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J Infect. 2012 Aug;65(2):173-9. doi: 10.1016/j.jinf.2012.03.020. Epub 2012 Apr 4.

Opportunistic infections in patients with pulmonary alveolar proteinosis.

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1
Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA.

Abstract

OBJECTIVES:

To describe the demographics, clinical manifestations, treatment, and outcomes of patients with pulmonary alveolar proteinosis (PAP) who developed an opportunistic infection with Nocardia spp., mycobacteria or fungal pathogens.

METHODS:

A case of PAP and Nocardia spp. brain abscess is described. A comprehensive review of the English-language literature was conducted to identify all reported cases of PAP and opportunistic infections between 1950 and July, 2010.

RESULTS:

Seventy five cases were reviewed. Thirty two patients (43%) had nocardial infection, 28 (37%) mycobacterial infection, and 15 (20%) fungal infection. Thirty nine patients (65%) were male. Seventeen patients (23%) were immunosuppressed. Twenty patients (27%) were active smokers. PAP was the initial diagnosis in 19 patients (33%), while infection presented first in 23 patients (40%); 16 patients (27%) had a concurrent diagnosis of PAP and infection. The average interval between PAP diagnosis and an opportunistic infection was 16 months. Lungs were the most common site of infection; extra-pulmonary infection was present in 27 patients (32%). Thirty nine patients (57%) survived through the follow-up period, while 31 died.

CONCLUSIONS:

Opportunistic infections can either precede or follow a diagnosis of PAP. PAP should be considered in apparently immunocompetent patients who present with an opportunistic infection and diffuse alveolar infiltrates.

PMID:
22484272
DOI:
10.1016/j.jinf.2012.03.020
[Indexed for MEDLINE]

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