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Comparison of Clinical Methods, Chest X-Ray and Sputum Polymerase Chain Reaction Test with Sputum Microscopy for Diagnosis of Pneumocystis Jiroveci Pneumonia
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A5519 - Comparison of Clinical Methods, Chest X-Ray and Sputum Polymerase Chain Reaction Test with Sputum Microscopy for Diagnosis of Pneumocystis Jiroveci Pneumonia
Author Block: S. Subramaniam, M. Kalyanasundaram, A. Gowrishankar, C. Chokalingam; Pulmonology, Govt. Hospital of Thoracic Medicine, Chennai, India.
Rationale:
Pneumocystis jiroveci pneumonia(PCP) is one of the most common opportunistic infection in HIV patients with CD4 count less than 200cells/microlitre. Sputum microscopy with Gomeri Methanamine Silver staining and sputum Polymerase Chain Reaction (PCR) are the standard diagnostic tests .Sputum microscopy which is considered as gold standard is labour intensive and PCR is expensive .In resource limited settings, clinical methods and chest x ray are used commonly for diagnosis of PCP. So we compared those methods with the gold standard test.
Methods:
We conducted a prospective cohort study of all HIV patients with CD4 less than 200 attended our institution from January 2014 to June 2014.Patients with pulmonary tuberculosis were excluded from the study. Presence of Cough , breathlessness with or without fever were used as sypmtomatic criteria and signs like tachypnea, bilateral crackles and SPO2 less than 90% in ambient air or after exertion of 200 meter walking were used as clinical methods for diagnosis .All patients were undergone chest x-ray PA view, sputum induction with hypertonic saline. Induced sputum was subjected to microscopy with GMS staining and PCR targeting mitochondrial ribosomal Ribonucleic acid(rRNA). Radiological diagnosis was based upon presence of any one of the findings like bilateral perihilar infiltrates ,bilateral consolidations/Viel like opacities, pneumatoceles, pneumomediastinum, subcutaneous emphysema, pneumothorax without obvious cavitating parenchymal lesion. Sensitivity, Specificity, Positive Predictive Value(PPV),Negative Predictive Value(NPV) were calculated .
Results:
The sensitivity (78%), specificity(55%), PPV(40%), NPV(87%) for clinical diagnosis of PCP were less on comparing with sputum GMS staining.
The chest x ray diagnosis also showed low sensitivity(60%),specificity(86%),PPV(62%),NPV(86).
Induced Sputum PCR diagnosis showed highest sensitivity(100%),specificity(97%),PPV(93%),NPV(100%) among the three methods.
Conclusion:
Clinical diagnosis or radiological diagnosis alone will lead to underdiagnosis of PCP in HIV patients. Induced sputum for GMS staining or PCR should be used for prompt diagnosis of PCP in HIV patients and treatment.
Author Block: S. Subramaniam, M. Kalyanasundaram, A. Gowrishankar, C. Chokalingam; Pulmonology, Govt. Hospital of Thoracic Medicine, Chennai, India.
Rationale:
Pneumocystis jiroveci pneumonia(PCP) is one of the most common opportunistic infection in HIV patients with CD4 count less than 200cells/microlitre. Sputum microscopy with Gomeri Methanamine Silver staining and sputum Polymerase Chain Reaction (PCR) are the standard diagnostic tests .Sputum microscopy which is considered as gold standard is labour intensive and PCR is expensive .In resource limited settings, clinical methods and chest x ray are used commonly for diagnosis of PCP. So we compared those methods with the gold standard test.
Methods:
We conducted a prospective cohort study of all HIV patients with CD4 less than 200 attended our institution from January 2014 to June 2014.Patients with pulmonary tuberculosis were excluded from the study. Presence of Cough , breathlessness with or without fever were used as sypmtomatic criteria and signs like tachypnea, bilateral crackles and SPO2 less than 90% in ambient air or after exertion of 200 meter walking were used as clinical methods for diagnosis .All patients were undergone chest x-ray PA view, sputum induction with hypertonic saline. Induced sputum was subjected to microscopy with GMS staining and PCR targeting mitochondrial ribosomal Ribonucleic acid(rRNA). Radiological diagnosis was based upon presence of any one of the findings like bilateral perihilar infiltrates ,bilateral consolidations/Viel like opacities, pneumatoceles, pneumomediastinum, subcutaneous emphysema, pneumothorax without obvious cavitating parenchymal lesion. Sensitivity, Specificity, Positive Predictive Value(PPV),Negative Predictive Value(NPV) were calculated .
Results:
The sensitivity (78%), specificity(55%), PPV(40%), NPV(87%) for clinical diagnosis of PCP were less on comparing with sputum GMS staining.
The chest x ray diagnosis also showed low sensitivity(60%),specificity(86%),PPV(62%),NPV(86).
Induced Sputum PCR diagnosis showed highest sensitivity(100%),specificity(97%),PPV(93%),NPV(100%) among the three methods.
Conclusion:
Clinical diagnosis or radiological diagnosis alone will lead to underdiagnosis of PCP in HIV patients. Induced sputum for GMS staining or PCR should be used for prompt diagnosis of PCP in HIV patients and treatment.
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