Pneumocystis carinii pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi
Identifieur interne : 001990 ( Istex/Corpus ); précédent : 001989; suivant : 001991Pneumocystis carinii pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi
Auteurs : N. J. Hargreaves ; O. Kadzakumanja ; S. Phiri ; C.-H. Lee ; X. Tang ; F. M. Salaniponi ; A. D. Harries ; S. B. SquireSource :
- Transactions of the Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ] ; 2001.
Abstract
The National TB Control Programme of Malawi registers and treats large numbers of patients with chronic cough for smear-negative pulmonary tuberculosis (PTB). Smear-negative PTB is diagnosed according to clinical and radiographic criteria, as mycobacterial cultures are not routinely available. In an area of high HIV seroprevalence there is a concern that other opportunistic infections apart from TB, such as Pneumocystis carinii, may be missed owing to lack of diagnostic facilities. The aims of this study were to investigate (i) the extent of P. carinii pneumonia (PCP) in patients about to be registered for smear-negative PTB; (ii) whether there were any clinical or radiological features that could help identify PCP in the absence of more detailed investigations; and (iii) the treatment outcome of PCP patients. A cohort of 352 patients who were about to be started on treatment for smear-negative PTB were investigated further in 1997–1999 by clinical assessment, HIV testing and bronchoscopy. HIV sero-prevalence was 89% ( 278 313). A total of 186 patients underwent bronchoscopy and bronchoalveolar lavage, and PCP was diagnosed by indirect immunofluorescence or polymerase chain reaction in 17 (9%) of this subgroup. Dyspnoea was significantly more common in PCP cases compared to non-PCP cases (RR 1·35; 95% CI 1·24–1·48; P = 0·008), but discrimination between the groups was difficult using clinical criteria alone. The outcome of PCP cases was poor despite management with high-dose co-trimoxazole and secondary co-trimoxazole prophylaxis, with a median survival of 4 months (25–75% range: 2–12 months).
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DOI: 10.1016/S0035-9203(01)90197-X
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Salaniponi</name><affiliation><mods:affiliation>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Harries, A D" sort="Harries, A D" uniqKey="Harries A" first="A. D." last="Harries">A. D. Harries</name><affiliation><mods:affiliation>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Squire, S B" sort="Squire, S B" uniqKey="Squire S" first="S. B." last="Squire">S. B. 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Hargreaves</name><affiliation><mods:affiliation>E-mail: nicky@malawi.net</mods:affiliation></affiliation><affiliation><mods:affiliation>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Kadzakumanja, O" sort="Kadzakumanja, O" uniqKey="Kadzakumanja O" first="O." last="Kadzakumanja">O. Kadzakumanja</name><affiliation><mods:affiliation>Lilongwe Central Hospital, Box 149, Lilongwe, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Phiri, S" sort="Phiri, S" uniqKey="Phiri S" first="S." last="Phiri">S. Phiri</name><affiliation><mods:affiliation>Lilongwe Central Hospital, Box 149, Lilongwe, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Lee, C H" sort="Lee, C H" uniqKey="Lee C" first="C.-H." last="Lee">C.-H. Lee</name><affiliation><mods:affiliation>Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA</mods:affiliation></affiliation></author><author><name sortKey="Tang, X" sort="Tang, X" uniqKey="Tang X" first="X." last="Tang">X. Tang</name><affiliation><mods:affiliation>Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA</mods:affiliation></affiliation></author><author><name sortKey="Salaniponi, F M" sort="Salaniponi, F M" uniqKey="Salaniponi F" first="F. M." last="Salaniponi">F. M. Salaniponi</name><affiliation><mods:affiliation>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Harries, A D" sort="Harries, A D" uniqKey="Harries A" first="A. D." last="Harries">A. D. Harries</name><affiliation><mods:affiliation>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</mods:affiliation></affiliation></author><author><name sortKey="Squire, S B" sort="Squire, S B" uniqKey="Squire S" first="S. B." last="Squire">S. B. Squire</name><affiliation><mods:affiliation>Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Transactions of the Royal Society of Tropical Medicine and Hygiene</title><title level="j" type="abbrev">TRSTMH</title><idno type="ISSN">0035-9203</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2001">2001</date><biblScope unit="volume">95</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="402">402</biblScope><biblScope unit="page" to="408">408</biblScope></imprint><idno type="ISSN">0035-9203</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0035-9203</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The National TB Control Programme of Malawi registers and treats large numbers of patients with chronic cough for smear-negative pulmonary tuberculosis (PTB). Smear-negative PTB is diagnosed according to clinical and radiographic criteria, as mycobacterial cultures are not routinely available. In an area of high HIV seroprevalence there is a concern that other opportunistic infections apart from TB, such as Pneumocystis carinii, may be missed owing to lack of diagnostic facilities. The aims of this study were to investigate (i) the extent of P. carinii pneumonia (PCP) in patients about to be registered for smear-negative PTB; (ii) whether there were any clinical or radiological features that could help identify PCP in the absence of more detailed investigations; and (iii) the treatment outcome of PCP patients. A cohort of 352 patients who were about to be started on treatment for smear-negative PTB were investigated further in 1997–1999 by clinical assessment, HIV testing and bronchoscopy. HIV sero-prevalence was 89% ( 278 313). A total of 186 patients underwent bronchoscopy and bronchoalveolar lavage, and PCP was diagnosed by indirect immunofluorescence or polymerase chain reaction in 17 (9%) of this subgroup. Dyspnoea was significantly more common in PCP cases compared to non-PCP cases (RR 1·35; 95% CI 1·24–1·48; P = 0·008), but discrimination between the groups was difficult using clinical criteria alone. The outcome of PCP cases was poor despite management with high-dose co-trimoxazole and secondary co-trimoxazole prophylaxis, with a median survival of 4 months (25–75% range: 2–12 months).</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>malawi</json:string><json:string>carinii</json:string><json:string>pneumocystis</json:string><json:string>bronchoscopy</json:string><json:string>lilongwe</json:string><json:string>filariasis</json:string><json:string>sputum</json:string><json:string>prophylaxis</json:string><json:string>immunofluorescence</json:string><json:string>endemic</json:string><json:string>hydrocoele</json:string><json:string>chronic cough</json:string><json:string>programme</json:string><json:string>sarcoma</json:string><json:string>asymptomatic</json:string><json:string>tropical medicine</json:string><json:string>endemic normals</json:string><json:string>pneumocystis carinii</json:string><json:string>pulmonary tuberculosis</json:string><json:string>acute filariasis</json:string><json:string>pneumocystis carinii pneumonia</json:string><json:string>median</json:string><json:string>median survival</json:string><json:string>bronchoalveolar lavage</json:string><json:string>royal society</json:string><json:string>asymptomatic amicrofilaraemic individuals</json:string><json:string>acute pneumonia</json:string><json:string>other conditions</json:string><json:string>polymerase chain reaction</json:string><json:string>national aids control programme</json:string><json:string>control programme</json:string><json:string>treatment outcome</json:string><json:string>first survey</json:string><json:string>diagnostic facilities</json:string><json:string>pneumonia</json:string><json:string>american review ofrespiratory diseases</json:string><json:string>adjunctive prednisolone</json:string><json:string>oxygen saturation</json:string><json:string>study clinic</json:string><json:string>sputum microscopy</json:string><json:string>presumptive diagnosis</json:string><json:string>clinical features</json:string><json:string>chest findings</json:string><json:string>full recovery</json:string><json:string>cryptococcal meningitis</json:string><json:string>radiographic features</json:string><json:string>other studies</json:string><json:string>oral candida</json:string><json:string>oral candidu</json:string><json:string>liverpool school</json:string><json:string>serum samples</json:string><json:string>cote aids</json:string><json:string>tropical paediatrics</json:string><json:string>chest examination</json:string><json:string>pulse oximeter</json:string><json:string>disease status</json:string><json:string>months range</json:string><json:string>secondary prophylaxis</json:string><json:string>bajapur village</json:string><json:string>olosingh village</json:string><json:string>clinical assessment</json:string><json:string>radiological features</json:string><json:string>filarial disease</json:string><json:string>mycobacterial cultures</json:string><json:string>acute filariasis patients</json:string><json:string>asymptomatic microfilaraemic</json:string><json:string>lucas</json:string></teeft></keywords><author><json:item><name>N.J. Hargreaves</name><affiliations><json:string>E-mail: nicky@malawi.net</json:string><json:string>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</json:string></affiliations></json:item><json:item><name>O. Kadzakumanja</name><affiliations><json:string>Lilongwe Central Hospital, Box 149, Lilongwe, Malawi</json:string></affiliations></json:item><json:item><name>S. Phiri</name><affiliations><json:string>Lilongwe Central Hospital, Box 149, Lilongwe, Malawi</json:string></affiliations></json:item><json:item><name>C.-H. Lee</name><affiliations><json:string>Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA</json:string></affiliations></json:item><json:item><name>X. Tang</name><affiliations><json:string>Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA</json:string></affiliations></json:item><json:item><name>F.M. Salaniponi</name><affiliations><json:string>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</json:string></affiliations></json:item><json:item><name>A.D. Harries</name><affiliations><json:string>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</json:string></affiliations></json:item><json:item><name>S.B. Squire</name><affiliations><json:string>Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Clinical and pathological studies</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Pneumocystis carinii</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>pneumonia</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>HIV infections</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>AIDS</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>smear-negative pulmonary tuberculosis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Malawi</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>The National TB Control Programme of Malawi registers and treats large numbers of patients with chronic cough for smear-negative pulmonary tuberculosis (PTB). Smear-negative PTB is diagnosed according to clinical and radiographic criteria, as mycobacterial cultures are not routinely available. In an area of high HIV seroprevalence there is a concern that other opportunistic infections apart from TB, such as Pneumocystis carinii, may be missed owing to lack of diagnostic facilities. The aims of this study were to investigate (i) the extent of P. carinii pneumonia (PCP) in patients about to be registered for smear-negative PTB; (ii) whether there were any clinical or radiological features that could help identify PCP in the absence of more detailed investigations; and (iii) the treatment outcome of PCP patients. A cohort of 352 patients who were about to be started on treatment for smear-negative PTB were investigated further in 1997–1999 by clinical assessment, HIV testing and bronchoscopy. HIV sero-prevalence was 89% ( 278 313). A total of 186 patients underwent bronchoscopy and bronchoalveolar lavage, and PCP was diagnosed by indirect immunofluorescence or polymerase chain reaction in 17 (9%) of this subgroup. Dyspnoea was significantly more common in PCP cases compared to non-PCP cases (RR 1·35; 95% CI 1·24–1·48; P = 0·008), but discrimination between the groups was difficult using clinical criteria alone. The outcome of PCP cases was poor despite management with high-dose co-trimoxazole and secondary co-trimoxazole prophylaxis, with a median survival of 4 months (25–75% range: 2–12 months).</abstract><qualityIndicators><score>7.633</score><pdfVersion>1.3</pdfVersion><pdfPageSize>576.28 x 828 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>7</keywordCount><abstractCharCount>1620</abstractCharCount><pdfWordCount>4705</pdfWordCount><pdfCharCount>31784</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>244</abstractWordCount></qualityIndicators><title>Pneumocystis carinii pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi</title><pii><json:string>S0035-9203(01)90197-X</json:string></pii><genre><json:string>research-article</json:string></genre><host><title>Transactions of the Royal Society of Tropical Medicine and Hygiene</title><language><json:string>unknown</json:string></language><publicationDate>2001</publicationDate><issn><json:string>0035-9203</json:string></issn><pii><json:string>S0035-9203(00)X0110-1</json:string></pii><volume>95</volume><issue>4</issue><pages><first>402</first><last>408</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>social science</json:string><json:string>public, environmental & occupational health</json:string><json:string>science</json:string><json:string>tropical medicine</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>tropical medicine</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string></inist></categories><publicationDate>2001</publicationDate><copyrightDate>2001</copyrightDate><doi><json:string>10.1016/S0035-9203(01)90197-X</json:string></doi><id>37F6448EF48D8A9FB5478094F3A16813FB06BEEC</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/37F6448EF48D8A9FB5478094F3A16813FB06BEEC/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/37F6448EF48D8A9FB5478094F3A16813FB06BEEC/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/37F6448EF48D8A9FB5478094F3A16813FB06BEEC/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Pneumocystis carinii pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>ELSEVIER</p></availability><date>2001</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Pneumocystis carinii pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi</title><author xml:id="author-0000"><persName><forename type="first">N.J.