Name

nInstitution

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nBacterial Pneumonia

nHIV positive patients are at a serious risk for bacterial pneumonia than HIV negative individuals. The disease usually precedes other opportunistic infections. In addition, bacterial pneumonia is usually recurrent in HIV positive people (Marrie, 308). Persons with recurrent bacterial pneumonia develop permanent destruction and dilation of the bronchial airways to their lungs.

nEtiology of Bacterial Pneumonia

nThere are many bacterial pathogens that have the potential of causing HIV-linked pneumonia. There are two most common types of bacteria that cause bacterial pneumonia among HIV positive persons (Mabey, 257). These are Streptococcus pneumonia and Haemophilus influenzae. Besides, atypical organisms such as Mycoplasma, Legionella and Chlamydophila can cause bacterial pneumonia (Marrie, 308). Rarely, bacterial pneumonia can be caused by Staphylococcus aureus and Pseudomonas aeruginosa are community-acquired pathogens seen at a higher level in HIV positive persons. However, it is quite difficult to isolate the causative agent or infectious organisms in cultures.

nNot only are HIV-positive persons more likely to develop bacterial pneumonia due to one of these infections, they are high probability to experience recurrent pneumonia (Torres, 58). Moreover, persons with CD4 count below 100 cells/mm3 and whose bacterial infection has spread beyond the lungs have a greater risk of death from bacterial pneumonia.

nResults of Gram stains and its limitations

nSputum gram stain is carried out when the doctor suspects that a respiratory disease is caused by bacterial infection. It is useful in testing pneumonia because it produces rapid results (Mabey, 258). The gram stain detects the thickness of bacteria cell wall because it is sensitive to peptidoglycan. Peptidoglycan is found in the cell wall of bacteria. The stain determines whether the bacteria are gram-positive or gram-negative.

nGram positive bacteria have thick cell wall while gram negative bacteria have thin cell wall. In addition, it is possible to detect White Blood Cells in the sputum because they are present during infection (Mabey, 259). However, the sputum gram stain was not carried out because it cannot identify all specific types of bacteria.

nLink to AIDS

nBacterial infection has been linked to several AIDS-related factors. It leads to weak immune system in HIV positive patients particularly to people with CD4 count below 200 cells/mm3 are at serious risk (Merson, et, al, 205). In addition, it leads to uncontrolled viral load and not being on antiretroviral therapy. The severity of HIV infection can be categorized by CD4 cell count into numerous phases. When the CD4 count of the HIV-positive person is above 500 cells/mm3 it indicates relatively intact immune systems (Torres, 60). When the CD4 count is between 200 and 500 cell/mm3, it indicates suppression of immunity. However, when the cd4 count is below 200 cell/mm3 the HIV infection progresses to AIDS. Bacterial pneumonia increases the risk of opportunistic infections when the CD4 count is decreases (Müller, et al, 169). This leads to diseases such as Fungal Pneumonias, Cytomegalovirus (CMV) pneumonia and Toxoplasma gondii pneumonia in people suffering from AIDS.

nAntimicrobial therapy

nAntimicrobial therapy differs based on whether the illness is severe enough to warrant inpatient treatment. Oral antibiotic is administered to outpatient treatment for mild cases of bacterial pneumonia (Müller, et al, 199). Outpatient treatment can be accomplished in seven to ten days of oral antibiotics. In inpatient treatment, intravenous antibiotics are typically administered. The US Public Health Services and Infectious Diseases Society recommend intravenous administration of beta lactam antibiotic plus either macrolide or doxycycline for inpatient treatment (Merson, et, al, 209). The preferred beta lactam antibiotics are ampicillin (Omnipen, polycillin, Principen), cefotaxime (Calforan), or ceftriaxone (Rocephin).

nOther three infections that this patient would also be susceptible to based on his HIV status.

nDue to decreased level of CD4 count in the body, the HIV positive patient is also susceptible to other infections such as pneumocystis Pneumonia, tuberculosis and Kaposi sarcoma (Merson, et, al, 208). The fungal pathogen Pneumocystis jirovecii causes Pneumocystis pneumonia. The infection is very common to AIDS patients when the CD4 count is below 200cell/mm3. In addition, it is most common AIDS-defining opportunistic infection in the United States of America. PCP presents with fever, shortness of breath and cough. The cough is usually dry and non-productive for the AIDS patient (Müller, et al, 209). It may also cause chest tightness due to a lot of coughing. There are no laboratory tests for PCP. On chest radiograph, persons with PCP have granular (grainy-looking) opaque areas, reticular (network-like) or opacities. Patients with PCP require hospitalization and close supervision.

nTuberculosis is caused by a pathogenic bacteria M. tuberculosis that spread from one person to another via respiratory droplets (Harries, et al, 56). Among the HIV positive persons, exposure and infection to M. tuberculosis leads to latent tuberculosis infection (LTBI). LTBI can progress to active tuberculosis when the cd4 count decreases among HIV positive persons. Moreover, HIV positive persons who have LTBI face more than 10 per cent risk of progressing from latent to active TB disease as compared with an approximately 10 per cent lifetime risk in general population (Harries, et al, 58). Effective management of active tuberculosis needs numerous antibiotics for not less than six months. The HI-positive patient should adhere to recommended therapy to avoid missed doses of antibiotics. This is because, it can lead to drug resistant TB to lack of compliance.

nKaposis sarcoma is a type of cancer that causes skin, lymph nodes and mouth infections. HIV is the common cause of this disease (Merson, et, al, 207). Due to weak immunity, HIV positive patients are likely to develop Kaposi sarcoma. The disease occurs in the late stages of HIV infection when the patients are suffering from AIDS. Herpes virus causes Kaposis sarcoma. However treatment with anti-HIV drugs causes 80 per cent drop in KS cases in HIV positive patients.

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nWorks cited

nHarries, A. D, Dermot Maher, and Stephen Graham TB/HIV 1st ed. Geneva: World Health Organization, 2004 Print

nMabey, David. Principles of Medicine In Africa. 1st ed. Cambridge: Cambridge University Press, 2013. Print.

nMarrie, Thomas J. Community-Acquired Pneumonia. 1st ed. New York: Kluwer Academic / Plenum Publishers, 2001. Print.

nMerson, Michael H, Robert E Black, and Anne J Mills Global Health 1st ed. Burlington, MA: Jones & Bartlett Learning, 2012. Print.

nMüller, Nestor Luiz et al. Imaging Of Pulmonary Infections 1st ed. Philadelphia: Lippincott Williams & Wilkins, 2007. Print.

nTorres Martí, A. Respiratory Infections. 1st ed. London: Hodder Arnold, 2006. Print.