An evaluation of the empirical diagnosis of pneumocystis pneumonia at Kenyatta national hospital

Abstract

Objectives: To evaluate the empirical diagnoses of PCP made at Kenyatta National Hospital. Design: A case series of 54 patients, seen at the Kenyatta Hospital over 12 weeks. Setting: General medical wards of Kenyatta National Hospital, a tertiary care, university teaching hospital in Nairobi, Kenya. Cases: Patients with an authoritative presumptive diagnosis of PCP made within the medical wards at KNH and definitive treatment started. Methods: Patients diagnosed with PCP were identified and their clinical parameters recorded .. Suitable patients underwent nebulization with hypertonic 4% saline and sputa induced. The sputa were subjected to bacterial and fungal cultures, ZN staining and IFAT staining for Pjiroveci. Results: 54 patients were diagnosed with PCP empirically during this period. Sputum induction was performed on 40 of the patients who fulfilled the inclusion criteria. P. j cysts were isolated in 27 of the specimens, 4 had equivocal results and 9 had negative results. Other organisms isolated were Klebsiella pneumoniae (8 patients) E. coli, Streptococci pneumoniae, Aspergillus sp. in 4 patients. 14 patients had P. jiroveci cysts isolated together with these other organisms in a mixed infection. The patient's ages ranged from19-61 yrs and 37.5% were male while 62.5% were female. Cough and dyspnoea were the ubiquitous presenting features in these patients. All the patients were HIV +ve but only 23 (58%) were diagnosed prior to the diagnosis of PCP. Only 8 (20%) of the patients were on HAART. Only 6 (15%) of the patients were on PCP prophylaxis. 34 (85%) of the patients presented in advanced HIV disease, stage III/IV. For the remainder, PCP was the AIDS defining illness