Diagnosis of Pneumocystis carinii pneumonia by multiple lobe, site-directed bronchoalveolar lavage with immunofluorescent monoclonal antibody staining in human immunodeficiency virus-infected patients receiving aerosolized pentamidine chemoprophylaxis.
The yields of both induced sputum examination and bronchoalveolar lavage (BAL) have been reported to be decreased for breakthrough episodes of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients receiving aerosolized pentamidine chemoprophylaxis. This study assessed whether the yield of a single middle or lower lobe BAL could be increased by the utilization of two techniques: (1) indirect immunofluorescent staining with a combination of two murine monoclonal anti-Pneumocystis antibodies in addition to routine toluidine blue O and cytopathologic staining, and (2) the performance of multiple lobe, site-directed BAL (i.e., both upper lobe and middle or lower lobe lavage, including the lobe with the greatest radiographic abnormality). Results of 252 fiberoptic bronchoscopies performed at the National Institutes of Health and the Los Angeles County-University of Southern California Medical Center were analyzed. P. carinii pneumonia was documented in 21 episodes in patients who did not receive prior anti-Pneumocystis chemoprophylaxis and in 41 episodes in patients who received aerosolized pentamidine. Monoclonal antibody staining and multiple lobe, site-directed BAL resulted in similar diagnostic yields for P. carinii in the nonprophylaxis (100%) and aerosolized pentamidine (98%) groups. If BAL had been performed without monoclonal antibody staining and multiple lobe, site-directed lavage, then the yield would have decreased to 95% in the nonprophylaxis group and to 80% in the aerosolized pentamidine group.(ABSTRACT TRUNCATED AT 250 WORDS)
Levine
S J
SJ
Critical Care Medicine Departments, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892.
Kennedy
D
D
Shelhamer
J H
JH
Kovacs
A
A
Feuerstein
I M
IM
Gill
V J
VJ
Stock
F
F
Solomon
D
D
Boylen
C T
CT
Masur
H
H
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000517:prevention & control; D000280:Administration, Inhalation; D000328:Adult; D000336:Aerosols; D001706:Biopsy / Q000379:methods; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy; D005455:Fluorescent Antibody Technique; D006801:Humans; D008168:Lung / Q000473:pathology; D010419:Pentamidine / Q000008:administration & dosage / Q000627:therapeutic use*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000517:prevention & control; D012680:Sensitivity and Specificity
D000336:Aerosols; D010419:Pentamidine