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Vol.71 No.5
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Value of Bronchoalveolar Lavage Fluid Cytology in the Diagnosis of Pneumocystis jirovecii Pneumonia: A Review of 30 Cases

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2011, v.71 no.5, pp.322-327
Ji-Youn Sung (Sungkyunkwan University)




Taeeun Kim (Gachon University Gil Hospital)
Ji-Youn, S. , & Taeeun, K. (2011). Value of Bronchoalveolar Lavage Fluid Cytology in the Diagnosis of Pneumocystis jirovecii Pneumonia: A Review of 30 Cases. Tuberculosis & Respiratory Diseases, 71(5), 322-327.
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Abstract

Background: Pneumocystis jirovecii is a fungus that has become an important cause of opportunistic infections. We present a summary of the clinical status and findings from bronchoalveolar lavage (BAL) of patients with Pneumocystis jirovecii pneumonia (PJP). Methods: We selected 30 cases of PJP that were proven through a surgical specimen evaluation. BAL fluid cytology was reviewed, and agreement with the initial diagnosis was evaluated. Results: All 30 cases of PJP occurred in immunocompromised patients. Only 15 of the 30 cases were initially diagnosed as PJP. We found PJP in 13 of the 15 cases that were negative at the initial diagnosis. The most characteristic finding of PJP was frothy exudates, and BAL fluid tended to show rare neutrophils. Two of seven patients with PJP and diffuse alveolar damage (DAD) revealed no frothy exudates in BAL fluid. Conclusion: BAL fluid cytology was reconfirmed as a sensitive and rapid method to diagnose PJP. We must be aware of the possibility of PJP to maintain high diagnostic sensitivity. We cannot exclude PJP in cases of PJP with DAD, even if frothy exudates are not observed in the BAL fluid.

keywords
Pneumocystis carinii, Pneumocystis jirovecii, Bronchoalveolar Lavage Fluid, Pathology

Reference

1.

1. Sidhu GS, Cassai ND, Pei Z. Pneumocystis carinii: an update. Ultrastruct Pathol 2003;27:115-22.

2.

2. Haque AK. Fungal disease. In: Zander DS, Farver CF, editors. Pulmonary pathology. 1st ed. Philadelphia: Churchill Livingstone; 2008. p. 236-9.

3.

3. Willebrand Ev, Lautenschlager I. Organ transplantation. In: Gray W, Kocjan G, editors. Diagnostic cytopathology. 3rd ed. Edinburgh: Chrchill Livingstone/Elsevier; 2010. p. 475-6.

4.

4. Jones JL, Hanson DL, Dworkin MS, Alderton DL, Fleming PL, Kaplan JE, et al. Surveillance for AIDS-defining opportunistic illnesses, 1992-1997. MMWR CDC Surveill Summ 1999;48:1-22.

5.

5. Choe KW, Oh MD, Park SW, Kim HB, Kim US, Kang SW, et al. Opportunistic infections and malignancies in 173 patients with HIV infection. Korean J Infect Dis 1998;30:507-15.

6.

6. Cho GJ, Hong SK, Chang KH, Chung JS, Choi YH, Song YG, et al. Epidemiology and clinical features of HIV infection/AIDS in Korea. YMJ 2003;44:363-70.

7.

7. