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PNEUMOCYTIS CARINII PNEUMONIA IN HIV/AIDS PATIENTS AT AN URBAN DISTRICT HOSPITAL IN KENYA
Abstract
ABSTRACT
Background: Pneumocytis carinii pneumonia has generally been regarded to be an
uncommon opportunistic infection in HIV infected individuals in sub-Saharan Africa.
The reason for this has not been clear but postulates included a lack of suitable
pathogenic types in the African environment, diagnostic difficulties and the more
commonly held belief that African HIV infected individuals were dying early from
common non-opportunistic pathogens before severe degrees of immunosuppression
occured. Recently a trend has emerged at the Mbagathi district hospital whereby an
increasing number of HIV infected patients are empirically treated for Pneumocytis
carinii pneumonia (PCP) based on clinical and radiological features.
Objective: To determine the prevalence of PCP and clinical outcomes of HIV infected
patients presenting at the Mbagathi District Hospital, Nairobi with the presumptive
diagnosis of PCP.
Setting: Mbagathi District Hospital, a 169-bed public hospital in Nairobi, Kenya.
Methods: Patients presenting with a sub-acute onset of cough and dyspnoea were eligible
for the study if they were found to have bilateral pulmonary shadows and had negative
sputum smears for AFBS. Consenting patients who had no contraindication to fiberoptic
bronchoscopy had a clinical evaluation which was followed with a fiberoptic bronchoscopy
procedure where bronchoalveolar lavage fluid (BALF) was obtained. BALF was
examined for cysts of P. carinii using toluidine blue stain and immunofluorescent
antibody test (IFAT). BALF was also processed for fungi, bacteria and mycobacteria
using routine procedures. Standard treatment with high dose cotrimoxazole was offered
to all patients who were then followed up until discharge from hospital or death
whichever came first.
Results: Between June 1999 and August 2000 a total of 63 patients were referred for
bronchoscopy. Of these four declined to undergo the fiberoptic bronchoscopy procedure,
four died before the procedure could be done, one was judged too sick to undergo the
procedure and three had been on cotrimoxazole for longer than five days. Thus 51
patients underwent bronchoscopy. Pneumocytis carinii stain was positive in 19 (37.2%)
while death occured in 16 (31.4%) of the 51 patients. There were more deaths in those
without PCP but this difference was not statistically significant (odds ratio 0.68 (95%
CI 0.35-1.32; P=0.2).
Conclusion: PCP was found to be common in HIV infected patients presenting with
clinical and radiological features of the disease. The mortality rate for patients with
a presumptive diagnosis of PCP is high. This study suggests that cotrimoxazole
preventive therapy may be a useful intervention in symptomatic HIV infected patients
in Kenya for the prevention of PCP and may avert deaths from this disease.
Background: Pneumocytis carinii pneumonia has generally been regarded to be an
uncommon opportunistic infection in HIV infected individuals in sub-Saharan Africa.
The reason for this has not been clear but postulates included a lack of suitable
pathogenic types in the African environment, diagnostic difficulties and the more
commonly held belief that African HIV infected individuals were dying early from
common non-opportunistic pathogens before severe degrees of immunosuppression
occured. Recently a trend has emerged at the Mbagathi district hospital whereby an
increasing number of HIV infected patients are empirically treated for Pneumocytis
carinii pneumonia (PCP) based on clinical and radiological features.
Objective: To determine the prevalence of PCP and clinical outcomes of HIV infected
patients presenting at the Mbagathi District Hospital, Nairobi with the presumptive
diagnosis of PCP.
Setting: Mbagathi District Hospital, a 169-bed public hospital in Nairobi, Kenya.
Methods: Patients presenting with a sub-acute onset of cough and dyspnoea were eligible
for the study if they were found to have bilateral pulmonary shadows and had negative
sputum smears for AFBS. Consenting patients who had no contraindication to fiberoptic
bronchoscopy had a clinical evaluation which was followed with a fiberoptic bronchoscopy
procedure where bronchoalveolar lavage fluid (BALF) was obtained. BALF was
examined for cysts of P. carinii using toluidine blue stain and immunofluorescent
antibody test (IFAT). BALF was also processed for fungi, bacteria and mycobacteria
using routine procedures. Standard treatment with high dose cotrimoxazole was offered
to all patients who were then followed up until discharge from hospital or death
whichever came first.
Results: Between June 1999 and August 2000 a total of 63 patients were referred for
bronchoscopy. Of these four declined to undergo the fiberoptic bronchoscopy procedure,
four died before the procedure could be done, one was judged too sick to undergo the
procedure and three had been on cotrimoxazole for longer than five days. Thus 51
patients underwent bronchoscopy. Pneumocytis carinii stain was positive in 19 (37.2%)
while death occured in 16 (31.4%) of the 51 patients. There were more deaths in those
without PCP but this difference was not statistically significant (odds ratio 0.68 (95%
CI 0.35-1.32; P=0.2).
Conclusion: PCP was found to be common in HIV infected patients presenting with
clinical and radiological features of the disease. The mortality rate for patients with
a presumptive diagnosis of PCP is high. This study suggests that cotrimoxazole
preventive therapy may be a useful intervention in symptomatic HIV infected patients
in Kenya for the prevention of PCP and may avert deaths from this disease.
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