Rhodococcus infection in HIV infected patients: Clinical presentation and diagnoses

Abstract

Background: Rhodococcus Equi is a gram positive coryneform bacterium that causes zoonotic infections in the animal kingdom and ias been reported in immunocompromised humans as emerging opportunistic pathogens. Methods & Materials: Retrospective review of patients electronic records from y 2006 to 2011, that were microbiologically confirmed rhodococcus equi infection. Results: A total of 26 patients were HIV positive with a median CD4 ount of 14 cells/ul.Mode of hiv transmission were 40.7% injecting drug use (11 patients), 51.7% sexual contact and 7.6% were unknown. None of the patients had a known history of contact with any animal sources for rhodococcus. 70.4%(19) patients were antiretroviral naïve at the time of presentation, 48%(13) patients had other concurrent AIDS defining illnesses. Pulmonary involvement with confirmed bacteraemia was seen in 77.8% (21) cases.18.5% (5) had primary bacteraemia with no other source of infection. One patient had isolated right suppurative lymphadenitis. Cavitatory pneumonia were seen in majority of the cases. In comparison to the available literature data, we saw a similar sensitivity pattern for most of our isolates with a resistance towards penicillin and ampicillin. Most patients were treated with a combination of antibiotics Conclusion: Increase awareness of rhodococcus infection as an opportunistic pathoegn,prompt microbiological diagnosis and combined antimicrobial treatment seem to be the cornerstone pf effective treatment. Early initiation of antiretroviral treatment and adherence seem to be necessary to improve outcome.