AEGiS-08IAC: Microbiologic diagnosis of Pneumocystis carinii pneumonia in HIV positive patients in Zimbabwe.

8th International AIDS Conference

Amsterdam, Netherlands — July 19-24, 1992

Microbiologic diagnosis of Pneumocystis carinii pneumonia in HIV positive patients in Zimbabwe.

Int Conf AIDS 1992 Jul 19-24; 8:We48 (abstract no. WeB 1021)
Gwanzura L, Mason P, Winter M, Katzenstein D; University of Zimbabwe Medical School, Harare.

OBJECTIVE: There is conflicting data on the presence or absence of P. carinii in patients with pneumonitis in sub-Saharan Africa. This study was undertaken in order to demonstrate unequivocally the presence of P. carinii in specimens from HIV positive patients and to determine which diagnostic procedure was most appropriate under local conditions.

METHODS: Pulmonary samples were obtained from 76 hospitalised HIV positive (ELISA) patients who showed clinical and radiological evidence of pneumonia. Bronchoalveolar lavage (BAL) specimens were obtained from 41 patients, induced sputum (IS) from 29 patients and both BAL and IS from 6 patients. Specimens were examined microscopically following staining with "Diff Quick", Toluidine Blue O and Grocot silver-methanamine. To confirm the presence of P. carinii, primers described by Wakefield (pAZ 102-E and pAZ 102-H) were used to amplify DNA obtained by digestion of specimens with Proteinase K.

RESULTS: P. carinii cysts or trophozoites were detected in 6/47 (13%) BAL specimens and 4/35 (11%) IS specimens, including a single case where both the BAL and IS were positive. Organisms were detected by all three staining procedures in positive specimens, though the Diff Quick stain was by far the easiest to complete and the least expensive. DNA amplification was successful in two specimens only, and the reason for failure in the other specimens is being investigated currently.

CONCLUSION: Pneumonia caused by P. carinii does occur in immunocompromised patients in Zimbabwe. The examination of IS specimens using the Diff Quick stain is a simple method for investigation of PCP, that can be completed without the need for bronchoscopy. In at least two cases, DNA from African P. carinii was amplified using primers based on sequence from European strains, suggesting there is little variation in the sequence detected by these primers.

Keywords: AEGIS, Pneumonia, Pneumocystis carinii, Sputum, HIV Seropositivity, HIV Infections, Tolonium Chloride, Staining and Labeling, Bronchoalveolar Lavage Fluid, Fluorescent Antibody Technique, Bronchoalveolar Lavage, Immunocompromised Host, DNA Primers, Dyes, Azure Stains, Zimbabwe, Africa South of the Sahara, Human, diagnosis, immunology, ICA8
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