Respiratory pathogens in bronchoalveolar lavage in a Puerto Rican population infected with the human immunodeficiency virus

OBJECTIVE: To describe the respiratory pathogens found in the bronchoalveolar lavage of a Puerto Rican population infected with the human immunodeficiency virus (HIV). BACKGROUND: Empirical treatment is an accepted strategy for management of HIV-related pneumonia, but it is usually recommended for countries that have knowledge of the prevalent organisms in their population. In Puerto Rico, we have relied on data from the United States, but ethnic and geographical differences have been reported. DESIGN: Case series of a HIV-infected population admitted to an academic hospital in Puerto Rico because of respiratory symptoms and who underwent diagnostic standard bronchoalveolar lavage. RESULTS: From August 1998 to March 2000, 32 bronchoalveolar lavages (BAL) were performed in 31 Puerto Rican HIV patients. Nine (31) were female. Mean age was 37 years old. Predominant mode of infection of the virus was intravenous drug use in men and heterosexual contact in women. BAL was diagnostic in 17/32 (53) of the cases. Identified respiratory pathogens were Pneumocystis carinii (5), Mycobacterium tuberculosis (4), Staphylococcus aureus (2), Pseudomonas aeuruginosa (1), Bordetella bronchiseptica (1), viridans streptococcus (1), Histoplasma capsulatum (1), Cytomegalovirus (1), and, Mycobacterium kansassi (1). Retrospective review of medical records of non bronchoscoped patients for the period added six culture confirmed tuberculosis cases increasing tuberculosis rate to 18(10/56). CONCLUSIONS: Tuberculosis appears to be a more frequent pathogen in Puerto Rico than is reported in the United States. A larger study is needed to confirm this finding and thus to clarify whether an initial presumption of tuberculosis should be assumed in the Puerto Rican HIV population.

The microbial etiologies of diarrhea in hospitalized patients from the Puerto Rico Medical Center Hospitals

The development of diarrhea in hospitalized patients is a frequently encountered clinical problem, which may be due to infectious or non-infectious causes. The purpose of this study was to identify which common community enteric pathogens, if any, are responsible for diarrheal episodes in hospitalized patients. Stool samples from 76 consecutive, hospitalized patients were analyzed utilizing routine bacterial cultures, smears for identification of ova and parasites and Enzyme-Link Immunoadsorbent Assay (ELISA) for enteric bacteria, parasites and viruses. The results obtained demonstrated that the usual community enteric pathogens were not identified as a major cause of nosocomial diarrhea. In hospital-acquired diarrhea, Clostridium difficile toxins assay was the only clinically significant test in the evaluation of these patients. As a result of this study a guideline for the management of this condition in hospitalized patients is presented.