Assefa Getachew, Nigussie Yared, Aderaye Getachew, Worku Alemayehu, Lindquist Lars
Dept. of Radiology Faculty of Medicine, AAU.
Ethiop Med J. 2011 Jan;49(1):35-42.
Pulmonary tuberculosis (TB), bacterial pneumonia (BP) and Pneumocystis pneumonia (PCP), account for the major causes of pneumonia-like syndromes seen in HIV-AIDS patients and have overlapping clinical and chest x-ray findings pausing challenge to early diagnosis and treatment in Africa. The accuracy of chest x-ray (CXR) interpretations, inter-observer agreement, degree of chest x-ray overlapping, and distinguishing features among these common lung infections was assessed at Tĩkur Anbessa hospital, a tertiary care referral hospital in Addis Ababa, Ethiopia.
chest x-rays were independently assessed by two radiologists blinded to the clinical between March 2004 and July 2005, the radiographic presentation of 131 smear-negative, HIV-positive patients with atypical laboratory data.
One hundred and twenty-four definite diagnoses were made in 107 (82%) of the 131 patients and PCP, BP and pulmonary TB combined accounted for 92% of the diagnoses. The chest x-ray interpretation had high sensitivity (88%), negative predictive value (NPV) (90%), and inter-observer agreement (84%) for PCP Thirty-six percent of the infections mimicked one another, of which BP accounted for the major share. BP mimicked PCP and pulmonary TB in 39% and 20% respectively. Diffuse and bilateral alveolar infiltrates (DBAI) and acinar CXR features discriminated between PCP, pulmonary TB and BP (P < 0.05) while Diffuse bilateral fine interstitial infiltrates (DBFI) did not (p > 0.05). The level of agreement between the radiologists was 79%. There was no exclusively distinguishing radiographic feature amongst the three diseases.
Overlapping clinical and radiographic features often occurs as is co-existing infections in HIV-AIDS patients with respiratory symptoms. Therefore, definitive microbiological method should be the main tool to expedite early diagnosis and treatment in HIV-infected patients with respiratory symptoms.
肺结核（TB）、细菌性肺炎（BP）和肺孢子菌肺炎（PCP）是艾滋病患者中类似肺炎综合征的主要病因，它们在临床和胸部X线表现上存在重叠，这给非洲地区的早期诊断和治疗带来了挑战。在埃塞俄比亚亚的斯亚贝巴的一家三级医疗转诊医院——提库安贝萨医院，评估了胸部X线（CXR）解读的准确性、观察者间的一致性、胸部X线重叠程度以及这些常见肺部感染之间的鉴别特征。
2004年3月至2005年7月期间，两名对临床情况不知情的放射科医生对131例涂片阴性、实验室数据不典型的HIV阳性患者的胸部X线进行了独立评估。
131例患者中的107例（82%）做出了124例明确诊断，PCP、BP和肺结核合计占诊断的92%。胸部X线解读对PCP具有高敏感性（88%）、阴性预测值（NPV）（90%）和观察者间一致性（84%）。36%的感染相互类似，其中BP占主要部分。BP分别在39%和20%的情况下类似PCP和肺结核。弥漫性双侧肺泡浸润（DBAI）和腺泡状CXR特征可区分PCP、肺结核和BP（P<0.05），而弥漫性双侧细间质浸润（DBFI）则不能（P>0.05）。放射科医生之间的一致性水平为79%。这三种疾病之间没有唯一的鉴别性影像学特征。
在有呼吸道症状的艾滋病患者中，临床和影像学特征重叠以及合并感染的情况经常发生。因此，明确的微生物学方法应是加快对有呼吸道症状的HIV感染患者进行早期诊断和治疗的主要工具。
