Organization of microbiology laboratory services for the diagnosis of pulmonary infections in patients with human immunodeficiency virus infection.
When faced with the ever-increasing demand for the rapid laboratory diagnosis of Pneumocystis carinii pneumonia (PCP), as well as a variety of fungal, parasitic, and bacterial opportunistic infections in Human Immunodeficiency Virus (HIV)-infected individuals, the Chest Service and the Clinical Microbiology Laboratory at San Francisco General Hospital developed a coordinated plan for the collection and rapid examination of specimens to allow presumptive diagnoses to be made as quickly as possible. Clinical studies have been performed to determine the efficacy of different specimens and diagnostic systems for the provision of clinically useful information. Our approach has been to provide medical care on an outpatient basis using less invasive diagnostic systems that do not require direct physician participation. Direct laboratory examination of a single specimen submitted to microbiology often yielded presumptive or final diagnoses that were directly communicated to the physician. The evolution of PCP diagnosis in AIDS patients is described. Our current procedure of examining mucolysed, concentrated induced sputum stained with a rapid Giemsatype stain, Diff-Quik (Baxter/Scientific Products, McGaw, IL), has a sensitivity for P carinii detection of 74% to 77%. We have found that the use of commercially available immunofluorescence staining diminishes screening time and increases the sensitivity of P carinii detection in mucolysed concentrated induced sputum. We also describe the appearance of bacterial, fungal, and parasitic agents seen on direct examination and the usefulness of antigen detection, serology, and various microbiologic culture systems for diagnosing infections caused by these organisms.
Hadley
W K
WK
Department of Laboratory Medicine, University of California, San Francisco.
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VL
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D001424:Bacterial Infections / Q000175:diagnosis; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D046508:Culture Techniques / Q000379:methods; D003954:Diagnostic Services / Q000458:organization & administration*; D006801:Humans; D007755:Laboratories, Hospital / Q000458:organization & administration*; D008172:Lung Diseases, Fungal / Q000175:diagnosis; D008828:Microbiological Techniques; D009164:Mycobacterium Infections / Q000175:diagnosis; D010272:Parasitic Diseases / Q000175:diagnosis; D011014:Pneumonia / Q000175:diagnosis*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis; D012698:Serologic Tests; D013183:Sputum / Q000382:microbiology; D013194:Staining and Labeling; D014777:Virus Diseases / Q000175:diagnosis