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Pneumocystis jiroveci pneumonia and other pulmonary infections in TB smear-negative HIV-positive patients with atypical chest X-ray in Ethiopia.
Scand J Infect Dis. 2007; 39(11-12):1045-53.SJ

Abstract

Pneumocystis pneumonia (PCP) has been considered a rare disease in sub-Saharan Africa. However, a rising prevalence has been noted recently. The objective of this study was to determine the relative prevalence of PCP and other pulmonary opportunistic diseases in patients infected with HIV in Ethiopia. 131 consecutive patients with respiratory symptoms and atypical chest X-ray, who were sputum smear-negative for AFB and seroreactive for HIV, underwent clinical evaluation and investigation for Pneumocystis jiroveci and Mycobacterium tuberculosis from sputum and bronchoalveolar lavage (BAL), and fungal and bacterial pathogens from BAL alone. Bacterial infections, Pneumocystis pneumonia (PCP) and pulmonary tuberculosis (PTB) occurred in 44 (33.6%), 39 (29.7%) and 31 (23.7%) patients, respectively. Pulmonary Kaposi sarcoma and non-specific interstitial pneumonitis occurred in 4 patients each. In a multivariate regression model, predictors of PCP were typical chest X-ray and low CD4 count while purulent sputum predicted bacterial infection. The sensitivity of physicians and chest X-ray diagnosis was particularly low for PTB and bacterial infections. We conclude that chronic bacterial infection and Pneumocystis pneumonia are important differential diagnoses in HIV-infected, smear-negative PTB patients presenting with atypical chest X-ray. We therefore need to escalate the use of preventive and highly active antiretroviral (HAART) treatment in order to prevent a PCP epidemic.

Authors+Show Affiliations

Departments of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia. getadera@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17852928

Citation

Aderaye, Getachew, et al. "Pneumocystis Jiroveci Pneumonia and Other Pulmonary Infections in TB Smear-negative HIV-positive Patients With Atypical Chest X-ray in Ethiopia." Scandinavian Journal of Infectious Diseases, vol. 39, no. 11-12, 2007, pp. 1045-53.
Aderaye G, Bruchfeld J, Aseffa G, et al. Pneumocystis jiroveci pneumonia and other pulmonary infections in TB smear-negative HIV-positive patients with atypical chest X-ray in Ethiopia. Scand J Infect Dis. 2007;39(11-12):1045-53.
Aderaye, G., Bruchfeld, J., Aseffa, G., Nigussie, Y., Melaku, K., Woldeamanuel, Y., Asrat, D., Worku, A., Gaegziabher, H., Lebaad, M., & Lindquist, L. (2007). Pneumocystis jiroveci pneumonia and other pulmonary infections in TB smear-negative HIV-positive patients with atypical chest X-ray in Ethiopia. Scandinavian Journal of Infectious Diseases, 39(11-12), 1045-53.
Aderaye G, et al. Pneumocystis Jiroveci Pneumonia and Other Pulmonary Infections in TB Smear-negative HIV-positive Patients With Atypical Chest X-ray in Ethiopia. Scand J Infect Dis. 2007;39(11-12):1045-53. PubMed PMID: 17852928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pneumocystis jiroveci pneumonia and other pulmonary infections in TB smear-negative HIV-positive patients with atypical chest X-ray in Ethiopia. AU - Aderaye,Getachew, AU - Bruchfeld,Judith, AU - Aseffa,Getachew, AU - Nigussie,Yared, AU - Melaku,Kibrebeal, AU - Woldeamanuel,Yimtubezinash, AU - Asrat,Daniel, AU - Worku,Alemayehu, AU - Gaegziabher,Haimanot, AU - Lebaad,Marianne, AU - Lindquist,Lars, Y1 - 2007/07/02/ PY - 2007/9/14/pubmed PY - 2008/3/15/medline PY - 2007/9/14/entrez SP - 1045 EP - 53 JF - Scandinavian journal of infectious diseases JO - Scand J Infect Dis VL - 39 IS - 11-12 N2 - Pneumocystis pneumonia (PCP) has been considered a rare disease in sub-Saharan Africa. However, a rising prevalence has been noted recently. The objective of this study was to determine the relative prevalence of PCP and other pulmonary opportunistic diseases in patients infected with HIV in Ethiopia. 131 consecutive patients with respiratory symptoms and atypical chest X-ray, who were sputum smear-negative for AFB and seroreactive for HIV, underwent clinical evaluation and investigation for Pneumocystis jiroveci and Mycobacterium tuberculosis from sputum and bronchoalveolar lavage (BAL), and fungal and bacterial pathogens from BAL alone. Bacterial infections, Pneumocystis pneumonia (PCP) and pulmonary tuberculosis (PTB) occurred in 44 (33.6%), 39 (29.7%) and 31 (23.7%) patients, respectively. Pulmonary Kaposi sarcoma and non-specific interstitial pneumonitis occurred in 4 patients each. In a multivariate regression model, predictors of PCP were typical chest X-ray and low CD4 count while purulent sputum predicted bacterial infection. The sensitivity of physicians and chest X-ray diagnosis was particularly low for PTB and bacterial infections. We conclude that chronic bacterial infection and Pneumocystis pneumonia are important differential diagnoses in HIV-infected, smear-negative PTB patients presenting with atypical chest X-ray. We therefore need to escalate the use of preventive and highly active antiretroviral (HAART) treatment in order to prevent a PCP epidemic. SN - 0036-5548 UR - https://www.unboundmedicine.com/medline/citation/17852928/Pneumocystis_jiroveci_pneumonia_and_other_pulmonary_infections_in_TB_smear_negative_HIV_positive_patients_with_atypical_chest_X_ray_in_Ethiopia_ DB - PRIME DP - Unbound Medicine ER -