title: Chest radiographic presenting features and radiographic progression of pneumocystis pneumonia in South African children.
abstract: OBJECTIVE
  To describe the radiographic features of PCP in South African children, including the progression of changes and the impact of HIV-infection and respiratory co-infections.
  
  
  METHODS
  A paediatric radiologist blinded to clinical details retrospectively reported the chest radiographs of children diagnosed with PCP at a South Africa paediatric hospital between January 2003 and June 2006 inclusive. Radiographic features were correlated with clinical findings and compared using Fisher's exact test and Wilcoxon's ranks-sum test. Institutional ethics approval was obtained.
  
  
  RESULTS
  Of 113 cases of PCP, 110 (97.3%) had presenting and 96 (84.9%) follow-up radiographs; 88 (82%) were HIV-infected; 65 (59%) had respiratory co-infection; 48 (43%) died in hospital. The commonest presenting radiographic findings were increased lung volumes (n = 86; 78%) and diffuse parenchymal opacification (n = 70; 64%); 89 (92.7%) ultimately progressed to diffuse alveolar opacification. Median time to maximum pulmonary opacification was 72 hours (inter-quartile range (IQR): 24-144 hrs). Pulmonary interstitial emphysema (PIE) developed in 33 patients (30%). There was no significant difference in the radiographic features of PCP when comparison was made between i) HIV-infected and -uninfected children, ii) those with and without respiratory co-infection and iii) fatal cases and survivors (P > 0.05 in all cases).
  
  
  CONCLUSIONS
  Increased lung volumes and PIE should be recognised as features of PCP in South African children. HIV-infection and respiratory co-infections do not influence the radiographic features of PCP in our setting.
authors.affiliation: Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa. pitcher@sun.ac.za
authors.forename: Richard D
authors.initials: RD
authors.lastname: Pitcher
authors.forename: Rupesh
authors.initials: R
authors.lastname: Daya
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Beningfield
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Zar
mesh_terms: D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000000981:diagnostic imaging*; D011859:Radiography; D012189:Retrospective Studies; D013019:South Africa