AEGiS-13IAC: Induced sputum in the diagnosis of pneumocystis carinii pneumonia (PCP) in HIV positive children using direct fluorescent antibody (DFA) techniques.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Induced sputum in the diagnosis of pneumocystis carinii pneumonia (PCP) in HIV positive children using direct fluorescent antibody (DFA) techniques.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrB117)

Ruffini DD, Madhi SA, Dahan E, Sherman G, Hayle M
D.D. Ruffini, Wits University, 34 The Braids Road, Emmarentia Ext 2195, Gauteng, South Africa, Tel.: +27-11-4898786, Fax: +27-11-4898692, E-mail: donnapaed@yahoo.com

BACKGROUND: The incidence of PCP in African HIV infected children is unknown and diagnostic methods are highly invasive and costly.

OBJECTIVES: To determine the value of induced sputum (IS) and/or nasopharyngeal aspiration (NPA) in identifying PC in HIV infected children admitted with clinically severe pneumonia using DFA techniques, and to detail the clinical characteristics of these children.

METHODS: 110 HIV infected children under two years of age, with clinically severe lower respiratory tract infections, were enrolled at Chris Hani/Baragwanath hospital. NPA followed by IS were performed on each child and submitted for DFA for PCP.

RESULTS: The mean age of children enrolled was 5,4 months with 48% females and 52% males. PC was identified in 51% of the children by IS and/or NPA. Of these 50% were diagnosed using IS alone, 27% using NPA alone and 23% using both IS and NPA; showing that IS is superior to NPA in identifying PC (p>0.0001). A significant percentage of PC positive and PC negative children were found to have concurrent viral infections and/or bacteraemias (20% vs 18,5%). No significant difference in mortality was noted between PC confirmed and negative children (25% vs 27%,p>0.74). In children with or without PC neither LDH values (mean of 1568U/l vs 1698U/l) nor CD4 counts (mean of 24,3% vs 18%) were helpful in the diagnosis of PCP (p>0.05). There were no differences in clinical and radiographic findings in children where PC was isolated versus those where PC was not.

CONCLUSION: There is a high prevalence of PCP in HIV infected children presenting with severe pneumonia. IS is a non-invasive and useful tool, whose value is supplemented by additional NPA, in isolating PC in children. All children under two years admitted with severe pneumonia, who are suspected to be HIV infected, should have PC treatment as part of their empiric therapy.

Keywords: AEGIS, Pneumonia, Pneumocystis, HIV Infections, Sputum, HIV Seropositivity, Incidence, CD4 Lymphocyte Count, Pneumonia, Child, Human, Female, Male, diagnosis, methods
000709
MoOrB117