There were no significant differences in clinical presentation (Table 4) due to fever, productive cough, chest pain, and dyspnea among the three groups (x2).
Although there was no difference (AN OVA) in average white blood cell (WBC) count among the three groups (Table 4), four AIDS patients had WBC counts below 5,000 X10* L. AIDS patients 2, 6, 11, and 12 had average WBC counts of 800, 2,200, 1,100, and 3,100 X 10®/L, respectively; death secondary to septic shock occurred in patient 2. In the HIV-negative patient group, patients 1, 8, and 15 had low WBC counts of 2,900, 2,000, and 3,800, respectively. Patients 1 and 15 in this group died of septic shock; both also had significant liver disease. The LDH levels (Table 4) were not significantly different among the three groups (AN OVA).
AIDS was diagnosed according to the Centers for Disease Control surveillance definition. For each of the 50 episodes of bacterial pneumonia, we recorded demographic data, clinical and roentgenographic presentation, lactate dehydrogenase (LDH) levels, peripheral leukocyte count, antibiotic therapy, and outcome.
Serotyping for strep pneumonia is not routinely done at this hospital and was not done in this study.
Bacteremic pneumococcal pneumonia has a mortality varying from 22.7 percent to 39.0 percent in patient populations without acquired immunodeficiency syndrome (AIDS). A recent study in the AIDS population reveals an attack rate for pneumococcal pneumonia of 17.9/1,000 vs 2.6/1,000 in the general population. This increased attack ratio of 6.9 is consistent with the impaired humoral immunity known to occur in AIDS- and in other patient groups predisposed toward developing pneumococcal pneumonia. Despite the increased attack rate in AIDS, the actual mortality rate for bacteremic pneumococcal pneumonia is unknown.