PCP in HIV patients

Q: Which of the following is the best predictor of Pneumocystis pneumonia (PCP) in HIV patients? (select one)

A) exercise-induced desaturation 

B) infiltrates on chest radiograph

C) resting arterial hypoxemia

Answer: A

Studies have shown that exercise-induced desaturation is a better indicator than an abnormal CXR in patients with Pneumocystis pneumonia (PCP) - OR 5.4 vs. 4.9. This becomes clinically more relevant when CXR is normal.

 

HIV patients without change in (A-a) oxygen gradient with exercise are very unlikely to have pulmonary disorder.

#pulmonary

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References:

1. Smith DE, Forbes A, Davies S, et al. Diagnosis of Pneumocystis carinii pneumonia in HIV antibody positive patients by simple outpatient assessments. Thorax 1992; 47:1005.

2. Stover DE, Greeno RA, Gagliardi AJ. The use of a simple exercise test for the diagnosis of Pneumocystis carinii pneumonia in patients with AIDS. Am Rev Respir Dis 1989; 139:1343.