title: Meta-analysis of diagnostic procedures for Pneumocystis carinii pneumonia in HIV-1-infected patients.
abstract: Sputum induction is a simple and noninvasive procedure for Pneumocystis carinii pneumonia (PCP) diagnosis in human immunodeficiency virus-1-positive patients, although less sensitive than bronchoalveolar lavage (BAL). In order to obtain an overview of the diagnostic accuracy of sputum induction, a systematic review and meta-analysis of studies reporting the comparative sensitivity and specificity of BAL (the "gold standard") and sputum induction was performed. The odds ratio and related 95% confidence interval were calculated using summary receiving operating characteristic curves as well as fixed-effect and random-effect models. Based on pooled data, the negative and positive predictive values were calculated for a range of PCP prevalence using a Bayesian approach. Seven prospective studies assessed the comparative accuracy of BAL and sputum induction. On the whole, sputum induction demonstrated 55.5% sensitivity and 98.6% specificity. The sensitivity of sputum induction was significantly higher with immunofluorescence than with cytochemical staining (67.1 versus 43.1%). In settings of 25-60% prevalence of PCP, the positive and negative predictive values ranged 86-96.7 and 66.2-89.8, respectively, with immunofluorescence, and 79-94.4 and 53-83.5% with cytochemical staining. In conclusion, in a setting of low prevalence of Pneumocystis carinii pneumonia, sputum induction, particularly with immunostaining, appears to be adequate for clinical decision-making.
authors.affiliation: Center of Preventive Medicine HIV Outpatient Clinic, Verona, Italy. crucianimario@virgilio.it
authors.forename: M
authors.initials: M
authors.lastname: Cruciani
authors.forename: P
authors.initials: P
authors.lastname: Marcati
authors.forename: M
authors.initials: M
authors.lastname: Malena
authors.forename: O
authors.initials: O
authors.lastname: Bosco
authors.forename: G
authors.initials: G
authors.lastname: Serpelloni
authors.forename: C
authors.initials: C
authors.lastname: Mengoli
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000453:epidemiology; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology*