Meta-analysis of diagnostic procedures for Pneumocystis carinii pneumonia in HIV-1-infected patients

Abstract

Sputum induction is a simple and noninvasive procedure for Pneumocystis carinii pneumonia (PCP) diagnosis in human immunodeficiency virus-1-positive patients, although less sensitive than bronchoalveolar lavage (BAL). In order to obtain an overview of the diagnostic accuracy of sputum induction, a systematic review and meta-analysis of studies reporting the comparative sensitivity and specificity of BAL (the "gold standard") and sputum induction was performed.The odds ratio and related 95% confidence interval were calculated using summary receiving operating characteristic curves as well as fixed-effect and random-effect models. Based on pooled data, the negative and positive predictive values were calculated for a range of PCP prevalence using a Bayesian approach.Seven prospective studies assessed the comparative accuracy of BAL and sputum induction. On the whole, sputum induction demonstrated 55.5% sensitivity and 98.6% specificity. The sensitivity of sputum induction was significantly higher with immunofluorescence than with cytochemical staining (67.1 versus 43.1%). In settings of 25-60% prevalence of PCP, the positive and negative predictive values ranged 86-96.7 and 66.2-89.8, respectively, with immunofluorescence, and 79-94.4 and 53-83.5% with cytochemical staining.In conclusion, in a setting of low prevalence of Pneumocystis carinii pneumonia, sputum induction, particularly with immunostaining, appears to be adequate for clinical decision-making. Eur Respir J 2002; 20: 982-989.

Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: A retrospective review and case–control study of 21 patients

“…Studies have shown that the organism is detectable on microscopic examination of induced sputum in 55-92% of PCP patients with HIV infection (39,40). In patients with PCP but without HIV infection, detectability is Ͻ10%; thus, bronchoalveolar lavage fluid examination is often required (38).…”

Diretrizes para tratamento da sepse grave/choque séptico: abordagem do agente infeccioso - diagnóstico

“…In AIDS patients, this technique has a 13% to 55.5% sensitivity and a 98.6% specificity; these figures could be improved if stained P. jiroveci detection was replaced with immunofluorescence (B). (71,72) In patients who are HIV-positive or have AIDS, non-induced sputum for the diagnosis of CAP is as effective as in HIV-negative patients (B). (73) In severe CAP patients with acute respiratory failure requiring intubation and mechanical ventilation, secretions collected via bronchial lavage without bronchoscopy and associated with semi-quantitative culture with a 10,000 colony forming units per milliliter threshold (10 4 CFU/mL) has good sensitivity, ranging from 58% to 83%, and is better than bronchoscopy lavage; additionally, it has the advantage of being noninvasive and easy to perform.…”

Pulmonary Manifestations of HIV Disease

“…In a meta analysis of diagnostic procedures for PcP, it was found that, compared with bronchoalvelaor lavage as the gold standard, examination of induced sputum had an overall sensitivity of 55.5% and a specificity of 98.6% with even better sensitivity at 67% versus 43.1% when comparing immunofluorescent staining with cytochemical staining. In settings where the prevalence of PcP is in the range of 25-60%, the positive and negative predictive values ranged from 86-96.7% and 66.2-89.8%, respectively, with immunofluorescent staining , and 79-94.4% and 53-83.5% with cytochemical staining 48 .…”