Original article| Volume 18, ISSUE 2, P111-117, March 1989

Diagnosis, treatment and outcome of pneumonia in the acquired immune deficiency syndrome

      This paper is only available as a PDF. To read, Please Download here.


      Fibreoptic bronchoscopy was performed in 43 of 52 consecutive patients with opportunistic pneumonia in the acquired immune deficiency syndrome (AIDS). The 15 patients in whom a likely pathogen was not found by bronchoscopy (including the nine not having the procedure) were treated for Pneumocystis carinii pneumonia (PCP) alone and all responded. In 11 of these a diagnosis of AIDS was confirmed because of an alternative opportunistic infection within 6 months.
      PCP was confirmed in 38 of the 52 patients and cytomegalovirus (CMV) was isolated from 15 patients. The lower the partial pressure of arterial oxygen (Pa02) on admission the more likely was a pathogen to be found by bronchoscopy.
      The admission Pa02 while the patient was breathing room air was the single most reliable prognostic indicator. The mean PaO2 for survivors was 9·6 kPa and 6·7 kPa for non-survivors (P < 0·01 Student's t-test), with 50% mortality for patients with a PaO2 of less than 8 kPa on admission.
      Temperature and pulse rate were sensitive indicators of response to treatment, obviating the need for frequent arterial gas measurements and chest radiography.
      Our findings suggest that although fibreoptic bronchoscopy contributed little to the treatment and final outcome of the infection, it identified the causative pathogen in most patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Update on acquired immunodeficiency syndrome (AIDS) United States. U.S.A. Centers for disease control. MMWR. 31. 1982: 507-508
      2. Update on acquired immunodeficiency syndrome (AIDS) United States. U.S.A. Centers for disease control. MMWR. 31. 1982: 513-514
      3. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome (AIDS). MMWR. 36. 1987: 1S
        • Oberg B
        Antiviral effects of phosphonoformate (PFA, foscarnet sodium).
        Pharmacol Ther. 1983; 19: 387-415
        • Masur H
        • Lane H
        • Palestine A
        • et al.
        Effect of 9-(1,3-dihydroxy-2-propoxymethyl) guanine in patients with the acquired immunodeficiency syndrome and other immunodeficiencies.
        Ann Intern Med. 1986; 104: 41-44
        • Griffiths PD
        • Panjwani DD
        • Stirk PR
        • et al.
        Rapid diagnosis of cytomegalovirus infection in immunocompromised patients by detection of early antigen fluorescent foci.
        Lancet. 1984; ii: 1242-1245
        • Shephard V
        • Jamieson B
        • Knowles G
        Pneumocystis carinii pneumonitis; a serological study.
        J Clin Pathol. 1979; 32: 773-777
      4. Report of a National Heart, Lung and Blood Institute Workshop. Pulmonary complications of the acquired immunodeficiency syndrome. New Engl J Med. 310. 1984: 1682-1688
        • Stover DE
        • White DA
        • Romano PA
        • Gellene RA
        • Robeson WA
        Spectrum of pulmonary disease associated with the acquired immunodeficiency syndrome.
        Am J Med. 1985; 78: 429-437
        • Collaborative DHPG treatment group
        Treatment of serious cytomegalovirus infections with 9-(1,3-dihydroxy-2-propoxymethyl) guanine in patients with AIDS and other immunodeficiencies.
        New Engl J Med. 1986; 314: 801-805
        • Kovacs JA
        • Hiemenz JW
        • Macher AM
        • et al.
        Pneumocystis carinii pneumonia: A comparison between patients with AIDS and patients with other immunodeficiencies.
        Ann Intern Med. 1984; 100: 663-671
        • Hanson PJV
        • Harcourt-Webster JN
        • Gazzard BG
        • Collins JV
        Fibreoptic bronchoscopy in diagnosis of bronchoscopy in diagnosis of bronchopulmonary Kaposi's sarcoma.
        Thorax. 1987; 42: 269-271
        • Pozniak AL
        • Tung KT
        • Swinburn CR
        • Tovey S
        • Semple SJ
        • Johnson N McI
        Clinical and bronchoscopic diagnosis of suspected pneumonia related to AIDS.
        Br Med J. 1986; 293: 797-799
        • Demopulos P
        • Sande M
        • Bryant C
        Influence of Mycobacterium avium intracellulare infection on morbidity and survival in patients with Pneumocystis carinii pneumonia and the acquired immunodeficiency syndrome.
        in: Program and Abstracts of the 25th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington D.C.American Society for Microbiology, Abstract 745. 1985: 230
        • Brodie HR
        • Broaddus C
        • Hopewell PC
        • Moss A
        • Mills J
        Is cytomegalovirus a cause of lung disease in patients with AIDS?.
        Am Rev Resp Dis. 1985; 131: A227
        • Ognibene FP
        • Steis RG
        • Macher AM
        • et al.
        Kaposi's sarcoma causing pulmonary infiltrates and respiratory failure in AIDS.
        Ann Intern Med. 1985; 102: 471-475
        • Coleman DL
        • Dodek PM
        • Luce JM
        Diagnostic utility of fibreoptic bronchoscopy in patients with PCP and AIDS.
        Am Rev Respir Dis. 1983; 128: 795-799
        • Blumenfeld W
        • Wagar E
        • Hadley WK
        Use of transbronchial biopsy for diagnosis of opportunistic pulmonary infections in AIDS.
        Am J Clin Pathol. 1984; 81: 1-5
        • Broaddus VC
        • Dake MD
        • Stulbarg MS
        • et al.
        BAL and transbronchial biopsy for the diagnosis of pulmonary infections in patients with AIDS.
        Ann Intern Med. 1985; 102: 747-752