Tachypnea, hypoxia, and lack of vomiting predict PCP in HIV-infected young infants with pneumonia

This study in South Africa looked at the clinical manifestations of HIV-infected children with and without PCP pneumonia. Of 151 children (median age 9 months), 15 had PCP. Clinical features that distinguished them from the other children were tachypnea (RR > 59/min), hypoxia (SaO2 < 92%), age < 6 months, and absence of vomiting. The sensitivity of any two signs was 100% (i.e., all 15 PCP cases had two or more signs) with a specificity of 49% (half the children without PCP had two positive signs).

Note that these results were obtained in children who were already known to be infected with HIV. The sensitivity and specificity of the signs would be different in a population with mixed HIV-positive and HIV-negative children. Nonetheless, these results emphasize the importance of having a high index of suspicion for PCP in infants with pneumonia presenting with hypoxia and/or tachypnea. In our institution, all these infants are treated presumptively with cotrimoxazole for PCP while we are awaiting the results of HIV serology on the infant or mother.

Clinical indicators of Pneumocystis jiroveci pneumonia (PCP) in South African children infected with the human immunodeficiency virus. Int. J. Infect. Dis. 10:4, 282-285, July 2006.

HIV