The Role of Lactate Dehydrogenase (LDH) Compared to Arterial Blood Gases (ABG) in Diagnosing Pneumocystis Carinii Pneumonia (PCP) in HIV/AIDS Patients on Routine Antiretroviral Therapy

Background: The lungs are one of the primary target organs for HIV disease and a major source of morbidity and mortality, among others, caused by Pneumocystis carinii pneumonia (PCP) or recurrent bacterial pneumonia. In developing countries, the incidence of PCP infection has soared, with high mortality rates ranging from 20% to 80%. The increase in serum LDH plays an important role in determining the severity of the disease. This study aims to determine the role of LDH examination as a diagnostic tool for PCP and Arterial Blood Gases (ABG) in HIV and AIDS patients. Method: This research is an analytical study using an observational diagnostic test design, conducted from November 2020-January 2021 at the HIV Treatment Room at H. Adam Malik Hospital, Medan with 158 subjects. We calculate the value of sensitivity, specificity, positive predictive value, and negative predictive value. Results: 75.3% of the total sample was male, with the highest age group being 30-39 years old (46.2%) 126 samples (79.7%) had CD4 levels 200 cells/mm3, 98 samples (62%) had LDH levels > 500 U/L. In this study, 113 samples (71.5%) fell into the ABG criteria [PaO2] <70 mmHg). LDH has superior sensitivity and specificity value compared to ABG examination. In this case PaO2 or A-A DO2 in diagnosing PCP in HIV-AIDS patients. Conclusion: LDH examination combined with clinical and radiological examinations has good sensitivity and specificity in the diagnosis of PCP. Keywords: HIV, AIDS, Lactate dehydrogenase, PCP.

Clinical Analysis of 15 Cases of Non-Hodgkin Lymphoma Complicated with Pneumocystis carinii Pneumonia Treated with R-CHOP Regimen

Objective: To investigate the clinical features of R-CHOP regimen in the treatment of non-Hodgkin’s lymphoma with Pneumocystis carinii pneumonia (PCP) in order to improve the understanding of PCP and the side effects of Rituxan. Methods: A retrospective analysis of 90 patients with non-Hodgkin’s lymphoma treated with R-CHOP chemotherapy in our hospital from November 2015 to November 2020, of which 15 (16.7%) patients, combined with PCP clinical data, including clinical symptoms, physical signs, chest imaging examination and treatment data were used for to analysis and summarization. Results: The clinical features of R-CHOP chemotherapy combined with PCP were fever, cough, and sputum. Some patients had fewer clinical symptoms. Common imaging manifestations were double lung membrane glass shadow, patchy shadow, and flocculent shadow. It can occur in all clinical stages, and the incidence of late stage is high, and there is no clear correlation with bone marrow suppression. Pneumocystis was found in 2 cases of sputum, and the rest of the patients were clinically diagnosed. The main therapeutic drugs are sulfamethoxazole (8/15), compound sulfamethoxazole (6/15), clindamycin (1/15, sulfa drug allergy), and adrenal cortex hormones (4/15). Fourteen cases were cured and 1 case died. Conclusion: The incidence of R-CHOP in advanced non-Hodgkin’s lymphoma of PCP is high. Patients with clinical use of R-CHOP chemotherapy will encounter fever, cough, chest computed tomography (CT) film glass shadow, and diffuse patch shadow. Patients should be alert to the possibility of PCP and take sulfonamides as soon as possible for medical treatment.