Pneumocystosis: diagnosis

Diagnosis of pneumocystis is carried out taking into account a complex of clinical and laboratory data.

[1], [2], [3]

Indications for consultation of other specialists

The development of severe, life-threatening complications (pneumothorax, severe pulmonary heart disease, shock lung) requires the consultation of an intensive care unit with subsequent intensive care.

Indications for hospitalization

Hospitalization of patients is mandatory in connection with the threat of complications. Mode in the midst of illness bedtime.

Clinical diagnosis of pneumocystosis

Among the clinical signs, the most pronounced dyspnea with minimal physical changes.

[4], [5], [6], [7], [8], [9], [10]

Specific and nonspecific laboratory diagnosis of pneumocystosis

When analyzing laboratory indicators, one should rely on an increase in LDH activity and a decrease in pO2 _{of the} blood, which indicates a respiratory insufficiency. These signs, although non-specific, are characteristic of pneumocystis pneumonia.

Instrumental diagnosis of pneumocystosis

X-ray diagnosis of pneumocystosis is not a valuable diagnostic method, since in some other opportunistic infections there are similar changes on the radiograph, and the picture on the roentgenogram can be normal.

Often the proof of the correct diagnosis of PCP is the effectiveness of therapy administered by exjuvantibus.

The standard diagnosis of pneumocystosis

Crucial to confirm the diagnosis of "pneumocystosis" is the discovery of the pathogen. The main material for the study is sputum, bronchial secretion, washing water obtained from washing the bronchi or bronchoalveolar lavage, pieces of pulmonary tissue taken with transbronchial, percutaneous or open biopsy. Most often, due to the severe condition of the patient, these manipulations are not carried out to avoid complications.

Sputum examination is the most accessible diagnosis of pneumocystis. To obtain a sufficient amount of sputum, as well as mucous secretions of the trachea and bronchi, where pneumocysts are more likely, inhalation of solutions that stimulate secretion and / or coughing is prescribed. When using saline inhalation, pneumocysts can be found in 40-50% of sputum samples. On the basis of a negative result of sputum examination, pneumocystosis can not be excluded, as it can not be said with absolute certainty that pneumocysts are the cause of pathology, and there is no carrier or disease caused by another pathogen when a positive result is obtained.

In patients with HIV infection, diagnosis 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, interaction of various flora of respiratory tract and factors of tissue resistance, loss of immunity in the stage of AIDS. In recent years, for more accurate diagnosis, PCR methods, immunofluorescence methods with mono- and polyclonal antibodies, antigen detection in sputum or washing waters of bronchoalveolar lavage have been developed with the help of NERIF.

Example of the formulation of the diagnosis

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

[11], [12], [13], [14], [15], [16],

Differential diagnosis of pneumocystis

Differential diagnosis of pneumocystosis is particularly difficult in patients with AIDS in developing other secondary lesions that occur with similar pulmonary symptoms - clinical and radiological (tuberculosis, cytomegalovirus infection, toxoplasmosis), especially since they often can occur as a mixed infection with PCP. 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.

[17], [18], [19], [20]