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Early bronchoscopic diagnosis of concomitant tuberculosis and Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection.




 

J Assoc Acad Minor Phys. 1996;7(4):99-103. Unique Identifier : AIDSLINE

Pulmonary infections, including mixed infections, are common in patients with human immunodeficiency virus (HIV), and a specific diagnosis is desirable to direct therapy. In a retrospective study of patients suspected of having Pneumocystis carinii pneumonia, we examined the usefulness of fiberoptic bronchoscopy in the immediate diagnosis of tuberculosis. In 267 patients, pneumocystis pneumonia was diagnosed in 115 (43%), of whom 5 (4%) also had concomitant tuberculosis. Bronchoalveolar lavage gave an immediate diagnosis of tuberculosis by positive acid-fast bacilli stain in 3 patients, while the transbronchial biopsy was suggestive in a fourth. Four of these patients developed respiratory failure, and 2 died. In patients with pneumocystis pneumonia, respiratory failure was significantly more common in those with tuberculosis (P = .0077). In 156 (58%) of the 267 cases, bronchoalveolar lavage was negative for pneumocystis pneumonia, while tuberculosis was diagnosed in 14 (9%), and an immediate diagnosis was made in 10 (71%). In a series of HIV-infected patients suspected mainly of having pneumocystis pneumonia, tuberculosis was found instead in 19 (7%), and both diseases were present in 5 (2%). Bronchoscopy provided an early diagnosis of tuberculosis in 63%. Patients with concomitant pneumocystis pneumonia and tuberculosis had a high rate of respiratory failure.

Adult AIDS-Related Opportunistic Infections/COMPLICATIONS/*DIAGNOSIS *Bronchoscopy Female Human Male Middle Age Pneumonia, Pneumocystis carinii/COMPLICATIONS/*DIAGNOSIS Retrospective Studies Sensitivity and Specificity Time Factors Tuberculosis/COMPLICATIONS/*DIAGNOSIS JOURNAL ARTICLE



 




Information in this article was accurate in March 30, 1997. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.