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[Diagnosis of pneumocystis carinii pneumonia in AIDS patients].
Wien Klin Wochenschr. 1998 Sep 18; 110(17):604-7.WK

Abstract

BACKGROUND

Based on the changing disease pattern of human immunodeficiency virus (HIV) associated pulmonary complications we conducted a prospective study in order to compare the value of laboratory tests in patients with Pneumocystis (P.) carinii pneumonia (PCP) and other pulmonary complications and of different identification methods of P. carinii in bronchoalveolar lavage fluid (BALF) in PCP patients.

PATIENTS AND METHODS

In 217 HIV-1-infected patients we evaluated the following parameters: platelets, serum lactat dehydrogenase (LDH), total serum protein (TP), hemoglobin (Hb), and CD4+ and CD8+ T-lymphocyte count. P. carinii was identified in BALF by May Grünwald Giemsa stain (MGG), direct immunofluorescence test (DIFT), and polymerase chain reaction (PCR). We correlated these parameters in patients with a presumptive diagnosis of PCP and compared them with those of patients suffering from other pulmonary complications.

RESULTS

All patients underwent bronchoscopy. 55 patients (25.3%) had a presumptive diagnosis of PCP. The sensitivity values of MGG stain, DIFT, and PCR differed considerably (79.1%, 56.1%, and 65.9%, respectively), but specificity values did not (99.2%, 97.3%, and 98.2%, respectively) as well as accuracy values (93.8%, 86.2%, and 89.7%, respectively). The mean values of platelets, of LDH, and of total serum protein of PCP patients and those of patients with other pulmonary diseases differed statistically significant as well as the mean values of these parameters of PCP patients and those of patients with bacterial pneumonia. Logistic-regression analysis revealed the number of platelets and the amount of total serum protein as independent, significant prognostic factors. Moreover, each PCP patient had a CD4+ T-lymphocyte count of less than 200 cells/mm3 blood. The CD4/CD8 ratio of PCP patients was statistically significant lower than that of patients with bacterial pneumonia.

CONCLUSIONS

A detection of P. carinii in BALF is inevitable for a definitive diagnosis of a PCP. The most efficient identification method in this case is the MGG stain. Platelets, total serum protein, and CD4+ T-lymphocyte count should be included into the criteria for the presumptive diagnosis of PCP.

Authors+Show Affiliations

Armbruster C
Interne Abteilung des Pulmologischen Zentrums der Stadt Wien, Osterreich. andreas.hassl@lunivie.ac.at
Hassl A
No affiliation info available
Kriwanek S
No affiliation info available

MeSH

AIDS-Related Opportunistic InfectionsAdolescentAdultAgedBronchoalveolar Lavage FluidCD4 Lymphocyte CountDiagnosis, DifferentialDiagnostic Tests, RoutineFemaleHIV-1HumansMaleMiddle AgedPneumocystisPneumonia, PneumocystisPredictive Value of Tests

Pub Type(s)

English Abstract
Journal Article

Language

ger

PubMed ID

9816629

Citation

Armbruster, C, et al. "[Diagnosis of Pneumocystis Carinii Pneumonia in AIDS Patients]." Wiener Klinische Wochenschrift, vol. 110, no. 17, 1998, pp. 604-7.
Armbruster C, Hassl A, Kriwanek S. [Diagnosis of pneumocystis carinii pneumonia in AIDS patients]. Wien Klin Wochenschr. 1998;110(17):604-7.
Armbruster, C., Hassl, A., & Kriwanek, S. (1998). [Diagnosis of pneumocystis carinii pneumonia in AIDS patients]. Wiener Klinische Wochenschrift, 110(17), 604-7.
Armbruster C, Hassl A, Kriwanek S. [Diagnosis of Pneumocystis Carinii Pneumonia in AIDS Patients]. Wien Klin Wochenschr. 1998 Sep 18;110(17):604-7. PubMed PMID: 9816629.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Diagnosis of pneumocystis carinii pneumonia in AIDS patients]. AU - Armbruster,C, AU - Hassl,A, AU - Kriwanek,S, PY - 1998/11/17/pubmed PY - 1998/11/17/medline PY - 1998/11/17/entrez SP - 604 EP - 7 JF - Wiener klinische Wochenschrift JO - Wien Klin Wochenschr VL - 110 IS - 17 N2 - BACKGROUND: Based on the changing disease pattern of human immunodeficiency virus (HIV) associated pulmonary complications we conducted a prospective study in order to compare the value of laboratory tests in patients with Pneumocystis (P.) carinii pneumonia (PCP) and other pulmonary complications and of different identification methods of P. carinii in bronchoalveolar lavage fluid (BALF) in PCP patients. PATIENTS AND METHODS: In 217 HIV-1-infected patients we evaluated the following parameters: platelets, serum lactat dehydrogenase (LDH), total serum protein (TP), hemoglobin (Hb), and CD4+ and CD8+ T-lymphocyte count. P. carinii was identified in BALF by May Grünwald Giemsa stain (MGG), direct immunofluorescence test (DIFT), and polymerase chain reaction (PCR). We correlated these parameters in patients with a presumptive diagnosis of PCP and compared them with those of patients suffering from other pulmonary complications. RESULTS: All patients underwent bronchoscopy. 55 patients (25.3%) had a presumptive diagnosis of PCP. The sensitivity values of MGG stain, DIFT, and PCR differed considerably (79.1%, 56.1%, and 65.9%, respectively), but specificity values did not (99.2%, 97.3%, and 98.2%, respectively) as well as accuracy values (93.8%, 86.2%, and 89.7%, respectively). The mean values of platelets, of LDH, and of total serum protein of PCP patients and those of patients with other pulmonary diseases differed statistically significant as well as the mean values of these parameters of PCP patients and those of patients with bacterial pneumonia. Logistic-regression analysis revealed the number of platelets and the amount of total serum protein as independent, significant prognostic factors. Moreover, each PCP patient had a CD4+ T-lymphocyte count of less than 200 cells/mm3 blood. The CD4/CD8 ratio of PCP patients was statistically significant lower than that of patients with bacterial pneumonia. CONCLUSIONS: A detection of P. carinii in BALF is inevitable for a definitive diagnosis of a PCP. The most efficient identification method in this case is the MGG stain. Platelets, total serum protein, and CD4+ T-lymphocyte count should be included into the criteria for the presumptive diagnosis of PCP. SN - 0043-5325 UR - https://www.unboundmedicine.com/medline/citation/9816629/[Diagnosis_of_pneumocystis_carinii_pneumonia_in_AIDS_patients]_ L2 - http://www.diseaseinfosearch.org/result/279 DB - PRIME DP - Unbound Medicine ER -