Diagnostic Clues in the HIV-Positive Patient with Respiratory Symptoms
Diagnosis | Clinical features | Chest X-ray features |
---|---|---|
Pneumocystis | Dyspnoea, often of slow onset | Perihilar haze: diffuse bilateral interstitial or alveolar shadowing |
(jirovecii)pneumonia (PCP) | ||
Dry cough | Lobar consolidation rare | |
Lungs clear, or sparse basal crackles | Pleural effusion rare | |
Fever | Pneumothorax may occur | |
See Table 34.4 | See 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-intracellulareinfection | Cough | Often normal |
Dyspnoea | ||
Fever | ||
Bacterial pneumonia (Chapter62) | Commoner in smokers | Focal consolidation |
Productive cough | ||
Focal signs | ||
Fever | ||
Cytomegalovirus pneumonitis | Clinically indistinguishable from PCP (dual infection may occur) | Diffuse bilateral interstitial shadowing |
Fungal pneumonia | Fever | Diffuse 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 sarcoma | Pleural effusion strongly suggestive |