Pneumocystis pneumonia in HIV patients: a diagnostic challenge till date

Abstract

HIV has become a major health problem in India, patients commonly succumb to opportunistic infections (OIs), respiratory infections being an important cause of morbidity and their accurate diagnosis is still a challenge. Our aim was to study the occurrence of Pneumocystis pneumonia (PCP) in HIV/AIDS patients with respiratory complaints attending ART clinic and to compare various diagnostic methodologies. One hundred and twenty five HIV/AIDS patients presenting with respiratory symptoms like cough, fever, breathlessness etc, were enrolled, and induced sputum samples were collected. Samples were homogenized using glass beads and Dithiothretol. Smears were prepared and examined by Immunoflourescent staining (IFAT), Gomori methanamine silver staining (GMSS), Toludine blue O staining (TBO) and Giemsa staining for Pneumocystis jiroveci. Among the 125 patients who presented with respiratory complaints, 34 cases (27.2%) were diagnosed as having PCP. All 34 cases were detected by IFAT followed by GMSS, Giemsa and Toludine blue O staining in decreasing order. The mean CD4 count was 67.27cells/μl. PCP has become an important health problem in HIV/AIDS patients with low CD4 counts in India. IFAT remains the most sensitive method for the detection of this uncultivable organism. In resource poor settings where an immunoflourecent microscope is not available, diagnosis of PCP still remains problematic.

Pneumocystis Jirovecii Pneumonia: Prevalence in Hospitalised Patients, a Study Conducted in a Tertiary Centre in Punjab

“…(18)(19) Our finding also corresponds with studies done earlier in India in both the northern and southern regions. (20)(21) Concomitant bacterial (44.6%) and fungal pneumonia (31.9%) is a significant finding in our study. In such cases, the dilemma for the clinician is to decide whether to treat the positive Pneumocystis finding as an infection or merely colonization.…”

Laboratory findings and clinical characteristics of Pneumocystis pneumonia and tuberculosis infection among HIV-infected patients with pulmonary infiltrates in Jakarta, Indonesia

“…The study in Ethiopia reported the clinical symptoms of PCP patients were shortness of breath, dry cough, and weight loss, while crackles were found only in a few patients (Aderaye et al, 2007). Patients affected with Pneumocystis pneumonia and HIV infection tend to present with subacute onset of progressive dyspnea, minimally productive or non-productive cough, malaise, and low-grade fever (Kaur et al, 2015).…”

“…Meanwhile, elevated levels of serum LDH is reported very sensitive but not specific to indicate PCP. It is likely to be the result of the lung inflammation and injury, as also occurs in other lung diseases such as PTB and bacterial pneumonia (Carmona et al, 2011;Crothers et al, 2011;Kaur et al, 2015).…”

“…The clinical specimen from broncho-alveolar lavage (BAL) or transbronchial biopsy remains the gold standard, but those procedures are invasive, require special skills, cost-prohibitive, and not all hospitals have the facilities. Therefore, sputum induction with hypertonic saline is recommended because it is easier, cheaper, less invasive, and has good equality in diagnosis (Choe et al, 2014;Kaur et al, 2015). An elevated level of serum lactate dehydrogenase (LDH) is frequently associated with PCP in HIV-infected patients, documented in 90% of patients (Vogel et al, 2011).…”

Recent Advances in the Diagnosis of <I>Pneumocystis</I> Pneumonia

“…Positive results in bronchoalveolar lavage fluid(BALF) and lung biopsy are considered as the "gold standard" for PCP diagnosis 9) . The sensitivities of immunofluorescent antibodies against surface antigens of P. carinii or P. jirovecii are higher than those using dye staining methods 10) .…”