title: Chest X-ray evaluation of pneumonia-like syndromes in smear negative HIV-positive patients with atypical chest x-ray. Findings in Ethiopian setting.
abstract: BACKGROUND
  Pulmonary tuberculosis (TB), bacterial pneumonia (BP) and Pneumocystis pneumonia (PCP), account for the major causes of pneumonia-like syndromes seen in HIV-AIDS patients and have overlapping clinical and chest x-ray findings pausing challenge to early diagnosis and treatment in Africa. The accuracy of chest x-ray (CXR) interpretations, inter-observer agreement, degree of chest x-ray overlapping, and distinguishing features among these common lung infections was assessed at Tĩkur Anbessa hospital, a tertiary care referral hospital in Addis Ababa, Ethiopia.
  
  
  METHODS
  chest x-rays were independently assessed by two radiologists blinded to the clinical between March 2004 and July 2005, the radiographic presentation of 131 smear-negative, HIV-positive patients with atypical laboratory data.
  
  
  RESULTS
  One hundred and twenty-four definite diagnoses were made in 107 (82%) of the 131 patients and PCP, BP and pulmonary TB combined accounted for 92% of the diagnoses. The chest x-ray interpretation had high sensitivity (88%), negative predictive value (NPV) (90%), and inter-observer agreement (84%) for PCP Thirty-six percent of the infections mimicked one another, of which BP accounted for the major share. BP mimicked PCP and pulmonary TB in 39% and 20% respectively. Diffuse and bilateral alveolar infiltrates (DBAI) and acinar CXR features discriminated between PCP, pulmonary TB and BP (P < 0.05) while Diffuse bilateral fine interstitial infiltrates (DBFI) did not (p > 0.05). The level of agreement between the radiologists was 79%. There was no exclusively distinguishing radiographic feature amongst the three diseases.
  
  
  CONCLUSIONS
  Overlapping clinical and radiographic features often occurs as is co-existing infections in HIV-AIDS patients with respiratory symptoms. Therefore, definitive microbiological method should be the main tool to expedite early diagnosis and treatment in HIV-infected patients with respiratory symptoms.
authors: Dept. of Radiology Faculty of Medicine, AAU.
authors: Getachew
authors: G
authors: Assefa
authors: Yared
authors: Y
authors: Nigussie
authors: Getachew
authors: G
authors: Aderaye
authors: Alemayehu
authors: A
authors: Worku
authors: Lars
authors: L
authors: Lindquist
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging* / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D015588:Observer Variation; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D018410:Pneumonia, Bacterial / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult