Journal of Tropical Pediatrics Advance Access published online on September 9, 2008
Journal of Tropical Pediatrics, doi:10.1093/tropej/fmn075
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Efficacy of 99mTc-DTPA Lung Clearance Test in the Diagnosis of PCP in HIV-Positive Patients*
aDepartments of Paediatrics,
bNuclear Medicine,
cMicrobiology, T.N. Medical College, B.Y.L Nair Charity Hospital, Mumbai 400008, Maharashtra, India
Correspondence: Akash Deep, 8, Hanson Gardens, Southall, Middlesex UB1 1BP, UK. Tel: +44 794644 2640; Fax: +44 20 7886 6958. E-mail <aakashdeeparora{at}hotmail.com>.
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Abstract |
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The study aims to evaluate the efficacy of technetium-99m diethylenetriaminepentaacetic acid (99mTc-DTPA) lung clearance test in the diagnosis of pneumocystis carinii pneumonia (PCP) in HIV-positive paediatric patients. Twenty HIV-negative patients with no chest symptoms constituted Group A, 25 HIV antibody positive asymptomatic children formed Group B, while 45 HIV antibody positive children with respiratory infections comprised Group C. Group C was subdivided into C1 (n = 20, documented PCP on microbiology), C2 (n = 10, tuberculosis) and C3 (n = 15, bacterial pneumonias). The mean age group of patients in Group A, Group B and Group C was 4.7 ± 1.9, 4.2 ± 1.5 and 4.8 ± 1.7 years, respectively. All patients were subjected to complete blood count, blood culture, chest radiographs, microscopic staining of sputum (PCP stains, Ziehl-Nielsen staining, Gram staining), ABG and Mantoux test. All these patients underwent dynamic lung scans using 99mTc-DTPA aerosols and lung clearance was calculated in terms of half-time transfer value (T1/2) value. T1/2 was compared between different groups and lung scan findings were correlated with radiological and microbiological results. Patients with PCP had T1/2 in the range of 9.02 ± 1.35, TB 28.2 ± 3.03 min and other bacterial pneumonias in the range of 20.5 ± 3.1 min (range for normal individuals was 49.8 ± 6.13 min). T1/2 in patients with PCP was found to be significantly lower when compared with T1/2 in other groups. Patients with PCP had characteristic biphasic curves while the rest had monophasic curves. Some patients with PCP had low T1/2 values even when chest radiographs and arterial blood gases were normal. 99mTc-DTPA lung clearance test is a sensitive, safe and non-invasive diagnostic tool for the early detection of PCP in HIV-positive paediatric patients.
Key Words: pneumocystis carinii pneumonia • PCP • HIV • TB • 99mTc-DTPA lung scan • lung clearance
*Presented in the Plenary Session of the Spring meeting at York organized by the Royal College of Paediatrics and Child Health, April 2006.