</forename><surname>Hargreaves</surname></persName><email>nicky@malawi.net</email><affiliation>Address for correspondence: Dr N Hargreaves, Lilongwe Central Hospital, Box 149, Lilongwe, Malawi; fax +265 756828.</affiliation><affiliation>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</affiliation></author><author xml:id="author-0001"><persName><forename type="first">O.</forename><surname>Kadzakumanja</surname></persName><affiliation>Lilongwe Central Hospital, Box 149, Lilongwe, Malawi</affiliation></author><author xml:id="author-0002"><persName><forename type="first">S.</forename><surname>Phiri</surname></persName><affiliation>Lilongwe Central Hospital, Box 149, Lilongwe, Malawi</affiliation></author><author xml:id="author-0003"><persName><forename type="first">C.-H.</forename><surname>Lee</surname></persName><affiliation>Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA</affiliation></author><author xml:id="author-0004"><persName><forename type="first">X.</forename><surname>Tang</surname></persName><affiliation>Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA</affiliation></author><author xml:id="author-0005"><persName><forename type="first">F.M.</forename><surname>Salaniponi</surname></persName><affiliation>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</affiliation></author><author xml:id="author-0006"><persName><forename type="first">A.D.</forename><surname>Harries</surname></persName><affiliation>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</affiliation></author><author xml:id="author-0007"><persName><forename type="first">S.B.</forename><surname>Squire</surname></persName><affiliation>Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK</affiliation></author><idno type="istex">37F6448EF48D8A9FB5478094F3A16813FB06BEEC</idno><idno type="DOI">10.1016/S0035-9203(01)90197-X</idno><idno type="PII">S0035-9203(01)90197-X</idno></analytic><monogr><title level="j">Transactions of the Royal Society of Tropical Medicine and Hygiene</title><title level="j" type="abbrev">TRSTMH</title><idno type="pISSN">0035-9203</idno><idno type="PII">S0035-9203(00)X0110-1</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2001"></date><biblScope unit="volume">95</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="402">402</biblScope><biblScope unit="page" to="408">408</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2001</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>The National TB Control Programme of Malawi registers and treats large numbers of patients with chronic cough for smear-negative pulmonary tuberculosis (PTB). Smear-negative PTB is diagnosed according to clinical and radiographic criteria, as mycobacterial cultures are not routinely available. In an area of high HIV seroprevalence there is a concern that other opportunistic infections apart from TB, such as Pneumocystis carinii, may be missed owing to lack of diagnostic facilities. The aims of this study were to investigate (i) the extent of P. carinii pneumonia (PCP) in patients about to be registered for smear-negative PTB; (ii) whether there were any clinical or radiological features that could help identify PCP in the absence of more detailed investigations; and (iii) the treatment outcome of PCP patients. A cohort of 352 patients who were about to be started on treatment for smear-negative PTB were investigated further in 1997–1999 by clinical assessment, HIV testing and bronchoscopy. HIV sero-prevalence was 89% ( 278 313). A total of 186 patients underwent bronchoscopy and bronchoalveolar lavage, and PCP was diagnosed by indirect immunofluorescence or polymerase chain reaction in 17 (9%) of this subgroup. Dyspnoea was significantly more common in PCP cases compared to non-PCP cases (RR 1·35; 95% CI 1·24–1·48; P = 0·008), but discrimination between the groups was difficult using clinical criteria alone. The outcome of PCP cases was poor despite management with high-dose co-trimoxazole and secondary co-trimoxazole prophylaxis, with a median survival of 4 months (25–75% range: 2–12 months).</p></abstract><textClass><keywords scheme="keyword"><list><head>article-category</head><item><term>Clinical and pathological studies</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Pneumocystis carinii</term></item><item><term>pneumonia</term></item><item><term>HIV infections</term></item><item><term>AIDS</term></item><item><term>smear-negative pulmonary tuberculosis</term></item><item><term>Malawi</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2000-12-15">Modified</change><change when="2001">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/37F6448EF48D8A9FB5478094F3A16813FB06BEEC/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla"><item-info><jid>TRSTMH</jid><aid>0190197X</aid><ce:pii>S0035-9203(01)90197-X</ce:pii><ce:doi>10.1016/S0035-9203(01)90197-X</ce:doi><ce:copyright type="unknown" year="2001"></ce:copyright><ce:doctopics><ce:doctopic><ce:text>Clinical and pathological studies</ce:text></ce:doctopic></ce:doctopics></item-info><head><ce:title><ce:italic>Pneumocystis carinii</ce:italic> pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi</ce:title><ce:author-group><ce:author><ce:given-name>N.J.