Performance of an algorithm to detect Pneumocystis carinii pneumonia in symptomatic HIV-infected persons. Pulmonary Complications of HIV Infection Study Group.
OBJECTIVE
To determine whether an algorithm consisting of a chest radiograph and the diffusing capacity of the lung for carbon monoxide (D(LCO)) is effective in detecting Pneumocystis carinii pneumonia (PCP) in symptomatic HIV-infected persons; and to establish a benchmark for future comparisons of alternative algorithms.


METHODS
Prospective, 64-month study.


METHODS
Multicenter, ambulatory care.


METHODS
306 HIV-infected subjects enrolled in the Pulmonary Complications of HIV Infection Study who developed 467 episodes of new or worsening respiratory symptoms.


METHODS
Chest radiography followed by D(LCO) measurement, if the radiograph was normal or unchanged.


RESULTS
An algorithm combining a chest radiograph followed by a D(LCO) measurement, if the radiograph was normal or unchanged, was effective and detected abnormalities that led to a diagnosis of PCP in 78 of 80 evaluable episodes (97.5%). The radiograph (specific parenchymal abnormality, number of lung zones involved) and the D(LCO) (degree of decrease, degree of decrease from baseline) also provided additional information on the probability of PCP.


CONCLUSIONS
In symptomatic HIV-infected patients suspected of having PCP, the diagnostic evaluation should begin with a chest radiograph, followed by a D(LCO) measurement, if the radiograph is normal or unchanged. If both of these tests are normal, it may be reasonable to conclude the evaluation rather than to proceed on to additional testing. This algorithm can serve as a benchmark for future comparisons.
Huang
L
L
San Francisco General Hospital and University of California, 94110, USA. lhuang@sfaids.ucsf.edu
Stansell
J
J
Osmond
D
D
Turner
J
J
Shafer
K P
KP
Fulkerson
W
W
Kvale
P
P
Wallace
J
J
Rosen
M
M
Glassroth
J
J
Reichman
L
L
Hopewell
P
P
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D000328:Adult; D000465:Algorithms; D002248:Carbon Monoxide / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D011653:Pulmonary Diffusing Capacity; D013902:Radiography, Thoracic
D002248:Carbon Monoxide