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PCP or Viral Pneumonia?
Mar 18, 1997

We are a couple and we have been diagnosed hiv positive almost four years ago, in the meantime We have been totally asyntomatic until a week ago, when both of us stared (at the same time) with fever, joint tendreness, dry cough, malaise. Our chest X Ray (both again) shows a peri-hiliar infiltrate, with a linear pattern in one of us and reticulo-nodular pattern in the other one. What make it difficult to think in PCP is the accute onset at the same time... with a difference of no more than hours between us. Do you think PCP can start like that? as a common infecto-contagious disesase? or we can take it as a viral pneumonia? We have been told that viral pneumonia is very common in this days in our location. Thank you very much for your time and your taking care of us. Regards.

Response from Dr. Cohen

By the time you read this, I hope you have been diagnosed and treated and are doing better. But I'll make a few general comments, anyway.

If you both have PCP it is pure coincidence, as PCP is not felt to be transmissible from person-to-person. However, if you both have CD4 counts in the right range (less than 200), PCP needs to be considered.

Viral pneumonia is never common , even in people with HIV infection. Your earlier symptoms sounded a lot like flu, though, and pneumonia (either due to influenza virus itself or due to bacteria) can sometimes complicate the flu. Again, it would be unusual for such an unusual complication to occur in both of you together at the same time.

There are number of other considerations that come to mind when you tell me that you both were affected at the same time. Fungal pneumonias can occur, especially in people living in certain parts of the country. For example, histoplasmosis sometimes occurs in small epidemics among immunosuppressed people living in the Ohio or Mississippi Valleys, especially if there has been recent construction that stirs up the soil. If you'd both been in the deserts of the Southwest or the San Joaquin Valley of California, then coccidioidomycosis would be a possibility.

If you both had parrots, psittacosis would come to mind. Tuberculosis could affect both of you at once if you'd both been exposed to someone with TB at the same time, but I would have expected you to be sick for a longer period of time. Legionellosis is another type of pneumonia than can occur in outbreaks and that is slightly more frequent in HIV-infected patients.

The important thing is that a specific diagnosis be made. It is entirely ossible that you each have a different type of pneumonia. Obviously, the treatment will vary depending on what it is you have.

Positive MAC culture
sphyillis treponema:What can it do?

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