Clinical indicators of Pneumocystis jiroveci pneumonia (PCP) in South African children infected with the human immunodeficiency virus.

BACKGROUND

Pneumocystis pneumonia (PCP) caused by Pneumocystis jiroveci is common in HIV-infected children, producing substantial morbidity and mortality. Initiation of timely, effective therapy depends on clinical identification of children with PCP.

OBJECTIVE

To develop a clinical decision rule to diagnose PCP in HIV-infected children for use where diagnostic resources are limited.

METHODS

Analysis of data collected during a prospective incidence study of the etiology, features, and outcome of HIV-infected children hospitalized with pneumonia.

RESULTS

Four clinical variables were independently associated with a diagnosis of PCP in multivariate analysis: age < 6 months (OR 15.6; 95% CI 2.4-99.8; p = 0.004), respiratory rate > 59 breaths/min (OR 8.1; 95% CI 1.5-53.2; p = 0.018), arterial percentage hemoglobin oxygen saturation (SaO2) < or = 92% (OR 5.1; 95% CI 1.0-26.1; p = 0.052) and absence of history of vomiting (OR 11.2; 95% CI 1.9-68.0; p = 0.008). The sensitivity and specificity of diagnosing PCP with any two or more of these variables were 1.00 (95% CI 0.74-1.00) and 0.49 (95% CI 0.39-0.59), respectively. Diagnosing PCP with three or more of the indicators had a decreased sensitivity of 0.75 (95% CI 0.43-0.95) and increased specificity of 0.90 (95% CI 0.83-0.95).

CONCLUSIONS

Empirical anti-pneumocystis therapy should be considered in HIV-infected infants presenting with tachypnea, hypoxia and absence of vomiting.