title: Pneumocystis carinii pneumonia in Zimbabwe.
abstract: 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.
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000328:Adult; D000465:Algorithms; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy; D018791:CD4 Lymphocyte Count; D003937:Diagnosis, Differential; D005260:Female; D005336:Fiber Optic Technology; D005544:Forecasting; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010406:Penicillins / Q000627:therapeutic use; D011020:Pneumonia, Pneumocystis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011859:Radiography; D012119:Respiration; D012514:Sarcoma, Kaposi / Q000175:diagnosis; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging; D015030:Zimbabwe
chemical_list: D010406:Penicillins; D010100:Oxygen