Pneumocystosis - Diagnosis

Diagnosis of pneumocystosis is carried out taking into account a set of clinical and laboratory data.

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Indications for consultation with other specialists

The development of severe, life-threatening complications (pneumothorax, severe pulmonary heart failure, shock lung) requires consultation with a resuscitator followed by intensive therapy.

Indications for hospitalization

Hospitalization of patients is mandatory due to the risk of complications. Bed rest during the peak of the disease.

Clinical diagnosis of pneumocystosis

Among the clinical signs, the most significant is severe dyspnea with minimal physical changes.

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Specific and non-specific laboratory diagnostics of pneumocystosis

When analyzing laboratory parameters, one should rely on the increase in LDH activity and the decrease in pO2 _of the blood, which indicates respiratory failure. Although these signs are nonspecific, they are characteristic of Pneumocystis pneumonia.

Instrumental diagnostics of pneumocystosis

Radiographic diagnosis of pneumocystosis is not a valuable diagnostic method, since some other opportunistic infections have similar changes on the radiograph, and the picture on the radiograph may be normal.

Often the proof of the correct diagnosis of Pneumocystis pneumonia is the effectiveness of the therapy prescribed exjuvantibus.

Standard for diagnosing pneumocystosis

The detection of the pathogen is of decisive importance for confirming the diagnosis of "pneumocystosis". The main material for the study is sputum, bronchial secretions, washings obtained during bronchial lavage or bronchoalveolar lavage, pieces of lung tissue taken during transbronchial, percutaneous or open biopsy. Most often, due to the serious condition of the patient, these manipulations are not carried out in order to avoid complications.

Sputum examination is the most accessible diagnostic method for pneumocystis. In order to obtain a sufficient amount of sputum, as well as mucous secretion from the trachea and bronchi, where pneumocystis are more likely, inhalations of solutions stimulating secretion and/or cough impulses are prescribed. When using saline inhalation, pneumocystis can be detected in 40-50% of sputum samples. Pneumocystis cannot be ruled out based on a negative sputum examination result, just as it is impossible to say with 100% certainty that, if a positive result is obtained, it is pneumocystis that are the cause of the pathology, and that there is no carriage or the disease is caused by another pathogen.

In patients with HIV infection, diagnostics based on the detection of antigens and antibodies is ineffective. Difficulties in interpreting the results of serological studies are associated with a high level of carriage among patients, the interaction of various respiratory tract flora and tissue resistance factors, and the loss of immunity at the AIDS stage. In recent years, PCR methods, immunofluorescence methods with mono- and polyclonal antibodies, and the determination of antigen in sputum or bronchoalveolar lavage lavage using NRIF have been developed for more accurate diagnostics.

Example of diagnosis formulation

HIV infection, stage of secondary manifestations 4B (AIDS): Pneumocystis pneumonia, severe course.

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Differential diagnosis of pneumocystosis

Differential diagnosis of pneumocystosis is especially difficult in AIDS patients with the development of other secondary lesions that occur with similar pulmonary symptoms - clinical and radiological (tuberculosis, cytomegalovirus infection, toxoplasmosis), especially since they can often occur as a mixed infection with pneumocystis pneumonia. It is necessary to take into account the most important clinical and laboratory signs (gradually increasing respiratory failure, scarcity of physical data, high activity of LDH and ESR), as well as the effect of therapy, often prescribed exjuvantibus.

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