title: Non-invasive management of fever and breathlessness in HIV positive patients.
abstract: In a prospective study of 72 human immunodeficiency virus (HIV) positive patients presenting with fever and breathlessness, a non-invasive management protocol, incorporating a scanning technique using radioactively labelled diethylenetriamine penta acetate (DTPA) and sputum induction, was found to be highly sensitive and specific in the early detection of Pneumocystis carinii pneumonia (PCP). At presentation, the DTPA scan was abnormal in 34 of 36 cases of PCP, irrespective of smoking history, whilst the chest radiograph was diffusely abnormal in 21 cases. Sputum induction identified 7 of 14 patients with PCP in the first six months of its use and 7 of 10 patients over the last six months. The DTPA lung scan and induced sputum examination are non-invasive techniques which can be used to investigate out-patients. In combination they detected all cases of PCP at presentation, reduced the need for bronchoscopy, resulted in a low case fatality (5.4%) and reduced the need for admission.
authors.affiliation: Dept. of Medicine, UMDS St Thomas' Hospital, London, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Leach
authors.forename: A C
authors.initials: AC
authors.lastname: Davidson
authors.forename: M J
authors.initials: MJ
authors.lastname: O'Doherty
authors.forename: M
authors.initials: M
authors.lastname: Nayagam
authors.forename: A
authors.initials: A
authors.lastname: Tang
authors.forename: N T
authors.initials: NT
authors.lastname: Bateman
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D002985:Clinical Protocols; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D005334:Fever / Q000209:etiology*; D006679:HIV Seropositivity; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013183:Sputum / Q000382:microbiology; D016284:Technetium Tc 99m Pentetate
chemical_list: D016284:Technetium Tc 99m Pentetate