title: [Comparative diagnosis of bacterial pneumonia and pulmonary tuberculosis in HIV positive patients].
abstract: BACKGROUND
  Immunodepression induced by the human immunodeficiency virus (HIV) modifies the clinical, radiological and microbiological manifestations of pulmonary tuberculosis; leading to similarities between pulmonary tuberculosis and acute community-acquired bacterial pneumonia. A consequence is the high proportion of discordant pre- and post-mortem diagnoses of pneumonia. The aim of our study was to contribute to the improvement in the diagnosis of acute bacterial pneumonia in HIV positive patients in areas where tuberculosis is endemic.
  
  
  METHODS
  This retrospective study in HIV positive patients has compared 94 cases of positive smear cases pulmonary tuberculosis and 78 cases of acute community-acquired bacterial pneumonia.
  
  
  RESULTS
  Using logistic regression, the following features were positively associated with bacterial pneumonia: the sudden onset of signs (OR=8.48 [CI 95% 2.50-28.74]), a delay in the evolution of symptoms of less than 15 days (OR=3.70 [CI 95% 1.11-12.35]), chest pain (OR=2.81 [CI 95% 1.10-7.18]), radiological alveolar shadowing (OR=12.98 [CI 95% 4.66-36.12) and high leukocytosis (OR=3.52 [CI 95% 1.19-10.44]). These five variables allowed us to establish a diagnostic score for bacterial pneumonia ranging from 0 to 5. The area under the ROC curve was 0.886 [CI 95% 0.84-0.94, P<0.001]). Its specificity was >96.8% for a score of greater than or equal to 4.
  
  
  CONCLUSIONS
  The diagnostic score for acute community-acquired pneumonia may improve the management of bacterial pneumonia in areas where tuberculosis is endemic.
authors.affiliation: Service de pneumologie, CHU de Cocody, BP 582, Abidjan cedex 03, Côte d'Ivoire. Electronic address: kigninlmanh@yahoo.fr.
authors.forename: K
authors.initials: K
authors.lastname: Horo
authors.affiliation: Service de pneumologie, CHU de Cocody, BP 582, Abidjan cedex 03, Côte d'Ivoire.
authors.forename: A
authors.initials: A
authors.lastname: Koné
authors.affiliation: Service de pneumologie, CHU de Cocody, BP 582, Abidjan cedex 03, Côte d'Ivoire.
authors.forename: M-O
authors.initials: MO
authors.lastname: Koffi
authors.affiliation: Service de pneumologie, CHU de Cocody, BP 582, Abidjan cedex 03, Côte d'Ivoire.
authors.forename: J M B
authors.initials: JM
authors.lastname: Ahui
authors.affiliation: Service de pneumologie, CHU de Cocody, BP 582, Abidjan cedex 03, Côte d'Ivoire.
authors.forename: C V
authors.initials: CV
authors.lastname: Brou-Godé
authors.affiliation: Service de pneumologie, CHU de Cocody, BP 582, Abidjan cedex 03, Côte d'Ivoire.
authors.forename: A B
authors.initials: AB
authors.lastname: Kouassi
authors.affiliation: Service de pneumologie, CHU de Cocody, BP 582, Abidjan cedex 03, Côte d'Ivoire.
authors.forename: A
authors.initials: A
authors.lastname: N'Gom
authors.affiliation: Service de pneumologie, CHU de Cocody, BP 582, Abidjan cedex 03, Côte d'Ivoire.
authors.forename: N G
authors.initials: NG
authors.lastname: Koffi
authors.affiliation: Service de pneumologie, CHU de Cocody, BP 582, Abidjan cedex 03, Côte d'Ivoire.
authors.forename: E
authors.initials: E
authors.lastname: Aka-Danguy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult
keywords: Acute community acquired bacterial pneumonia; HIV; Immunodepression; Immunodépresssion; Pneumonies; Pulmonary tuberculosis; Tuberculose pulmonaire; VIH