient with Respiratory Symptoms

DiagnosisClinical featuresChest X-ray features
PneumocystisDyspnoea, often of slow onsetPerihilar haze: diffuse bilateral interstitial or alveolar shadowing
(jirovecii)pneumonia (PCP)
Dry coughLobar consolidation rare
Lungs clear, or sparse basal cracklesPleural effusion rare
FeverPneumothorax may occur
See Table 34.4See Table 34.4

Mycobacteriumtuberculosis infection

Cough

Haemoptysis

Fever

More often typical of tuberculosis if CD4 count is >200: multiple areas of consolidation, often with cavitation, in one or both upper lobes
Mycobacterium avium-intracellulareinfectionCoughOften normal
Dyspnoea
Fever
Bacterial pneumonia (Chapter62)Commoner in smokersFocal consolidation
Productive cough
Focal signs
Fever

Cytomegalovirus pneumonitis

Clinically indistinguishable from PCP (dual infection may occur)Diffuse bilateral interstitial shadowing
Fungal pneumoniaFeverDiffuse bilateral interstitial shadowing in 50%
Cough
Weight loss
Systemic features of fungal infection may be present (skin lesions, lymphadenopathy, hepatosplenomegaly)Focal shadowing, nodules, cavities, pleural effusion and hilar adenopathy may be seen
Kaposi's sarcoma

No fever

Dyspnoea

Diffuse bilateral interstitial shadowing, more nodular than PCP

May be unilateral and associated with hilar adenopathy

May be associated with cutaneous Kaposi's sarcomaPleural effusion strongly suggestive