Risk stratification of ambulatory patients suspected of Pneumocystis pneumonia

Article Abstract:

Pneumocystis carinii pneumonia (PCP) is the most common infection among patients with acquired immunodeficiency syndrome (AIDS), and has a fatality rate of 20 percent with treatment. PCP is difficult to diagnose because the symptoms are no different from those of most other respiratory tract infections. Chest X-rays identify between 56 percent and 94 percent of patients with PCP. A high erythrocyte sedimentation rate (ESR, clotting time of a blood component) occurs in these patients, but it may not be specific for PCP. A negative sputum induction test does not exclude PCP, and few facilities are equipped to perform this test. Bronchoscopy is invasive and expensive, but it is the best diagnostic test for PCP. To determine an easier way to assess the risk of PCP, 302 patients with respiratory symptoms and risk factors for HIV (human immunodeficiency virus) infection were followed-up. It was found that a chest X-ray consistent with PCP, mouth lesions, high ESR, and a high level of lactate dehydrogenase (LDH, an enzyme) were useful predictors for the stratification of patients into low, low-intermediate, high-intermediate, and high risk categories. If none of these findings were abnormal, the probability of PCP was zero. One abnormality represented a risk of 9 percent, but two or more predictors raised the probability to 47 percent, indicating the need for further evaluation. Patients with X-rays indicating PCP had an 84 percent probability of the disease, and they should be evaluated by sputum induction or bronchoscopy. Checking for mouth lesions and performing ESR and LDH level tests are inexpensive methods of improving the diagnostic sensitivity of chest X-rays. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pneumocystis carinii pneumonia, X-rays, Lactate dehydrogenase, Pneumocystis carinii, Erythrocyte sedimentation rate

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Comparative yield of blood culture for fungi and mycobacteria, liver biopsy, and bone marrow biopsy in the diagnosis of fever of undetermined origin in human immunodeficiency virus-infected patients

Article Abstract:

Infection with human immunodeficiency virus (HIV) may be associated with the development of fever. Several diagnostic methods, including bone marrow and liver biopsies, have been used to determine the cause of the fever. It is known that mycobacterial infection frequently occurs in HIV-infected patients with fever. Thus, the screening of blood for the presence of mycobacteria may save time and prevent the need for a bone marrow or liver biopsy. The diagnostic value of mycobacterial blood culture, bone marrow biopsy, and liver biopsy was assessed in determining the cause of unexplained fever in 12 HIV-infected patients with fever of unknown cause. Based on all the test procedures done, it was determined that three patients were infected with Mycobacterium tuberculosis, and five with M. avium. Mycobacteria were isolated from the blood of six of these patients. Microorganisms and granuloma or granular growths were detected in four bone marrow and six liver biopsies. The liver biopsy showed microorganisms in 75 percent of cases, whereas bone marrow biopsy revealed microorganisms in only 25 percent of cases. Mycobacterial blood culture is a slow method and may sometimes fail to diagnose mycobacterial infection. The liver biopsy provides a rapid technique for diagnosing mycobacterial infection in HIV-infected patients with unexplained fever. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Fever, Mycobacterial infections, Mycobacterium infections

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