sodium-pertechnetate-tc-99m and AIDS-Related-Opportunistic-Infections

The value of immunoscintigraphy with technetium-99m (99Tcm) labelled anti-granulocyte monoclonal antibody (BW250/183) was studied prospectively in human immunodeficiency virus (HIV-1) antibody-positive patients presenting with fever without localizing symptoms or signs. Twenty-three studies were performed in 23 patients and the results of 99Tcm-anti-granulocyte imaging were compared with the definitive microbiological or cytological diagnosis. Twenty-one patients had an infective cause of pyrexia, one patient had disseminated lymphoma and one Kaposi sarcoma. 99Tcm-anti-granulocyte antibody imaging correctly identified the sites of infection in only five (24%) patients, four of whom had infective colitis (one also had bacterial pneumonia) and one of whom had cellulitis. Sixteen foci of infection were not localized by 99Tcm-anti-granulocyte immunoscintigraphy (false-negative scans). Six of these patients had Pneumocystis carinii pneumonia; other diagnoses in this group included bacterial or fungal pneumonia and bacteraemia secondary to line infections. 99Tcm-anti-granulocyte antibody did not accumulate in the patients with disseminated lymphoma and Kaposi sarcoma (true-negative scans). 99Tcm-anti-granulocyte imaging, therefore, appears useful in identifying extrathoracic infection in HIV-1 positive patients. Its lack of sensitivity for the identification of pulmonary infection means that its role in the investigation of HIV-1 antibody-positive patients with fever without localizing symptoms or signs is limited.

Topics: Adult; AIDS-Related Opportunistic Infections; Antibodies, Monoclonal; Antibody Specificity; Bacterial Infections; False Negative Reactions; False Positive Reactions; Fever of Unknown Origin; Granulocytes; HIV Infections; Humans; Immunoconjugates; Lung Neoplasms; Lymphoma, AIDS-Related; Male; Middle Aged; Mycoses; Pneumonia; Pneumonia, Pneumocystis; Prospective Studies; Radioimmunodetection; Sarcoma, Kaposi; Sodium Pertechnetate Tc 99m; Virus Diseases

The salivary disease in two patients with human immunodeficiency virus infection was investigated by technetium pertechnetate scintiscanning. Although there was good histologic evidence of benign lymphoepithelial disease, scintiscanning failed to delineate any salivary lesions. Technetium pertechnetate scintiscanning seems to be of little value in the detailed investigation of salivary disease in human immunodeficiency virus infection, though gallium scanning can help. Fine needle aspiration or biopsy remain the main diagnostic tools.

Topics: Adult; AIDS-Related Opportunistic Infections; Evaluation Studies as Topic; Female; Gallium; Humans; Male; Parotid Diseases; Radionuclide Imaging; Salivary Gland Diseases; Salivary Glands, Minor; Sodium Pertechnetate Tc 99m