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 |