AI Article Synopsis
- A systematic review and meta-analysis examined chest x-ray (CXR) features to diagnose pneumonia in adults with HIV, focusing on those with laboratory-confirmed Pneumocystis pneumonia (PCP) compared to other respiratory diseases.
- The review included 51 studies, highlighting that interstitial infiltrates (59%) and ground-glass opacification (48%) are common in PCP cases, while pleural effusion and cystic lesions are rare.
- Findings suggest that specific CXR changes, like diffuse alterations and interstitial-alveolar infiltrates, can indicate a higher likelihood of PCP, potentially improving clinical diagnosis for HIV patients.
Article Abstract
Background: The performance of chest x-ray (CXR) features for pneumonia (PCP) diagnosis has been evaluated in small studies. We conducted a systematic review and meta-analysis to describe CXR changes in adults with HIV-associated laboratory-confirmed PCP, comparing these with non-PCP respiratory disease.
Methods: We searched databases for studies reporting CXR changes in people >15 years old with HIV and laboratory-confirmed PCP and those with non-PCP respiratory disease. CXR features were grouped using consensus terms. Proportions were pooled and odds ratios (ORs) generated using random-effects meta-analysis, with subgroup analyses by CD4 count, study period, radiology review method, and study region.
Results: Fifty-one studies (with 1821 PCP and 1052 non-PCP cases) were included. Interstitial infiltrate (59%; 95% CI, 52%-66%; 36 studies, n = 1380; = 85%) and ground-glass opacification (48%; 95% CI, 15%-83%; 4 studies, n = 57; = 86%) were common in PCP. Cystic lesions, central lymphadenopathy, and pneumothorax were infrequent. Pleural effusion was rare in PCP (0%; 95% CI, 0%-2%). Interstitial infiltrate (OR, 2.3; 95% CI, 1.4-3.9; = 60%), interstitial-alveolar infiltrate (OR, 10.2; 95% CI, 3.2-32.4; = 0%), and diffuse CXR changes (OR, 7.3; 95% CI, 2.7-20.2; = 87%) were associated with PCP diagnosis. There was loss of association with alveolar infiltrate in African studies.
Conclusions: Diffuse CXR changes and interstitial-alveolar infiltrates indicate a higher likelihood of PCP. Pleural effusion, lymphadenopathy, and focal alveolar infiltrates suggest alternative causes. These findings could be incorporated into clinical algorithms to improve diagnosis of HIV-associated PCP.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11020241 | PMC |
| http://dx.doi.org/10.1093/ofid/ofae146 | DOI Listing |
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