Clearance of Pneumocystis carinii cysts in acute P carinii pneumonia: assessment by serial sputum induction.
OBJECTIVE
To determine the feasibility of repeat sputum induction in acute Pneumocystis carinii pneumonia (PCP) and to define the rate of clearance of P carinii cysts from the respiratory tract of HIV-seropositive patients with acute PCP.


METHODS
Prospective cohort evaluation.


METHODS
University medical center.


METHODS
Twenty-four HIV-seropositive subjects with acute PCP.


METHODS
Sputum induction for P carinii 2, 3, 4, and 6 weeks after initial diagnosis, and follow-up for 1 year.


RESULTS
Eighty-eight percent of subjects had residual cysts at 2 weeks, 76% at 3 weeks, 29% at 4 weeks, and 24% at 6 weeks postdiagnosis. A prior AIDS-defining illness (p = 0.033) or prior PCP (p = 0.004) predicted relapse within 6 months, but persistent cysts at 3 weeks did not; 8 of 16 sputum-positive subjects and 1 of 5 sputum-negative subjects experienced a relapse within 6 months (p = 0.34). Secondary prophylaxis with trimethoprim-sulfamethoxazole was associated with a reduced risk of relapse.


CONCLUSIONS
Serial sputum induction coupled with direct fluorescent antibody staining is a feasible, noninvasive method of respiratory tract surveillance for the eradication of P carinii during and after acute PCP. Three-quarters of HIV-seropositive patients with acute PCP have persistent cysts in their lungs at the end of antimicrobial treatment, despite clinical recuperation, but only one quarter have residual cysts 6 weeks postdiagnosis. A prior AIDS-defining illness and prior PCP are positively associated, and subsequent trimethoprim-sulfamethoxazole prophylaxis is negatively associated, with relapse within 6 months, while persistent organisms at 3 weeks do not appear to be a significant predictor of relapse risk.
O'Donnell
W J
WJ
Pulmonary/Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. wodonnel@aherf.edu
Pieciak
W
W
Chertow
G M
GM
Sanabria
J
J
Lahive
K C
KC
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology*; D000208:Acute Disease; D000328:Adult; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D008297:Male; D011010:Pneumocystis / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000382:microbiology*; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology*