Correlations between semiquantiative amounts of Pneumocystis carinii (PC) the measure of inflammation.

Correlations between semiquantiative amounts of Pneumocystis carinii (PC) the measure of inflammation, and the severity of pneumonia were analyzed in 58 patients with PC pneumonia (PCP) Material from the two transbronchial biopsies (TBBs; n = 39) and bronchoalveolar lavage fluid (BALF; n = 57) was examined. In the TBB the amount of PC correlated strenuously with overall inflammation in the interstitium (Kendall correlation coefficient [Kcc] = 059; p<00001) representation 2 pneumocyte proliferation, and edema formation. The amount of PC in the TBB also correlated with interstitial accumulation of neutrophils (Kcc = 054; p = 00001) lymphocyte and macrophages. In BALF the amount of PC correlated with edema formation and archetype 2 pneumocyte proliferation in the TBB if it were not that not with the percentage of neutrophils, lymphocyte or macrophages in BALF. The amount of PC in the BALF and the percentage of neutrophils in the BALF correlated significantly with [POsub2] and the serum lactate dehydrogenase (LDH) flat Neither short-term nor long-term survival was affected by the agency of the amount of PC, inflammatory markers in the TBB inflammatory lonely dwellings in BALF, [PO.sub.2], or the serum LDH horizontals In conclusion, the amount of PC is associated with the expansion of the acute inflammatory reaction in the lung in PCP associated with human immunodeficiency virus (HIV).

Several characteristics of Pneumocystis carinii pneumonia (PCP) in patients with AIDS have been propos as prognostic indicators, partly supported by the agency of studies correlating especially the percentage of neutrophils in bronchoalveolar lavage fluid (BALF) with the severity and prognosis of PCP[1-3] The amount of Pneumocystis carinii (PC) could also be prognostic indicator, although our at hand knowledge does not support this.[4] No application of mind has attempted to correlate the following three aspects of PCP associated with the human immunodeficiency virus (HIV): (1) amounts of PC; (2) inflammatory changes in the lung; and (3) the severity and prognosis of PCP

In this studious mood we examined the relationship between the amount of PC with markers of inflammatory in transbronchial biopsis (TBBs) and BALF of HIV-associated PCP In order to studious mood the clinical relevance of these findings, the amount of PC and the measure of inflammation were correlated with indicators of the severity of the pneumonia, ie, [POsub2] and the serum lactate dehydrogenase (LDH) of the same height at the time of diagnosis, and with short- and long-term survival of the patients.

MATERIALS AND METHODS

Patients

There were 189 fiberoptic bronchoscopic processs performed on 153 HIV-positive patients with pulmonary symptoms in the period from September 1989 to June 1991 Thirty-six measures were follow-up examinations due to either persistent symptoms or just to assess the issue of the treatment. Sixty-nine patients had PCP during the period, and of those, we report the findings in a assign places to of 58 consecutive patients who had a primary episode of PCP Clinical data, including PCP prophylaxis prior to bronchoscopy were gathered prospectively. Chest x-ray films and laboratory values, including CD4 think serum LDH level, and arterial life-blood gas levels, were gathered les than 24 h before bronchoscopy issue was recorded from the medical files.

Bronchoscopy

Bronchoscopy was done beneath local anesthesia as previously described.[5] The BAL and TBB were performed in the right middle lobe in the case of diffuse infiltrates onward the chest x-ray film (otherwise from the site of localized infiltration). The BAL was performed with instillation of up to 240 ml of warmed saline solution in 4 to 6 aliquots. The reclaimed BALF was pooled; 60 to 80 percent of the instilled whirl was aspirated. Two or three TBB were taken in another subsegment in the same lobe.

BALF, small cavity Differential Counts, and TBBs

Immediately after bronchoscopy a standardized convolution of the obtained BALF (35 ml) was centrifuged for 5 min at 1500 g and smears were prepared from the desposit by means of aliquoting 1 drop per slide. The following staining systems were used: May-Grunwald-Giemsa stain (MGG); Papanicolaou stain; Grocott methenamine-silver stain; and an immunoperoxidase stain using monoclonal antibodies against PC (DAKO-Pneumocystis, M 778; DAKO-DK). The biopsies were fixed in 4 percent clowned Formalin, embedded in paraffin, and stained with hematoxylin-eosin, van Gieson-Hansen stain, periodic acid-Schiff (PAS), Grocott methenamine-silver stain, and the immunoperoxidase stain. Biopsies were considered satisfactory for evaluation if they contained more than 10 well-preserved alveolar lumina. Evaluation of the BALF and TBB was done prospectively and without knowledge of the patient's clinical status. Also, the beholder was blinded to the information forward the BALF when studying the TBB and vice versa.

The port of PC was diagnosed if a honeycombed foamy material (ie, trophozoites) could be demonstrated by means of either MGG or Papanicolaou stain and confirmed forward the immunoperoxidase stained slide or if pouchs were found in the silver-stained smear (or both) In one as well as the other BALF and TBB, trophozoites contributed for the greatest part in the overall score of PC They were graded in either MGG staining or using immunoperoxidase staining. In solely two cases were only pouchs detected. The amount of PC was graded semiquantitatively forward a scale of 0 to 3 as described in Table 1 In a previous series of patients with PCP the intraobserver variation for grading the amount of PC and indices of inflammation was examined. For the amount of PC in the couple the TBB and BALF, a k value of 081 was found

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