Pneumococcal pneumonia in patients requiring hospitalization: effects of bacteremia and HIV seropositivity on radiographic appearance

Abstract

Objective: Our purpose was to establish the incidence of lobar versus bronchopneumonia patterns in patients hospitalized for pneumococcal pneumonia and to determine whether bacteremia or HIV status affects the radiographic appearance.

Materials and methods: Eighty-one patients with community-acquired pneumococcal pneumonia and positive findings on admission chest radiographs were selected from a group of 105 patients with positive findings for Streptococcus pneumoniae from sputum or blood cultures. Patients less than 16 years old and those with nosocomial pneumonia, aspiration pneumonia, or coexistent lung disease were excluded. The dominant pattern was classified as lobar or lobular bronchopneumonia by two radiologists who were unaware of results from blood cultures and HIV testing.

Results: Forty-three females and 38 males, with a mean age of 48 years (age range, 16-92 years), required admission for pneumococcal pneumonia. Fifty-nine (73%) of the 81 patients were bacteremic and 20 (25%) of the 81 patients were HIV-positive, including 14 patients (17%) who were both bacteremic and HIV-positive. Among all the patients, focal lobar consolidation was the most common pattern, observed in 48%. Multifocal lobar consolidation was the next most frequent pattern, occurring in 33%. Multifocal and focal bronchopneumonia patterns were seen in 16% and 2% of the patients, respectively. Overall, multifocal consolidation occurred in 49%. The dominant radiographic pattern and incidence of multicentric disease were not affected by HIV seropositivity (p = 0. 61) or bacteremia (p = 0.17).

Conclusion: Lobar consolidation, involving single or multiple lobes, is the most common radiographic pattern of community-acquired pneumococcal pneumonia in patients requiring hospitalization. The pattern of consolidation is not influenced by bacteremia or HIV status.