Abstract
Editor: Respiratory infections remain a major cause of morbidity among people living with HIV. 1 Tuberculosis (TB) and pneumocystosis are opportunistic diseases associated with HIV/AIDS infection, yet other common HIV opportunistic infections may be caused by bacteria, fungi, parasites, and viruses. 2 In Cameroon, 34% of HIV-infected patients also have TB, placing this country among the 30 countries with the highest burden for TB/HIV coinfection. 3 However, limited data are available on clinical evidence of respiratory tract infections (RTIs) with pneumocystosis and bacteria.
HIV-positive and HIV-negative patients with RTIs were screened for bacteria, Pneumocystis jirovecii (PCP) and tubercle bacilli infections from January 2017 to January 2018 at the Jamot Hospital in Yaounde (Table 1). For this purpose, clinical samples including nasopharyngeal swabs, bronchoalveolar lavages, pleural fluids, and sputa were subjected to bacterial culture and multiplex reverse transcriptase real-time polymerase chain reaction (RT-PCR) analyses targeting 10 bacteria and PCP. Specimens from suspected TB patients were subjected to microscopy, culture, and/or GeneXpert analysis.
Microbial Detection Among HIV-Positive and HIV-Negative Patients with Respiratory Tract Infections Following Age Groups
+, positive; −, negative; %, percentage; PCP, Pneumocystis jirovecii; RTIs, respiratory tract infections; TB, tuberculosis.
A total of 211 participants with RTIs including 80 HIV-infected patients (37.9%) were enrolled. The median age of the study population was 42.8 years with a male-to-female sex ratio of 1.43. The median duration of clinical signs before diagnosis was 30 days and the common clinical symptoms were cough (94.8%), dyspnea (89.1%), breathlessness (85.8%), asthenia (84.4%), fever (60.2%), and chest pain (58.8%). Only diarrhea (23.8%), vomiting (22.5%), and conjunctivitis (5%) were significantly associated with HIV-positive patients (p < .05). Most of the study participants were on antibiotic therapy (83.4%) before laboratory diagnosis. Bacterial detection rate by culture was ∼20% in both HIV-positive and HIV-negative patients. Haemophilus influenzae (4.7%) and Streptococcus pneumoniae (3.8%) were the most represented bacteria detected.
The overall detection rate of TB bacilli was 17.1% and was higher in HIV-positive subjects (25%) than in HIV-negative subjects (12.2%) (p = .023). Regarding PCP, 48.8% (39/80) of HIV-positive patients were treated by prophylaxis and PCP was detected in only 8.8% of HIV-positive patients. A 10% TB/PCP coinfection rate was found.
Our results have several implications: data on bacterial detection rate in both HIV-positive and HIV-negative patients are not opportunistic in our context.
TB remains one of the most widely distributed infectious disease among HIV-positive patients. For over a decade, data reporting on the frequency of PCP among HIV-infected patients from Cameroon has been scarce. 4 Low PCP detection rate could be due to the widespread use of prophylaxis against opportunistic infections together with highly active antiretroviral therapy that has reduced the risk of life-threatening infection, hence confirming the benefits of PCP prophylaxis.
The presence of TB/PCP coinfection indicates that HIV-infected patients with TB are at increased risk of PCP infections. Therefore, laboratory testing of PCP could improve the diagnosis and management of RTIs in HIV-infected patients.
Although TB remains the main opportunistic infection among HIV-positive patients with RTIs, PCP infections should be investigated for a better follow-up of these patients.