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Clinical Investigations: INFECTION |

Performance of an Algorithm To Detect Pneumocystis carinii Pneumonia in Symptomatic HIV-Infected Persons*

Laurence Huang, MD, FCCP; John Stansell, MD; Dennis Osmond, PhD; Joan Turner, RN, MS; Kimberly Page Shafer, PhD, MPH; William Fulkerson, MD, FCCP; Paul Kvale, MD, FCCP; Jeanne Wallace, MD, FCCP; Mark Rosen, MD, FCCP; Jeffrey Glassroth, MD, FCCP; Lee Reichman, MD, MPH, FCCP; Philip Hopewell, MD; the Pulmonary Complications of HIV Infection Study Group
Author and Funding Information

*From the San Francisco General Hospital and University of California, San Francisco (Drs. Huang, Stansell, Osmond, Shafer, and Hopewell, and Ms. Turner), San Francisco, CA; Research Triangle Institute (Dr. Fulkerson), Durham, NC; Henry Ford Hospital (Dr. Kvale), Detroit, MI; University of California, Los Angeles (Dr. Wallace), Los Angeles, CA; Mount Sinai Medical Center (Dr. Rosen), New York, NY; Northwestern University (Dr. Glassroth), Chicago, IL; and University of Medicine and Dentistry of New Jersey (Dr. Reichman), Newark, NJ. 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.

*From the San Francisco General Hospital and University of California, San Francisco (Drs. Huang, Stansell, Osmond, Shafer, and Hopewell, and Ms. Turner), San Francisco, CA; Research Triangle Institute (Dr. Fulkerson), Durham, NC; Henry Ford Hospital (Dr. Kvale), Detroit, MI; University of California, Los Angeles (Dr. Wallace), Los Angeles, CA; Mount Sinai Medical Center (Dr. Rosen), New York, NY; Northwestern University (Dr. Glassroth), Chicago, IL; and University of Medicine and Dentistry of New Jersey (Dr. Reichman), Newark, NJ. 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.


*From the San Francisco General Hospital and University of California, San Francisco (Drs. Huang, Stansell, Osmond, Shafer, and Hopewell, and Ms. Turner), San Francisco, CA; Research Triangle Institute (Dr. Fulkerson), Durham, NC; Henry Ford Hospital (Dr. Kvale), Detroit, MI; University of California, Los Angeles (Dr. Wallace), Los Angeles, CA; Mount Sinai Medical Center (Dr. Rosen), New York, NY; Northwestern University (Dr. Glassroth), Chicago, IL; and University of Medicine and Dentistry of New Jersey (Dr. Reichman), Newark, NJ. 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.


Chest. 1999;115(4):1025-1032. doi:10.1378/chest.115.4.1025
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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 suspected 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.

Abbreviations: Dlco = diffusing capacity of the lung for carbon monoxide; LDH = lactate dehydrogenase; OR = odds ratio; PCHIS = Pulmonary Complications of HIV Infection Study; PCP = Pneumocystis carinii pneumonia; PCP+ = positive for PCP; PCP− = negative for PCP

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