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Chest radiographic presenting features and radiographic progression of pneumocystis pneumonia in South African children
Author(s) -
Pitcher Richard D.,
Daya Rupesh,
Beningfield Stephen J.,
Zar Heather J.
Publication year - 2011
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.21465
Subject(s) - medicine , radiography , pneumonia , quartile , respiratory system , lung , chest radiograph , radiology , confidence interval
Purpose 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.Methods 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.Results 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). Conclusion 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. Pediatr. Pulmonol. 2011; 46:1015–1022. © 2011 Wiley‐Liss, Inc.