Pneumocystis carinii pneumonia in Zimbabwe

• Published in: The Lancet (British edition) Vol. 346; no. 8985; pp. 1258 - 1261
• Main Authors: Malin, A.S, Gwanzura, L.K.Z, Robertson, V.J, Musvaire, P, Mason, P.R, Klein, S
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 11.11.1995; Elsevier Limited
• Subjects: Adult; AIDS-Related Opportunistic Infections - blood; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - diagnostic imaging; AIDS/HIV; Algorithms; Alveoli; Bacilli; Bronchoalveolar Lavage Fluid - microbiology; Bronchoscopy; Bronchus; CD4 antigen; CD4 Lymphocyte Count; Diagnosis, Differential; Female; Fiber Optic Technology; Forecasting; Fungi; HIV; Human immunodeficiency virus; Humans; Kaposi's sarcoma; Logistic Models; Lung Neoplasms - diagnosis; Lymphocytes; Lymphocytes T; Male; Middle Aged; Oxygen - blood; Patients; Penicillin; Penicillins - therapeutic use; Pneumocystis carinii; Pneumonia; Pneumonia, Pneumocystis - blood; Pneumonia, Pneumocystis - diagnosis; Pneumonia, Pneumocystis - diagnostic imaging; Population; Radiographs; Radiography; Regression models; Resource management; Respiration; Respiratory rate; Sarcoma; Sarcoma, Kaposi - diagnosis; Signs and symptoms; Smear; Sputum; Sputum - microbiology; Tuberculosis; Tuberculosis, Pulmonary - blood; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - diagnostic imaging; Viruses; Zimbabwe; Zimbabwe; Africa; Eastern Africa; Respiratory Infections; Acquired Immunodeficiency Syndrome; Africa; Viral Diseases; Zimbabwe; Developing Countries; Infections; Africa South Of The Sahara; Hiv Infections; English Speaking Africa; Diseases
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(95)91862-0

Summary 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% Cl 6·1-10·9]). A respiratory rate of more than 40/min was the best clinical predictor of PCP (odds ratio 11·2 [95% Cl 8·8-13·6]). Median CD4+ T cell count for all cases of PCP was 134/μL (range 5-355) and for tuberculosis without PCP 206/μL (range 61-787). In resource-limited countries, a regionally appropriate management algorithm is required.