Aderaye Getachew, Bruchfeld Judith, Aseffa Getachew, Nigussie Yared, Melaku Kibrebeal, Woldeamanuel Yimtubezinash, Asrat Daniel, Worku Alemayehu, Gaegziabher Haimanot, Lebaad Marianne, Lindquist Lars
Departments of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
Scand J Infect Dis. 2007;39(11-12):1045-53. doi: 10.1080/00365540701474508. Epub 2007 Jul 2.
Pneumocystis pneumonia (PCP) has been considered a rare disease in sub-Saharan Africa. However, a rising prevalence has been noted recently. The objective of this study was to determine the relative prevalence of PCP and other pulmonary opportunistic diseases in patients infected with HIV in Ethiopia. 131 consecutive patients with respiratory symptoms and atypical chest X-ray, who were sputum smear-negative for AFB and seroreactive for HIV, underwent clinical evaluation and investigation for Pneumocystis jiroveci and Mycobacterium tuberculosis from sputum and bronchoalveolar lavage (BAL), and fungal and bacterial pathogens from BAL alone. Bacterial infections, Pneumocystis pneumonia (PCP) and pulmonary tuberculosis (PTB) occurred in 44 (33.6%), 39 (29.7%) and 31 (23.7%) patients, respectively. Pulmonary Kaposi sarcoma and non-specific interstitial pneumonitis occurred in 4 patients each. In a multivariate regression model, predictors of PCP were typical chest X-ray and low CD4 count while purulent sputum predicted bacterial infection. The sensitivity of physicians and chest X-ray diagnosis was particularly low for PTB and bacterial infections. We conclude that chronic bacterial infection and Pneumocystis pneumonia are important differential diagnoses in HIV-infected, smear-negative PTB patients presenting with atypical chest X-ray. We therefore need to escalate the use of preventive and highly active antiretroviral (HAART) treatment in order to prevent a PCP epidemic.
肺孢子菌肺炎（PCP）在撒哈拉以南非洲一直被视为一种罕见疾病。然而，最近其患病率呈上升趋势。本研究的目的是确定埃塞俄比亚感染HIV的患者中PCP和其他肺部机会性疾病的相对患病率。131例连续出现呼吸道症状且胸部X线表现不典型、痰涂片抗酸杆菌阴性且HIV血清反应阳性的患者，接受了临床评估，并对痰液和支气管肺泡灌洗（BAL）液进行了耶氏肺孢子菌和结核分枝杆菌检测，对单独的BAL液进行了真菌和细菌病原体检测。细菌感染、肺孢子菌肺炎（PCP）和肺结核（PTB）分别发生在44例（33.6%）、39例（29.7%）和31例（23.7%）患者中。肺卡波西肉瘤和非特异性间质性肺炎各发生在4例患者中。在多变量回归模型中，PCP的预测因素是典型的胸部X线表现和低CD4细胞计数，而脓性痰预测细菌感染。医生和胸部X线诊断对PTB和细菌感染的敏感性特别低。我们得出结论，慢性细菌感染和肺孢子菌肺炎是HIV感染且痰涂片阴性、胸部X线表现不典型的PTB患者的重要鉴别诊断。因此，我们需要加强预防性和高效抗逆转录病毒（HAART）治疗的使用，以预防PCP的流行。
