TY - JOUR
T1 - Performance of an algorithm to detect Pneumocystis carinii pneumonia in symptomatic HIV-infected persons
AU - Huang, Laurence
AU - Stansell, John
AU - Osmond, Dennis
AU - Turner, Joan
AU - Shafer, Kimberly Page
AU - Fulkerson, William
AU - Kvale, Paul
AU - Wallace, Jeanne
AU - Rosen, Mark
AU - Glassroth, Jeffrey
AU - Reichman, Lee
AU - Hopewell, Philip
N1 - Funding Information:
Supported by contract nos. N01-HR7–6029, 6030,6031, 6032, 6033, 6034, and 6035 from the National Heart, Lung, and Blood Institute and by the National Institute of Allergy and Infectious Diseases.
PY - 1999
Y1 - 1999
N2 - Study objectives: To determine whether an algorithm consisting of a chest radiograph and the diffusing capacity of the lung for carbon monoxide (DLCO) is effective in detecting Pneumocystis carinii pneumonia (PCP) in symptomatic HIV-infected persons; and to establish a benchmark for future comparisons of alternative algorithms. Design: Prospective, 64-month study. Setting: Multicenter, ambulatory care. Patients: 306 HIV-infected subjects enrolled in the Pulmonary Complications of HIV Infection Study who developed 467 episodes of new or worsening respiratory symptoms. Measurements: Chest radiography followed by DLCO measurement, if the radiograph was normal or unchanged. Results: An algorithm combining a chest radiograph followed by a DLCO measurement, if the radiograph was normal or unchanged, was effective and detected abnormalities that led to a diagnosis of PCP in 78 of 80 evaluable episodes (97.5%). The radiograph (specific parenchymal abnormality, number of lung zones involved) and the DLCO (degree of decrease, degree of decrease from baseline) also provided additional information on the probability of PCP. Conclusions: In symptomatic HIV-infected patients respected of having PCP, the diagnostic evaluation should begin with a chest radiograph, followed by a DLCO measurement, if the radiograph is normal or unchanged. If both of these tests are normal, it may be reasonable to conclude the evaluation rather than to proceed on to additional testing. This algorithm can serve as a benchmark for future comparisons.
AB - Study objectives: To determine whether an algorithm consisting of a chest radiograph and the diffusing capacity of the lung for carbon monoxide (DLCO) is effective in detecting Pneumocystis carinii pneumonia (PCP) in symptomatic HIV-infected persons; and to establish a benchmark for future comparisons of alternative algorithms. Design: Prospective, 64-month study. Setting: Multicenter, ambulatory care. Patients: 306 HIV-infected subjects enrolled in the Pulmonary Complications of HIV Infection Study who developed 467 episodes of new or worsening respiratory symptoms. Measurements: Chest radiography followed by DLCO measurement, if the radiograph was normal or unchanged. Results: An algorithm combining a chest radiograph followed by a DLCO measurement, if the radiograph was normal or unchanged, was effective and detected abnormalities that led to a diagnosis of PCP in 78 of 80 evaluable episodes (97.5%). The radiograph (specific parenchymal abnormality, number of lung zones involved) and the DLCO (degree of decrease, degree of decrease from baseline) also provided additional information on the probability of PCP. Conclusions: In symptomatic HIV-infected patients respected of having PCP, the diagnostic evaluation should begin with a chest radiograph, followed by a DLCO measurement, if the radiograph is normal or unchanged. If both of these tests are normal, it may be reasonable to conclude the evaluation rather than to proceed on to additional testing. This algorithm can serve as a benchmark for future comparisons.
KW - Acquired immunodeficiency syndrome
KW - Human immunodeficiency virus
KW - Lung radiography
KW - Opportunistic infections
KW - Pneumocystis carinii pneumonia
KW - Respiratory function tests
UR - http://www.scopus.com/inward/record.url?scp=0032961789&partnerID=8YFLogxK
U2 - 10.1378/chest.115.4.1025
DO - 10.1378/chest.115.4.1025
M3 - Article
C2 - 10208204
AN - SCOPUS:0032961789
SN - 0012-3692
VL - 115
SP - 1025
EP - 1032
JO - Chest
JF - Chest
IS - 4
ER -