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Pneumonia Question
Sep 22, 2013

I found out I was poz in 2008, when I was hospitalized with bacterial pneumonia. I had awful back and side pains, from plural effusion, but I didn't recognize what that was. I assumed I pulled some muscles. My lungs sounded clear, as it was so compacted. I didn't feel very sick really. I felt like I had a cold or something. One night the pains were so awful, I couldn't breathe well, and my lips turned blue. I was rushed to the ER.

My CD4 count bounced back to over 1,000, so I didn't start ARV's. Plus, the hospital had put me on Sustiva only, which lead to resistance. Over the last 5 years, my CD4 has been high 600's to 700's. I kept debating when to start. Friday evening, I began feeling bad, with the chills and fever. On Saturday, my fever spiked to over 104 degrees. I decided it was time to go to the ER. They said I had a small spot of pneumonia. I was sent home with Levaquin. It was in the same lung as before. Just as before, my lungs sounded clear.

They took some blood cultures before I left. I am not sure exactly what that was for. They used these four glass bottles, that they took the cultures in. Are those to check for PCP pneumonia? I was wondering how they could be sure it was bacterial pneumonia only. They said my labs were good, with my WBC slightly elevated. I was not feeling well, so I didn't even ask whether they checked my CD4.

Anyway, I was curious about those blood cultures and what they are for. I know poz folks are more prone to pneumonia, especially if you smoke. I quit smoking after the last time in 2008. Do we pick up these bacteria from others? It just doesn't happen spontaneously, does it? I am actually due for my 5 year booster vaccine, in a few weeks. This did have me wondering whether that was a coincidence, or whether the vaccine was providing me protection, but it has worn off? Before this happened, I was already going over med options, and was planning to take the med plunge when I see my doc next.

Thanks for any input.

Response from Dr. Holodniy

Blood cultures are obtained routinely in anyone who has a high fever in which the doctors might suspect a bacterial infection as the cause. They are not just used in people with HIV infection, and they are not used for PCP diagnosis. Given your history, it was very appropriate for them to see whether you had a bacterial infection in your blood. Many of the organisms that cause bacterial pneumonia are acquired through inhaling the organisms or coming in contact with them through the nose or eyes after putting unwashed fingers in your eyes or nose. Bacteria can leave the lung and go into the blood stream or the reverse, where you might have a blood stream infection which then infects the lung. Yes, you should go get another pneumonia shot.



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