Prognostic Indicators in the Initial Presentation of Pneumocystis carinii Pneumonia: Material and Methods

2 Nov

The patient population in group 1 (PCP patients) consisted of 140 men and ten women. There were 125 homosexual men, 17 IV drug abusers, five patients with transfusion-related disease, and three women who were sexual partners of known AIDS patients. The mean age was 33 ±5 years. Group 2 consisted of 62 homosexual men and five women, who were IV drug abusers. The mean age was 35 ± 3 years. Group 3 consisted of 15 homosexual men whose mean age was 31 ±4 years.

Diagnostic Approach
The diagnosis of P carinii pneumonia was based on the demonstration of organisms in alveolar lavage fluid or by transbronchial biopsy specimens obtained by fiberoptic bronchoscopy. Lung biopsy specimens were fixed and stained by hematoxylin and eosin, methenamine silver, Giemsa, and Ziehl-Neelsen stains. Lavage fluid was stained with methenamine silver, PAS, Ziehl-Neelsen, and mucicarimine stains. The diagnosis of pulmonary Kaposi’s sarcoma was confirmed by open lung biopsy (nine patients), bronchoscopy (11 patients) and autopsy (ten patients). Open lung biopsy results confirmed the diagnoses of lymphocytic interstitial pneumonia as well as pulmonary lymphoma. All 12 patients with nonspecific interstitial pneumonitis underwent lavage and transbronchial biopsy, which proved negative for organisms. None had follow-up open lung biopsy, and all were discharged from the hospital. read more
All patients in groups 1 and 2 were evaluated similarly. The duration of the three most common symptoms (fever, cough, and dyspnea), as well as the presence of physical findings (temperature, respiratory rate, and inspiratory crackles) were noted. Admission leukocyte and lymphocyte counts, room air arterial blood gas values (with calculation of the P[A-a]Oa gradient), serum chemistry values including LDH, and chest roentgenograms were obtained (Table 1). The pulmonary diagnoses were confirmed by techniques described above. Patients in group 3 did not undergo bronchoscopy or open lung biopsy.
Table 1—Admission Assessment

Temperature (°C)39 ± 139 ± 1
Respiratory rate (breaths/min)23±522 ±4
Inspiratory crackles25/15030/41
Arterial Po2 (mm Hg)73 ±778 ±5
(A-a) 02 gradient (mm Hg)44±836 ± 6
Leukocyte (/nun-)5500 ±12304750 ±960
Lymphocyte (/mm)591 ± 10501 ±385
LDH (IU/L)465 ±67211 ±28
Diffuse interstitial infiltrates80/15026/41