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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Predictors of pneumocystosis or tuberculosis in HIV-infected asian patients with AFB smear-negative sputum pneumonia
Journal of Acquired Immune Deficiency Syndromes, Volume 48, No. 5, Year 2008
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Description
OBJECTIVES:: To identify predictors of Pneumocystis jiroveci pneumonia (PCP) or pulmonary tuberculosis (TB) in acid-fast bacillus smear-negative HIV-infected patients and to develop clinical prediction rules. DESIGN:: A cohort study conducted in consecutive hospitalized Asian patients. METHODS:: Multivariate analyses were performed on the Cambodian sample to determine clinical, radiological, and biological predictors of PCP or TB at hospital admission. The Vietnamese sample was kept for independent validation. RESULTS:: In Cambodia, the gold standard technique for TB and PCP were fulfilled in 172 (27 cases) and 160 (84 cases) patients, respectively. For TB, independent predictors included the following: headache [odds ratio (OR) 3.0; 95% confidence interval (CI) 1.04 to 8.6], localized radiological opacity (OR 5.8; 95% CI 1.9-17.9), and mediastinal adenopathy (OR 10.1; 95% CI 3.5 to 29.0); and for PCP: resting oxygen saturation <90% (OR 3.3; 95% CI 1.3 to 8.5 for resting arterial oxygen saturation ≥80%; and OR 9.1; 95% CI 1.8 to 44.5 for resting arterial oxygen saturation <80%), trimethoprim-sulphamethoxazole prophylaxis (OR 0.1; 95% CI 0.04 to 0.6), and diffuse radiological shadowing (OR 7.0; 95% CI 2.7 to 18.6). PCP risk predicted by a score based on these 3 factors ranged from 3% to 92% (Cambodia). When tested on Vietnamese patients (n = 69, 38 with PCP), the score maintained correct predictive ability (c-index = 0.72) but with poor calibration. CONCLUSIONS:: The PCP score could provide a useful clinical tool to identify PCP among acid-fast bacillus smear-negative pneumonia and start specific therapy. © 2008 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Germani, Yves
France, Paris
Institut Pasteur, Paris
Chartier, Loïc
France, Paris
Institut Pasteur, Paris
Lân, Nguyen Huu
Viet Nam, Ho Chi Minh City
Pasteur Institute in ho Chi Minh City
Lan, Nguyen Thi Phuong
Viet Nam, Ho Chi Minh City
Pasteur Institute in ho Chi Minh City
Duc, Nguyenhong
Viet Nam, Ho Chi Minh City
Hôpital Phan Ngoc Thach
Laureillard, Didier
France, Paris
Hôpital Européen Georges-pompidou
Fontanet, A. L.
France, Paris
Institut Pasteur, Paris
Sar, Borann
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Saman, Manil
Unknown Affiliation
Chan, Sarin
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
L'Her, Pierre
France, Paris
Hôpital Tenon
Mayaud, Charles Marie
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Vray, Muriel M.
France, Paris
Institut Pasteur, Paris
Statistics
Citations: 24
Authors: 13
Affiliations: 6
Identifiers
Doi:
10.1097/QAI.0b013e31817efb3c
ISSN:
15254135
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Case-Control Study
Study Approach
Qualitative
Quantitative