Chest radiographic presenting features and radiographic progression of pneumocystis pneumonia in South African children

Pitcher, R.D.; Daya, R.; Beningfield, S.J.; Zar, H.J.

Pediatric Pulmonology 46(10): 1015-1022

2011


ISSN/ISBN: 1099-0496
PMID: 21692194
DOI: 10.1002/ppul.21465
Accession: 052055084

Download citation:  
Text
  |  
BibTeX
  |  
RIS

Article/Abstract emailed within 0-6 h
Payments are secure & encrypted
Powered by Stripe
Powered by PayPal

Abstract
To describe the radiographic features of PCP in South African children, including the progression of changes and the impact of HIV-infection and respiratory co-infections. A paediatric radiologist blinded to clinical details retrospectively reported the chest radiographs of children diagnosed with PCP at a South Africa paediatric hospital between January 2003 and June 2006 inclusive. Radiographic features were correlated with clinical findings and compared using Fisher's exact test and Wilcoxon's ranks-sum test. Institutional ethics approval was obtained. Of 113 cases of PCP, 110 (97.3%) had presenting and 96 (84.9%) follow-up radiographs; 88 (82%) were HIV-infected; 65 (59%) had respiratory co-infection; 48 (43%) died in hospital. The commonest presenting radiographic findings were increased lung volumes (n = 86; 78%) and diffuse parenchymal opacification (n = 70; 64%); 89 (92.7%) ultimately progressed to diffuse alveolar opacification. Median time to maximum pulmonary opacification was 72 hours (inter-quartile range (IQR): 24-144 hrs). Pulmonary interstitial emphysema (PIE) developed in 33 patients (30%). There was no significant difference in the radiographic features of PCP when comparison was made between i) HIV-infected and -uninfected children, ii) those with and without respiratory co-infection and iii) fatal cases and survivors (P > 0.05 in all cases). Increased lung volumes and PIE should be recognised as features of PCP in South African children. HIV-infection and respiratory co-infections do not influence the radiographic features of PCP in our setting.

Chest radiographic presenting features and radiographic progression of pneumocystis pneumonia in South African children