Introduction. The respiratory tract is the most common site of opportunistic
infections in patients with acquired immunodeficiency syndrome, and
respiratory failure is the leading cause of death in these cases. In
addition, the use of mechanical ventilation in the treatment of respiratory
failure carries a high risk of nosocomial pneumonia caused by
multidrug-resistant strains of bacteria. Case report. We present a human
immunodeficiency virus-positive patient with positive outcome of Pneumocystis
jiroveci pneumonia whose condition progressed to acute respiratory distress
syndrome with the development of complications associated with mechanical
ventilation. As soon as an opportunistic infection was suspected,
trimethoprim-sulfamethoxazole and corticosteroid therapy were initiated, with
a short application of mechanical ventilation. Despite a good initial
response to treatment, during the mechanical ventilation, a relapse of fever
occurred, as well as development of productive cough, new zones of
consolidation on chest X-ray and Acinetobacter spp. was isolated in a swab
culture. According to the literature recommendations, colistinmeropenem
combination was conducted with adequate response. The patient was discharged
after 22 days of treatment, in good general condition, afebrile, with normal
laboratory parameters and gas exchange, without subjective symptoms.
Conclusion. Early identification of Pneumocystis jiroveci pneumonia, timely
initiation of prophylaxis and treatment, along with antiretroviral therapy,
re?duced the risk of severe clinical events and respiratory failure. Also,
timely recognition of complications of mechanical ventilation, identification
of infection, early extubation and application of appropriate antibiotic
therapy, reduce the mortality from nosocomial pneumonia caused by multi-drug
resistant hospital strains of microorganisms.
A multivariate prognostic score for predicting mortality of acquired immunodeficiency syndrome patients with Hypoxemic Respiratory Failure and Pneumocystis Jiroveci Pneumonia
