Community-Acquired Pneumonia: Impact of Immune Status

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This cross-sectional, prospective, one-year study (1990–1991) involved 385 adult patients with community-acquired pneumonia (CAP) who required admission to an inner-city hospital. Over half of the study patients (221, or 57%) were immunosuppressed, including 180 patients (46.9%) with human immunodeficiency virus (HIV) infection. An extensive array of diagnostic tests was employed for the detection of bacteria (including atypical organisms), viruses, and mycobacteria in multiple-patient specimens. Nevertheless, 31% of the patients lacked an etiologic diagnosis. Overall, the most commonly identified microbiologic agents were Streptococcus pneumoniae (17.9%), Pneumocystis carinii (12.7%), aspiration pneumonia (9.1%), Haemophilus influenzae (73%), and gram-negative bacilli (6.8%), although P. carinii was the most common cause of pneumonia among HIV-infected patients. Preantibiotic sputum culture for conventional bacteria yielded a

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