sodium-pertechnetate-tc-99m and Mycoses

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