In patients with HIV infection the diagnosis of PCP is relatively simple when patients present late, with advanced pneumonia. The diagnosis becomes more difficult when patients present with minimal symptoms, are receiving specific prophylactic therapy or have had previous AIDS-related pulmonary diseases. A number of non-invasive tests, such as Gallium scanning, exercise-induced hypoxaemia, DTPA scanning and lung function testing have been developed to improve on the diagnostic value of clinical examination and the chest X-ray. Although each has its own particular advantages and disadvantages, the most efficient means of diagnosing PCP, in patients presenting with respiratory symptoms, is to use these investigations as part of a diagnostic algorithm, thereby maximizing resources and defining relative risks for different types of patients.
SelikRMStarcherETCurranJW.Opportunistic diseases reported in AIDS patients: Frequencies, associations, and trends. AIDS1987;1:175–82.
2.
WalzerPDPerlDPKrogstadDJPneumocystis carinii pneumonia in the United States. Epidemiologic, diagnostic, and clinical features. Ann Intern Med1974;80:83–93.
3.
KovacsJAHiemenzJWMacherAMPneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med1984;100:663–71.
4.
BrennerMOgnibeneFPLackEEPrognostic factors and life expectancy of patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia. Am Rev Respir Dis1987;136:1199–206.
5.
SmithDEForbesADaviesSDiagnosis of Pneumocystis carinii pneumonia in HIV antibody positive patients by simple outpatient assessments. Thorax1992;47:1005–7.
6.
MurrayJFFeltonCPGaraySMPulmonary complications of the acquired immunodeficiency syndrome. N Engl J Med1984;310:1682–8.
7.
StoverDEWhiteDARomanoPASpectrum of pulmonary diseases associated with the acquired immunodeficiency syndrome. Am J Med1985;78:429–37.
8.
GottliebMSSchroffRSchankerHMPneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency. N Engl J Med1981;305:1425–31.
9.
MasurHMichelisMAGreeneJBAn outbreak of community acquired Pneumocystis carinii pneumonia. Initial manifestation of cellular immune dysfunction. N Engl J Med1981;305:1431–8.
10.
Jules-ElyseeKMStoverDEZamanMBAerosolized pentamidine: Effect on diagnosis and presentation of Pneumocystis carinii pneumonia. Ann Intern Med1990;112:750–7.
11.
BigbyTDMargolskeeDCurtisJLThe usefulness of induced sputum in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. Clin Rev Respir Dis1986;133:515–18.
12.
PitchenikAEGanjeiPTorresASputum examination for the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Am Rev Respir Dis1986;133:226–9.
13.
KovacsJANgVLMasurHDiagnosis of Pneumocystis carinii pneumonia: improved detection in sputum with use of monoclonal antibodies. J Engl J Med1988;318:589–93.
14.
MillerRFKocjanGBucklandJSputum induction for the diagnosis of pulmonary disease in HIV positive patients. J Infect1991;23:5–15.
15.
NelsonMBowerMSmithDLife-threatening complication of sputum induction. Lancet1990;335:112–13.
16.
O'BrienRF.In search of shortcuts: Definitive and indirect tests in the diagnosis of Pneumocystis carinii pneumonia in AIDS. Am Rev Respir Dis1989;139:1324–7.
17.
BroaddusCDakeMDStulbargMSBronchoalveolar lavage and transbronchial biopsy for the diagnosis of pulmonary infections in the acquired immunodeficiency syndrome. Ann Intern Med1985;102:747–52.
18.
StoverDEWhiteDARomanoPADiagnosis of pulmonary disease in the acquired immunodeficiency syndrome (AIDS). Role of bronchoscopy and bronchoalveolar lavage. Am Rev Respir Dis1984;130:659–62.
19.
MillerRFMillarABWellerIVDEmpirical treatment without bronchoscopy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Thorax1989;44:559–64.
20.
SmithDEMcLuckieAWyattJSevere exercise hypoxaemia with normal or near normal X-rays: A feature of Pneumocystis carinii pneumonia. Lancet1988;ii:1049–1051.
21.
LeachRMDavidsonACO'DohertyMJNon-invasive management of fever and breathlessness in HIV positive patients. Eur Respir J1991;4:19–25.
22.
ShawRJRoussackCForsterSMLung function abnormalities in patients infected with the human immunodeficiency virus with and without overt pneumonitis. Thorax1988;43:436–40.
23.
HansenJECasaburiR.Validity of ear oximetry in clinical exercise testing. Chest1987;91:333–7.