</ce:given-name><ce:surname>Hargreaves</ce:surname><ce:cross-ref refid="COR1"><ce:sup>∗</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF1"><ce:sup>1</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF2"><ce:sup>2</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF3"><ce:sup>3</ce:sup></ce:cross-ref><ce:e-address>nicky@malawi.net</ce:e-address></ce:author><ce:author><ce:given-name>O.</ce:given-name><ce:surname>Kadzakumanja</ce:surname><ce:cross-ref refid="AFF3"><ce:sup>3</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>S.</ce:given-name><ce:surname>Phiri</ce:surname><ce:cross-ref refid="AFF3"><ce:sup>3</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>C.-H.</ce:given-name><ce:surname>Lee</ce:surname><ce:cross-ref refid="AFF4"><ce:sup>4</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>X.</ce:given-name><ce:surname>Tang</ce:surname><ce:cross-ref refid="AFF4"><ce:sup>4</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>F.M.</ce:given-name><ce:surname>Salaniponi</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>A.D.</ce:given-name><ce:surname>Harries</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>1</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>S.B.</ce:given-name><ce:surname>Squire</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>2</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="AFF1"><ce:label>1</ce:label><ce:textfn>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</ce:textfn></ce:affiliation><ce:affiliation id="AFF2"><ce:label>2</ce:label><ce:textfn>Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK</ce:textfn></ce:affiliation><ce:affiliation id="AFF3"><ce:label>3</ce:label><ce:textfn>Lilongwe Central Hospital, Box 149, Lilongwe, Malawi</ce:textfn></ce:affiliation><ce:affiliation id="AFF4"><ce:label>4</ce:label><ce:textfn>Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA</ce:textfn></ce:affiliation><ce:correspondence id="COR1"><ce:label>∗</ce:label><ce:text>Address for correspondence: Dr N Hargreaves, Lilongwe Central Hospital, Box 149, Lilongwe, Malawi; fax +265 756828.</ce:text></ce:correspondence></ce:author-group><ce:date-received day="13" month="4" year="2000"></ce:date-received><ce:date-revised day="15" month="12" year="2000"></ce:date-revised><ce:date-accepted day="18" month="1" year="2001"></ce:date-accepted><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para>The National TB Control Programme of Malawi registers and treats large numbers of patients with chronic cough for smear-negative pulmonary tuberculosis (PTB). Smear-negative PTB is diagnosed according to clinical and radiographic criteria, as mycobacterial cultures are not routinely available. In an area of high HIV seroprevalence there is a concern that other opportunistic infections apart from TB, such as <ce:italic>Pneumocystis carinii</ce:italic>, may be missed owing to lack of diagnostic facilities. The aims of this study were to investigate (i) the extent of <ce:italic>P. carinii</ce:italic> pneumonia (PCP) in patients about to be registered for smear-negative PTB; (ii) whether there were any clinical or radiological features that could help identify PCP in the absence of more detailed investigations; and (iii) the treatment outcome of PCP patients. A cohort of 352 patients who were about to be started on treatment for smear-negative PTB were investigated further in 1997–1999 by clinical assessment, HIV testing and bronchoscopy. HIV sero-prevalence was 89% (<math altimg="si1.gif"><fr shape="sol"><nu>278</nu><de>313</de></fr></math>). A total of 186 patients underwent bronchoscopy and bronchoalveolar lavage, and PCP was diagnosed by indirect immunofluorescence or polymerase chain reaction in 17 (9%) of this subgroup. Dyspnoea was significantly more common in PCP cases compared to non-PCP cases (RR 1·35; 95% CI 1·24–1·48; <ce:italic>P</ce:italic> = 0·008), but discrimination between the groups was difficult using clinical criteria alone. The outcome of PCP cases was poor despite management with high-dose co-trimoxazole and secondary co-trimoxazole prophylaxis, with a median survival of 4 months (25–75% range: 2–12 months).