Comparison of empyema thoracis presentation between HIV infected and Non HIV infected Patients as Seen at a Tertiary Hospital In Kenya.

Abstract

Background: Emphysema thoracis accounts for 23% of chest related complications in Human Immunodeficiency Virus-Acquired immunodeficiency Syndrome (HIV/ AIDS) and is a frequent complication of pneumonia in patients with HIV. Patients infected with HIV developing empyema thoracis tend to present late and are sometimes subjected to different management modalities with a lot of complications. Existing literature shows that this results in long hospital stay, high morbidity and mortality and that HIV infection has changed the pattern of presentation of many diseases. A clear understanding of symptoms, signs and microbial causes will help bridge the knowledge gap leading to early diagnosis and shortened hospital stay among these patients. Objective: To compare the symptoms, signs and microbial causes of empyema thoracis between HIV and non HIV infected patients. Study design: Cross-sectional comparative study at Kenyatta National Hospital over 4 month’s duration between December 2012 and April 2013. Methods and materials: We recruited 32 HIV infected patients and 32 non HIV infected patients making up a total of 64 subjects using convenient sampling method. Independent variables were presence or absence of HIV infection. The dependent variables were signs, symptoms and microbiology of empyema thoracis. Statistical analysis: Graph Pad Instat ™ version 2.04 statistical software was used for analysis of data. The p value of equal or less than 0.05 was considered significant. Results: Thirty six males (56.25%) and 28 females (43.75%) participated. Chest pain was the most common and consistent symptom in both HIV infected and non-HIV infected patients, 100% and 97% respectively. Cough was the second commonest symptom seen in 97% of HIV and 84% of non-HIV infected. Weight loss was noted in 81.3% of HIV and 53.1% of non-HIV infected patients. Patients without HIV infection presented with massive pleural pus with midline shift in 43.8%, while those with HIV infection only 15% had a noticeable midline shift. Whereas 81.3% of HIV infected patients reported fever prior to hospital admission only 68% had clinically demonstrable fever. Among the non-HIV infected, 66.4% reported febrile illness but only 59% had demonstrable fever. The commonest etiological factor among the HIV infected patients was TB (50%) and Para pneumonia (47%). In non-HIV infected patient’s malignancies (34%) and iatrogenic causes mainly chest tube insertions (32%) were the main etiological factors. The most common cultured organism in HIV infected were pseudomonas spp (25%) while Staphylococcus aureus were the most common isolates among non HIV infected at 34%. Conclusion: Chest pain is the most common and consistent symptom in both HIV and non-HIV infected patients presenting with empyema thoracis. Aseptic technique should be observed during chest tube insertion at all times.