24.
JohnsonJEAndersGTBlantonHMExercise dysfunction in patients seropositive for the human immunodeficiency virus. Am Rev Respir Dis1990;141:618–22.
25.
RobinsonDSCunninghamDADaveSDiagnostic value of lung clearance of 99mTcDTPA compared with other non-invasive investigations in Pneumocystis carinii pneumonia in AIDS. Thorax1991;46:722–6.
26.
NisamMWongSFallatRJ.Pulse oximetry and diffusing capacity in AIDS patients with Pneumocystis carinii pneumonia. Chest1987;92:134S (abstract).
27.
StoverDEGreenoRAGagliardiJ.The use of a simple exercise test for the diagnosis of Pneumocystis carinii pneumonia in patients with AIDS. Am Rev Respir Dis1989;139:1343–6.
28.
MillarABMitchellDM, Non-invasive investigation of pulmonary disease in patients positive for the human immunodeficiency virus. Thorax1990;45:57–61.
29.
TuazonCUDelaneyMDSimonGLUtility of Gallium67 scintigraphy and bronchial washings in the diagnosis and treatment of Pneumocystis carinii pneumonia in patients with the acquired immune deficiency syndrome. Am Rev Respir Dis1985;132:1087–92.
30.
KramerELSangerJJGaraySMGallium-67 scans of the chest in patients with acquired immunodeficiency syndrome. J Nuc Med1987;28:1107–14.
31.
MoserETatschKKirschCMValue of 67Gallium scintigraphy in primary diagnosis and follow-up of opportunistic pneumonia in patients with AIDS. Lung1990;168;Suppl:692–703.
32.
TurbinerEHYehSDRosenPPAbnormal gallium scintigraphy in Pneumocystis carinii pneumonia with a normal chest radiograph. Radiology1978;127:437–8.
33.
O'DohertyMJPageCJCroftDNRegional lung epithelial leakiness in smokers and non-smokers. Nucl Med Commun1985;6:353–7.
34.
MasonGRDuaneGBEffrosRMRapid clearance of inhaled aerosols of technetium-99m DTPA in patients with Pneumocystis carinii pneumonia. J Nucl Med1985;26:59.
35.
RossoJPicardCMayaudCComparison of Tc-99m DTPA aerosol and gallium scans in early detection of Pneumocystis carinii pneumonia in acquired immunodeficiency syndrome, (abstract)J Nucl Med1986;27:951.
36.
ColemanDLDodekPMGoldenJACorrelation between serial pulmonary function tests and fiberoptic bronchoscopy in patients with Pneumocystis carinii pneumonia and the acquired immunodeficiency syndrome. Am Rev Respir Dis1984;129:491–3.
37.
SmithRLRippsCSLewisML.Elevated lactate dehydrogenase values in patients with Pneumocystis carinii pneumonia. Chest1988;93:987–92.
38.
ZamanNKWhiteDA.Serum lactate dehydrogenase levels and Pneumocystis carinii pneumonia. Diagnostic and prognostic significance. Am Rev Respir Dis1988;137:796–800.
39.
KaatzMHBaronRBGradyD.Risk stratification of ambulatory patients suspected of Pneumocystis pneumonia. Arch Intern Med1991;151:105–10.
40.
GaraySMGreeneJ.Prognostic indicators in the initial presentation of Pneumocystis carinii pneumonia. Chest1989;95:769–72.
41.
CurtisJGoodmanPHopewellP.Noninvasive tests in the diagnostic evaluation for P. carinii pneumonia in patients with or suspected of having AIDS. Am Rev Respir Dis1986;133:A182.
42.
HopewellPC.“Pneumocystis carinii pneumonia.” In: SandeMAVolberdingPA, eds. Medical management of AIDS, 2nd edn. Philadelphia: WB Saunders, 1990:209–40.
43.
GriffithsMHKocjanGMillerRFDiagnosis of pulmonary disease in human immunodeficiency virus infection: Role of transbronchial biopsy and bronchoalveolar lavage. Thorax1989;44:554–8.
44.
WakefieldAEPixleyFJBanerjiSDetection of Pneumocystis carinii with DNA amplification. Lancet1990;336:451–3.
45.
JensenBNGerstoftJHojlyngNPulmonary pathogens in HIV-infected patients. Scand J Infect Dis1990;22:413–20.
46.
FaetkenheuerGSalzbergerBAllolioBExercise oximetry for early diagnosis of Pneumocystis carinii pneumonia. Lancet1989;i:222.
