title: Predictors of pneumocystosis or tuberculosis in HIV-infected Asian patients with AFB smear-negative sputum pneumonia.
abstract: OBJECTIVE
  To identify predictors of Pneumocystis jiroveci pneumonia (PCP) or pulmonary tuberculosis (TB) in acid-fast bacillus smear-negative HIV-infected patients and to develop clinical prediction rules.
  
  
  METHODS
  A cohort study conducted in consecutive hospitalized Asian patients.
  
  
  METHODS
  Multivariate analyses were performed on the Cambodian sample to determine clinical, radiological, and biological predictors of PCP or TB at hospital admission. The Vietnamese sample was kept for independent validation.
  
  
  RESULTS
  In Cambodia, the gold standard technique for TB and PCP were fulfilled in 172 (27 cases) and 160 (84 cases) patients, respectively. For TB, independent predictors included the following: headache [odds ratio (OR) 3.0; 95% confidence interval (CI) 1.04 to 8.6], localized radiological opacity (OR 5.8; 95% CI 1.9-17.9), and mediastinal adenopathy (OR 10.1; 95% CI 3.5 to 29.0); and for PCP: resting oxygen saturation <90% (OR 3.3; 95% CI 1.3 to 8.5 for resting arterial oxygen saturation >or=80%; and OR 9.1; 95% CI 1.8 to 44.5 for resting arterial oxygen saturation <80%), trimethoprim-sulphamethoxazole prophylaxis (OR 0.1; 95% CI 0.04 to 0.6), and diffuse radiological shadowing (OR 7.0; 95% CI 2.7 to 18.6). PCP risk predicted by a score based on these 3 factors ranged from 3% to 92% (Cambodia). When tested on Vietnamese patients (n = 69, 38 with PCP), the score maintained correct predictive ability (c-index = 0.72) but with poor calibration.
  
  
  CONCLUSIONS
  The PCP score could provide a useful clinical tool to identify PCP among acid-fast bacillus smear-negative pneumonia and start specific therapy.
authors.affiliation: Institut Pasteur, Paris, France. leminor@pasteur.fr
authors.forename: Odile
authors.initials: O
authors.lastname: Le Minor
authors.forename: Yves
authors.initials: Y
authors.lastname: Germani
authors.forename: Loic
authors.initials: L
authors.lastname: Chartier
authors.forename: Nguyen Huu
authors.initials: NH
authors.lastname: Lan
authors.forename: Nguyen T P
authors.initials: NT
authors.lastname: Lan
authors.forename: Nguyen H
authors.initials: NH
authors.lastname: Duc
authors.forename: Didier
authors.initials: D
authors.lastname: Laureillard
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fontanet
authors.forename: Borann
authors.initials: B
authors.lastname: Sar
authors.forename: Manil
authors.initials: M
authors.lastname: Saman
authors.forename: Sarin
authors.initials: S
authors.lastname: Chan
authors.forename: Pierre
authors.initials: P
authors.lastname: L'Her
authors.forename: Charles
authors.initials: C
authors.lastname: Mayaud
authors.forename: Muriel
authors.initials: M
authors.lastname: Vray
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D002160:Cambodia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology; D014744:Vietnam / Q000453:epidemiology