Sixty children aged between 1 and 23 months admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi for diagnosis of acute lower respiratory tract infections (ALRI) were investigated for laboratory diagnosis of Pneumocystis carinii pneumonia (PCP) by indirect immunofluorescence assay on nasopharyngeal secretions. P. carinii was found in five of the 60 children. Three PCP cases had AIDS. The clinical presentation of children with PCP was of little diagnostic value and all the children were infants. Arterial oxygen saturation was significantly lower in PCP cases. Of the five PCP cases, four died, indicating that the marked hypoxaemia was associated with poor prognosis. These results indicate that an immunofluorescence assay on nasopharyngeal secretions could be used for first-line diagnosis of PCP in Africa.
PIP: Indirect immunofluorescence assay of nasopharyngeal secretions from 60 children 1-23 months of age admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi, with acute lower respiratory tract infections confirmed the presence of Pneumocystis carinii pneumonia (PCP) in 5 children. In Africa, diagnosis of PCP is generally based on clinical features, suspected immunosuppression, and chest radiography--all of which are limited in their capability to differentiate PCP from other pneumonias. 3 of the 5 infants diagnosed with PCP had AIDS. 14 children, including 8 of the 19 children with AIDS, died during hospitalization. 4 of the 5 children with PCP died, despite high-dose cotrimoxazole and oxygen therapy. In African children, PCP is often the first HIV-associated infection. More widespread use of the indirect immunofluorescence assay method is recommended for the rapid diagnosis of PCP cases in African children.