title: Clinical indicators of Pneumocystis jiroveci pneumonia (PCP) in South African children infected with the human immunodeficiency virus.
abstract: BACKGROUND
  Pneumocystis pneumonia (PCP) caused by Pneumocystis jiroveci is common in HIV-infected children, producing substantial morbidity and mortality. Initiation of timely, effective therapy depends on clinical identification of children with PCP.
  
  
  OBJECTIVE
  To develop a clinical decision rule to diagnose PCP in HIV-infected children for use where diagnostic resources are limited.
  
  
  METHODS
  Analysis of data collected during a prospective incidence study of the etiology, features, and outcome of HIV-infected children hospitalized with pneumonia.
  
  
  RESULTS
  Four clinical variables were independently associated with a diagnosis of PCP in multivariate analysis: age < 6 months (OR 15.6; 95% CI 2.4-99.8; p = 0.004), respiratory rate > 59 breaths/min (OR 8.1; 95% CI 1.5-53.2; p = 0.018), arterial percentage hemoglobin oxygen saturation (SaO2) < or = 92% (OR 5.1; 95% CI 1.0-26.1; p = 0.052) and absence of history of vomiting (OR 11.2; 95% CI 1.9-68.0; p = 0.008). The sensitivity and specificity of diagnosing PCP with any two or more of these variables were 1.00 (95% CI 0.74-1.00) and 0.49 (95% CI 0.39-0.59), respectively. Diagnosing PCP with three or more of the indicators had a decreased sensitivity of 0.75 (95% CI 0.43-0.95) and increased specificity of 0.90 (95% CI 0.83-0.95).
  
  
  CONCLUSIONS
  Empirical anti-pneumocystis therapy should be considered in HIV-infected infants presenting with tachypnea, hypoxia and absence of vomiting.
authors.affiliation: Department of Human Biology, and Lung Institute, University of Cape Town, Cape Town, South Africa.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Fatti
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Zar
authors.forename: George H
authors.initials: GH
authors.lastname: Swingler
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000382:microbiology / Q000503:physiopathology; D003657:Decision Making; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000382:microbiology / Q000503:physiopathology; D010818:Practice Patterns, Physicians'; D012680:Sensitivity and Specificity; D013019:South Africa