Streptococcus pneumoniae, and Streptococcus pyogenes, although rare cases of pneumatocele formation with Klebsiella pneumoniae, Haemophilus influenzae, Escherichia coli, Mycobacterium tuberculosis, Nocardia asteroides, various anaerobes, and P carinii have been described. Indeed, a review of PCP prior to the AIDS epidemic documented a 4 percent incidence of pneumothorax or pneumomediastinum in non-AIDS-associated PCP.
Six of our eight patients with pneumothorax had other possible risk factors for the development of pneumothoraces, including Broviac catheter placement, transbronchial biopsy, and positive pressure ventilation. The time lag (>72 h) between Broviac catheter placement and the occurrence of pneumothorax in patient 3, however, suggests that this factor probably played no role in the development of the pneumothorax. None of the patients who underwent transbronchial biopsy (patients 2, 3, 4, and 6) demonstrated pneumothorax on the postprocedure chest x-ray film. Furthermore, in all cases the biopsy preceded the pneumothorax by at least six days. The occurrence of delayed pneumothorax due to the procedure was, therefore, unlikely in thoses cases.
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