PNEUMOCYTIS CARINII PNEUMONIA IN HIV/AIDS PATIENTS AT AN URBAN DISTRICT HOSPITAL IN KENYA

ABSTRACTBackground: Pneumocytis carinii pneumonia has generally been regarded to be anuncommon opportunistic infection in HIV infected individuals in sub-Saharan Africa.The reason for this has not been clear but postulates included a lack of suitablepathogenic types in the African environment, diagnostic difficulties and the morecommonly held belief that African HIV infected individuals were dying early fromcommon non-opportunistic pathogens before severe degrees of immunosuppressionoccured. Recently a trend has emerged at the Mbagathi district hospital whereby anincreasing number of HIV infected patients are empirically treated for Pneumocytiscarinii pneumonia (PCP) based on clinical and radiological features.Objective: To determine the prevalence of PCP and clinical outcomes of HIV infectedpatients presenting at the Mbagathi District Hospital, Nairobi with the presumptivediagnosis of PCP.Setting: Mbagathi District Hospital, a 169-bed public hospital in Nairobi, Kenya.Methods: Patients presenting with a sub-acute onset of cough and dyspnoea were eligiblefor the study if they were found to have bilateral pulmonary shadows and had negativesputum smears for AFBS. Consenting patients who had no contraindication to fiberopticbronchoscopy had a clinical evaluation which was followed with a fiberoptic bronchoscopyprocedure where bronchoalveolar lavage fluid (BALF) was obtained. BALF wasexamined for cysts of P. carinii using toluidine blue stain and immunofluorescentantibody test (IFAT). BALF was also processed for fungi, bacteria and mycobacteriausing routine procedures. Standard treatment with high dose cotrimoxazole was offeredto all patients who were then followed up until discharge from hospital or deathwhichever came first.Results: Between June 1999 and August 2000 a total of 63 patients were referred forbronchoscopy. Of these four declined to undergo the fiberoptic bronchoscopy procedure,four died before the procedure could be done, one was judged too sick to undergo theprocedure and three had been on cotrimoxazole for longer than five days. Thus 51patients underwent bronchoscopy. Pneumocytis carinii stain was positive in 19 (37.2%)while death occured in 16 (31.4%) of the 51 patients. There were more deaths in thosewithout PCP but this difference was not statistically significant (odds ratio 0.68 (95%CI 0.35-1.32; P=0.2).Conclusion: PCP was found to be common in HIV infected patients presenting withclinical and radiological features of the disease. The mortality rate for patients witha presumptive diagnosis of PCP is high. This study suggests that cotrimoxazolepreventive therapy may be a useful intervention in symptomatic HIV infected patientsin Kenya for the prevention of PCP and may avert deaths from this disease

Pneumocystis carinii pneumonia in HIV/AIDS patients at an urban district hospital in Kenya

Background: Pneumocytis carinii pneumonia has generally been regarded to be an uncommon opportunistic infection in HIV infected individuals in sub-Saharan Africa. The reason for this has not been clear but postulates included a lack of suitable pathogenic types in the African environment, diagnostic difficulties and the more commonly held belief that African HIV infected individuals were dying early from common non-opportunistic pathogens before severe degrees of immunosuppression occured. Recently a trend has emerged at the Mbagathi district hospital whereby an increasing number of HIV infected patients are empirically treated for Pneumocytis carinii pneumonia (PCP) based on clinical and radiological features. Objective: To determine the prevalence of PCP and clinical outcomes of HIV infected patients presenting at the Mbagathi District Hospital, Nairobi with the presumptive diagnosis of PCP. Setting: Mbagathi District Hospital, a 169-bed public hospital in Nairobi, Kenya. Methods: Patients presenting with a sub-acute onset of cough and dyspnoea were eligible for the study if they were found to have bilateral pulmonary shadows and had negative sputum smears for AFBS. Consenting patients who had no contraindication to fiberoptic bronchoscopy had a clinical evaluation which was followed with a fiberoptic bronchoscopy procedure where bronchoalveolar lavage fluid (BALF) was obtained. BALF was examined for cysts of P. carinii using toluidine blue stain and immunofluorescent antibody test (IFAT). BALF was also processed for fungi, bacteria and mycobacteria using routine procedures. Standard treatment with high dose cotrimoxazole was offered to all patients who were then followed up until discharge from hospital or death whichever came first. Results: Between June 1999 and August 2000 a total of 63 patients were referred for bronchoscopy. Of these four declined to undergo the fiberoptic bronchoscopy procedure, four died before the procedure could be done, one was judged too sick to undergo the procedure and three had been on cotrimoxazole for longer than five days. Thus 51 patients underwent bronchoscopy. Pneumocytis carinii stain was positive in 19 (37.2%) while death occured in 16 (31.4%) of the 51 patients. There were more deaths in those without PCP but this difference was not statistically significant (odds ratio 0.68 (95% CI 0.35-1.32; P=0.2). Conclusion: PCP was found to be common in HIV infected patients presenting with clinical and radiological features of the disease. The mortality rate for patients with a presumptive diagnosis of PCP is high. This study suggests that cotrimoxazole preventive therapy may be a useful intervention in symptomatic HIV infected patients in Kenya for the prevention of PCP and may avert deaths from this disease. (East African Medical Journal: 2003 80(1): 30-35

Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January\u2013April 2020

Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic