Pneumocystis carinii pneumonia in Zimbabwe

Lancet. 1995 Nov 11;346(8985):1258-61. doi: 10.1016/s0140-6736(95)91862-0.

Abstract

Pneumocystis carinii pneumonia (PCP) is said to be rare in Africa, with reported rates of 0-22% in human-immunodeficiency-virus (HIV) infected individuals with respiratory symptoms. Over one year in a central hospital in southern Africa, 64 HIV-infected patients with acute diffuse pneumonia unresponsive to penicillin and sputum smear-negative for acid-fast bacilli underwent fibreoptic bronchoscopy. Bronchoalveolar lavage fluid was assessed for bacteria, fungi, Pneumocystis carinii, and mycobacteria. 21 patients (33%) had PCP and 24 (39%) had tuberculosis; 6 of these had both infections. 5 patients had Kaposi's sarcoma (KS) associated with PCP, tuberculosis, or another infection, in 1 patient KS was the only finding, and in 21 no pathogen was identified. A logistic regression model was used to assess clinical, radiographic, and arterial blood gas predictors of PCP and tuberculosis. Fine reticulonodular shadowing on the chest radiograph (nodular component < 1 mm) was the strongest independent predictor of PCP (odds ratio 8.5 [95% CI 6.1-10.9]). A respiratory rate of more than 40/min was the best clinical predictor of PCP (odds ratio 11.2 [95% CI 8.8-13.6]). Median CD4+ T cell count for all cases of PCP was 134/microL (range 5-355) and for tuberculosis without PCP 206/microL (range 61-787). In resource-limited countries, a regionally appropriate management algorithm is required.

PIP: The authors enrolled 64 patients in a large central hospital in Harare, Zimbabwe, over a 12-month period from May 1992 in their study of the prevalence of Pneumocystis carinii pneumonia (PCP) among HIV-infected individuals with acute diffuse pneumonia unresponsive to penicillin and sputum smear-negative for acid-fast bacilli. Subjects underwent fiberoptic bronchoscopy, while bronchoalveolar lavage fluid was assessed for bacteria, fungi, Pneumocystis carinii, and mycobacteria. 21 patients had PCP and 24 had tuberculosis (TB); 6 of these had both infections. 5 patients had Kaposi's sarcoma (KS) associated with PCP, TB, or another infection. KS was the only finding in 1 patient, and no pathogen was identified in 21 patients. Fine reticulonodular shadowing on the chest radiograph and a respiratory rate of more than 40 per minute were the strongest independent predictor of PCP and the best clinical predictor of PCP, respectively. Median CD4+ T cell count for all cases of PCP was 134/mcl (range, 5-355) and for TB without PCP 206/mcl (range, 61-787).

MeSH terms

  • AIDS-Related Opportunistic Infections / blood
  • AIDS-Related Opportunistic Infections / diagnosis*
  • AIDS-Related Opportunistic Infections / diagnostic imaging
  • Adult
  • Algorithms
  • Bronchoalveolar Lavage Fluid / microbiology
  • Bronchoscopy
  • CD4 Lymphocyte Count
  • Diagnosis, Differential
  • Female
  • Fiber Optic Technology
  • Forecasting
  • Humans
  • Logistic Models
  • Lung Neoplasms / diagnosis
  • Male
  • Middle Aged
  • Oxygen / blood
  • Penicillins / therapeutic use
  • Pneumonia, Pneumocystis / blood
  • Pneumonia, Pneumocystis / diagnosis*
  • Pneumonia, Pneumocystis / diagnostic imaging
  • Radiography
  • Respiration
  • Sarcoma, Kaposi / diagnosis
  • Sputum / microbiology
  • Tuberculosis, Pulmonary / blood
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / diagnostic imaging
  • Zimbabwe

Substances

  • Penicillins
  • Oxygen