</ce:simple-para></ce:abstract-sec></ce:abstract><ce:keywords><ce:section-title>Keywords</ce:section-title><ce:keyword><ce:text><ce:italic>Pneumocystis carinii</ce:italic></ce:text></ce:keyword><ce:keyword><ce:text>pneumonia</ce:text></ce:keyword><ce:keyword><ce:text>HIV infections</ce:text></ce:keyword><ce:keyword><ce:text>AIDS</ce:text></ce:keyword><ce:keyword><ce:text>smear-negative pulmonary tuberculosis</ce:text></ce:keyword><ce:keyword><ce:text>Malawi</ce:text></ce:keyword></ce:keywords></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Pneumocystis carinii pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi</title></titleInfo><name type="personal"><namePart type="given">N.J.</namePart><namePart type="family">Hargreaves</namePart><affiliation>E-mail: nicky@malawi.net</affiliation><affiliation>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</affiliation><description>Address for correspondence: Dr N Hargreaves, Lilongwe Central Hospital, Box 149, Lilongwe, Malawi; fax +265 756828.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">O.</namePart><namePart type="family">Kadzakumanja</namePart><affiliation>Lilongwe Central Hospital, Box 149, Lilongwe, Malawi</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S.</namePart><namePart type="family">Phiri</namePart><affiliation>Lilongwe Central Hospital, Box 149, Lilongwe, Malawi</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C.-H.</namePart><namePart type="family">Lee</namePart><affiliation>Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">X.</namePart><namePart type="family">Tang</namePart><affiliation>Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">F.M.</namePart><namePart type="family">Salaniponi</namePart><affiliation>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.D.</namePart><namePart type="family">Harries</namePart><affiliation>National Tuberculosis Control Programme, Community Health Sciences Unit, Private Bag 65, Lilongwe, Malawi</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S.B.</namePart><namePart type="family">Squire</namePart><affiliation>Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">2001</dateIssued><dateModified encoding="w3cdtf">2000-12-15</dateModified><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">The National TB Control Programme of Malawi registers and treats large numbers of patients with chronic cough for smear-negative pulmonary tuberculosis (PTB). Smear-negative PTB is diagnosed according to clinical and radiographic criteria, as mycobacterial cultures are not routinely available. In an area of high HIV seroprevalence there is a concern that other opportunistic infections apart from TB, such as Pneumocystis carinii, may be missed owing to lack of diagnostic facilities. The aims of this study were to investigate (i) the extent of P. carinii pneumonia (PCP) in patients about to be registered for smear-negative PTB; (ii) whether there were any clinical or radiological features that could help identify PCP in the absence of more detailed investigations; and (iii) the treatment outcome of PCP patients. A cohort of 352 patients who were about to be started on treatment for smear-negative PTB were investigated further in 1997–1999 by clinical assessment, HIV testing and bronchoscopy. HIV sero-prevalence was 89% ( 278 313). A total of 186 patients underwent bronchoscopy and bronchoalveolar lavage, and PCP was diagnosed by indirect immunofluorescence or polymerase chain reaction in 17 (9%) of this subgroup. Dyspnoea was significantly more common in PCP cases compared to non-PCP cases (RR 1·35; 95% CI 1·24–1·48; P = 0·008), but discrimination between the groups was difficult using clinical criteria alone. The outcome of PCP cases was poor despite management with high-dose co-trimoxazole and secondary co-trimoxazole prophylaxis, with a median survival of 4 months (25–75% range: 2–12 months).</abstract><subject><genre>article-category</genre><topic>Clinical and pathological studies</topic></subject><subject><genre>Keywords</genre><topic>Pneumocystis carinii</topic><topic>pneumonia</topic><topic>HIV infections</topic><topic>AIDS</topic><topic>smear-negative pulmonary tuberculosis</topic><topic>Malawi</topic></subject><relatedItem type="host"><titleInfo><title>Transactions of the Royal Society of Tropical Medicine and Hygiene</title></titleInfo><titleInfo type="abbreviated"><title>TRSTMH</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">200107</dateIssued></originInfo><identifier type="ISSN">0035-9203</identifier><identifier type="PII">S0035-9203(00)X0110-1</identifier><part><date>200107</date><detail type="volume"><number>95</number><caption>vol.</caption></detail><detail type="issue"><number>4</number><caption>no.</caption></detail><extent unit="issue pages"><start>345</start><end>456</end></extent><extent unit="pages"><start>402</start><end>408</end></extent></part></relatedItem><identifier type="istex">37F6448EF48D8A9FB5478094F3A16813FB06BEEC</identifier><identifier type="DOI">10.1016/S0035-9203(01)90197-X</identifier><identifier type="PII">S0035-9203(01)90197-X</identifier><recordInfo><recordContentSource>ELSEVIER</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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