Performance of an Algorithm To Detect Pneumocystis carinii Pneumonia in Symptomatic HIV-Infected Persons

• Published in: Chest Vol. 115; no. 4; pp. 1025 - 1032
• Main Authors: Huang, Laurence, Stansell, John, Osmond, Dennis, Turner, Joan, Shafer, Kimberly Page, Fulkerson, William, Kvale, Paul, Wallace, Jeanne, Rosen, Mark, Glassroth, Jeffrey, Reichman, Lee, Hopewell, Philip
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.04.1999; American College of Chest Physicians; Elsevier B.V
• Subjects: Acquired immune deficiency syndrome; acquired immunodeficiency syndrome; AIDS; Algorithms; Ambulatory care; Biological and medical sciences; Carbon monoxide; Complications and side effects; Dehydrogenases; Diagnosis; Drug use; Enrollments; Fever; HIV; HIV infection; Human immunodeficiency virus; Human viral diseases; Immune system; Infections; Infectious diseases; lung radiography; Medical sciences; opportunistic infections; Pneumocystis carinii pneumonia; Pneumonia; respiratory function tests; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; United States; opportunistic infections; LDH; OR; Dlco; respiratory function tests; Pneumocystis carinii pneumonia; human immunodeficiency virus; PCHIS; PCP; acquired immunodeficiency syndrome; lung radiography; Human; Immunopathology; Lung disease; Pneumonia; Radiodiagnosis; Respiratory disease; Lung; Exploration; Pneumocystis carinii; AIDS; Parasitosis; Immune deficiency; Algorithm; Fungi; Infection; Radiography; Viral disease; Diffusing capacity; Gas exchange; Fungi Imperfecti; Carbon monoxide; Diagnosis; Thallophyta
• DOI: 10.1378/chest.115.4.1025
• ISSN: 0012-3692

To determine whether an algorithm consisting of a chest radiograph and the diffusing capacity of the lung for carbon monoxide (Dlco) is effective in detecting Pneumocystis carinii pneumonia (PCP) in symptomatic HIV-infected persons; and to establish a benchmark for future comparisons of alternative algorithms. Prospective, 64-month study. Multicenter, ambulatory care. 306 HIV-infected subjects enrolled in the Pulmonary Complications of HIV Infection Study who developed 467 episodes of new or worsening respiratory symptoms. Chest radiography followed by Dlco measurement, if the radiograph was normal or unchanged. An algorithm combining a chest radiograph followed by a Dlco measurement, if the radiograph was normal or unchanged, was effective and detected abnormalities that led to a diagnosis of PCP in 78 of 80 evaluable episodes (97.5%). The radiograph (specific parenchymal abnormality, number of lung zones involved) and the Dlco (degree of decrease, degree of decrease from baseline) also provided additional information on the probability of PCP. In symptomatic HIV-infected patients suspected of having PCP, the diagnostic evaluation should begin with a chest radiograph, followed by a Dlcomeasurement, if the radiograph is normal or unchanged. If both of these tests are normal, it may be reasonable to conclude the evaluation rather than to proceed on to additional testing. This algorithm can serve as a benchmark for future comparisons.