Pneumocystis jiroveci pneumonia

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Lung ultrasound (US) can be applied as point-of-care approach for ... exams of Pneumocystis jiroveci versus other etiologies of pneumonia in critically ill patients ...
INTERNATIONAL SYMPOSIUM ON INTENSIVE CARE AND EMERGENCY MEDICINE 2012 : P-086

Lung ultrasound can differentiate Pneumocystis jiroveci versus other etiologies among critically ill AIDS patients with pneumonia André M. Japiassú, Fernando A. Bozza Intensive Care Medicine Clinical Research Laboratory, Instituto de Pesquisa Clínica Evandro Chagas, Fiocruz – Rio de Janeiro, RJ, Brazil; Instituto D’ Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil

INTRODUCTION Lung ultrasound (US) can be applied as point-of-care approach for diagnosis of pneumonia on AIDS patients. We compare US exams of Pneumocystis jiroveci versus other etiologies of pneumonia in critically ill patients.

METHODS All HIV/AIDS patients admitted to the ICU with pneumonia were included. The 1st US exam was performed until 72 hours after admission. Pneumonia was defined by clinical examination, laboratorial parameters and chest X-rays. Etiologic agents were defined according to appropriate cultures and serology. US was applied to 4 fields (apex, lateral middle third, anterior basal and posterior basal regions) for each hemithorax, with 2.5 MHz curved transducer. Three pneumonia patterns were defined: interstitial pneumonia, bronchopneumonia and pneumonia with consolidation. The presence of B lines, peripheral microabscesses (bronchopneumonia), consolidations and pleural effusions were compared between Pneumocystis pneumonia group (PCP) versus other etiologies.

RESULTS Table 1 - Clinical and ultrasonographic characteristics of pneumonia in critically ill HIV/AIDS patients Numeric variables are expressed as median. Patient

Age

1 2 3 4 5 6 N=6 7 8 9 10 11 12 13 14 15

32 41 46 47 34 33 37 41 24 31 43 26 45 46 54 33

CD4 cell count (/mm3) 47 40 117 53 28 83 50 502 139 16 301 405 258 82 1073 34

16 17 18 19 20 21 N=15 P value

43 37 45 37 34 64 41 0.77

490 346 540 289 6 45 289 0.005

Clinical data SAPS 2 35 45 46 47 47 36 45 53 50 30 44 33 25 63 48 36 50 34 63 55 48 53 48 0.56

Etiology

B lines

Pneumocystis jiroveci pneumonia Pneumocystis jiroveci pneumonia Pneumocystis jiroveci pneumonia Pneumocystis jiroveci pneumonia Pneumocystis jiroveci pneumonia Pneumocystis jiroveci pneumonia Tuberculosis Tuberculosis Tuberculosis Tuberculosis Tuberculosis Tuberculosis M kansasii pneumonia Community-acquired pneumonia (S pneumoniae) Community-acquired pneumonia/abscess (Rodococcus equi) Community-acquired pneumonia Community-acquired pneumonia Aspergillus fumigatus pneumonia Aspirative community-acquired pneumonia Nosocomial pneumonia (P aeruginosa) Nosocomial pneumonia (P aeruginosa) -

Interstitial pneumonia Probable Pneumocystis jiroveci pneumonia

Lung ultrasound changes Peripheral microabscess Consolidation Pleural effusion

Symmetry

Yes Yes Yes Yes Yes Yes 100% Yes Yes Yes Yes Yes Yes Yes Yes Yes

No No No Yes No No 17% Yes Yes No No Yes No Yes Yes No

No No No No Yes No 17% No No No Yes Yes No Yes Yes Yes

No No No No No No 0% Yes No No Yes Yes Yes No No Yes

Yes Yes Yes Yes Yes Yes 100% No No No No No No No No No

Yes Yes Yes Yes Yes Yes 100% 1.00

No No No No Yes No 40% 0.67

Yes Yes Yes Yes Yes Yes 73% 0.05

No No Yes No No Yes 47% 0.06

No No No No No No 0%