Pneumocystis jirovecii Pneumonia: Sensitivity and Specificity

Introduction: None written.

Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
HIV, CD4 count 200-350	0.5%	[From UpToDate] One study showed that the incidence of PCP with a CD4 count of 201 to 350 cells/mm3 was 0.5 percent.
HIV, CD4 count < 200	8%	[From UpToDate] Within six months of the CD4 count falling below 200 cells/mm3, 8 percent of patients developed PCP.
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The sensitivity and specificity of findings for Pneumocystis jirovecii Pneumonia are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

100%

89%

May be useful for ruling out PCP

Study: http://www.ajronline.org/cgi/reprint/162/3/547

Diagnosis of thoracic complications in AIDS: accuracy of CT.

Hartman TE; Primack SL; Muller NL; Staples CA

AJR Am J Roentgenol 1994 Mar;162(3):547-53.

Specific Findings

80%

100%

Sensitivity can be increased to 98 if BAL is site-directed by chest imaging.

Study: http://www.ncbi.nlm.nih.gov/sites/entrez

Aerosolized pentamidine: effect on diagnosis and presentation of Pneumocystis carinii pneumonia.

Jules-Elysee KM; Stover DE; Zaman MB; Bernard EM; White DA

Ann Intern Med 1990 May 15;112(10):750-7.

55%

100%

Specificity found to be in 55-92% range in meta-analysis below.

Using an immunofluorescent staining technique to evaluate sputum specimens induced by the inhalation of hypertonic saline.

Study: http://erj.ersjournals.com/cgi/content/full/20/4/982

Meta-analysis of diagnostic procedures for Pneumocystis carinii pneumonia in HIV-1-infected patients.

Cruciani M; Marcati P; Malena M; Bosco O; Serpelloni G; Mengoli C

Eur Respir J 2002 Oct;20(4):982-9.

Findings With Unspecified Accuracy

Finding	Sensitivity	Specificity	Comments, Study
Diffusing capacity for carbon monoxide (DLCO)	No accuracy specified.		PCP is highly unlikely if the DLCO is normal, defined by 70 percent of the predicted value or greater Study: http://www.chestjournal.org/cgi/content/full/115/4/1025 Performance of an algorithm to detect Pneumocystis carinii pneumonia in symptomatic HIV-infected persons. Pulmonary Complications of HIV Infection Study Group. Huang L; Stansell J; Osmond D; Turner J; Shafer KP; Fulkerson W; Kvale P; Wallace J; Rosen M; Glassroth J; Reichman L; Hopewell P Chest 1999 Apr;115(4):1025-32.
O2 desaturation with exercise	No accuracy specified.		Assessment of oxygenation at rest and with exercise. The presence of PCP is highly unlikely if the response to exercise is normal, ie, a decrease in the alveolar-arterial oxygen gradient or an increase in the oxygen saturation with exercise. Study: http://www.ncbi.nlm.nih.gov/pubmed/3044683 Pulmonary function tests. Stover DE; Meduri GU Clin Chest Med 1988 Sep;9(3):473-9.
High LDH	No accuracy specified.		An LDH of <220 IU/L rules out PCP in an immunocompromised patient Study: no study specified.
Low CD4 count	No accuracy specified.		Study: no study specified.