       Document 0328
 DOCN  M9620328
 TI    Pneumocystis carinii pneumonia in Zimbabwe [see comments]
 DT    9602
 AU    Malin AS; Gwanzura LK; Klein S; Robertson VJ; Musvaire P; Mason PR;
       Department of Clinical Pharmacology, University of Zimbabwe,; Harare.
 SO    Lancet. 1995 Nov 11;346(8985):1258-61. Unique Identifier : AIDSLINE
       MED/96064881
 CM    Comment in: Lancet 1995 Nov 11;346(8985):1242-3
 AB    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% CI
       6.1-10.9]). A respiratory rate of more than 40/min was the best clinical
       predictor of PCP (odds ratio 11.2 [95% CI 8.8-13.6]). Median CD4+ T cell
       count for all cases of PCP was 134/microL (range 5-355) and for
       tuberculosis without PCP 206/microL (range 61-787). In resource-limited
       countries, a regionally appropriate management algorithm is required.
 DE    Adult  Algorithms  AIDS-Related Opportunistic
       Infections/BLOOD/*DIAGNOSIS/  RADIOGRAPHY  Bronchoalveolar Lavage
       Fluid/MICROBIOLOGY  Bronchoscopy  CD4 Lymphocyte Count  Diagnosis,
       Differential  Female  Fiber Optics  Forecasting  Human  Logistic Models
       Lung Neoplasms/DIAGNOSIS  Male  Middle Age  Oxygen/BLOOD
       Penicillins/THERAPEUTIC USE  Pneumonia, Pneumocystis
       carinii/BLOOD/*DIAGNOSIS/RADIOGRAPHY  Respiration  Sarcoma,
       Kaposi's/DIAGNOSIS  Sputum/MICROBIOLOGY  Tuberculosis,
       Pulmonary/BLOOD/DIAGNOSIS/RADIOGRAPHY  Zimbabwe  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

