title: Pulmonary surfactant in patients with Pneumocystis pneumonia and acquired immunodeficiency syndrome.
abstract: OBJECTIVE
  Pneumocystis pneumonia (PCP) is a severe infection of the immunocompromised host, resulting in diffuse alveolar damage and life-threatening respiratory failure. We analyzed pulmonary surfactant composition and function in bronchoalveolar lavage fluid (BALF) from ventilated and spontaneously breathing HIV-positive patients with PCP.
  
  
  METHODS
  Prospective clinical trial.
  
  
  METHODS
  University hospital intensive care unit.
  
  
  METHODS
  Thirty-four spontaneously breathing (SB-PCP) and 20 ventilated HIV-positive patients with PCP (V-PCP), ten patients with acute respiratory distress syndrome (ARDS), 11 spontaneously breathing patients with bacterial pneumonia (PNEU), and 22 healthy volunteers.
  
  
  METHODS
  None.
  
  
  RESULTS
  Total phospholipid in BALF did not differ between any category vs. controls, whereas total protein increased approximately 14-fold in V-PCP and five-fold in SB-PCP compared with controls (p < .001). The relative content of large surfactant aggregates (LA) was reduced in SB-PCP and V-PCP compared with controls (p < .05). The phospholipid and fatty acid profiles showed a significant reduction in the relative content of phosphatidylcholine (PC), phosphatidylglycerol, and palmitic acid in PC in all patient categories compared with controls, with more in V-PCP (p < .001) compared with SB-PCP (p < .05). The neutral lipid-to-phospholipid ratio in LA was three-fold elevated in V-PCP (p < .01 compared with control) but not in SB-PCP. Analysis of neutral lipid classes showed a significant increase in the relative content of triglycerides and a reduction in free fatty acids in V-PCP compared with controls. BALF surfactant protein (SP)-A and SP-D significantly increased in V-PCP and SB-PCP, but not in ARDS and PNEU, compared with controls (p < .05). SP-B and SP-C content in LA remained unchanged in PCP compared with controls but decreased significantly in ARDS and PNEU. The minimum surface tension of LA was impaired (p < .001) in V-PCP more than in SB-PCP and was strongly correlated with the reduction in palmitic acid levels in PC LA (r = -.81). Reductions in phosphatidylglycerol strongly correlated with decreased Pao2/Fio2 values (r = .72).
  
  
  CONCLUSIONS
  We conclude that severe alterations in surfactant function and composition occur in patients with PCP and are even more pronounced in ventilated patients than in nonventilated patients. Surfactant lipid changes in PCP, but not surfactant protein profiles, closely resemble those found in ARDS.
authors.affiliation: University of Giessen Lung Center, Germany.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Schmidt
authors.forename: Philipp
authors.initials: P
authors.lastname: Markart
authors.forename: Clemens
authors.initials: C
authors.lastname: Ruppert
authors.forename: Bettina
authors.initials: B
authors.lastname: Temmesfeld
authors.forename: Robert
authors.initials: R
authors.lastname: Nass
authors.forename: Jürgen
authors.initials: J
authors.lastname: Lohmeyer
authors.forename: Werner
authors.initials: W
authors.lastname: Seeger
authors.forename: Andreas
authors.initials: A
authors.lastname: Günther
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000378:metabolism*; D000328:Adult; D001059:Apoproteins / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D002452:Cell Count; D005260:Female; D015658:HIV Infections / Q000378:metabolism*; D006801:Humans; D007362:Intensive Care Units; D008055:Lipids / Q000032:analysis; D008168:Lung / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism; D011020:Pneumonia, Pneumocystis / Q000378:metabolism*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D011663:Pulmonary Surfactants / Q000032:analysis*; D012121:Respiration, Artificial
chemical_list: D001059:Apoproteins; D008055:Lipids; D011663:Pulmonary Surfactants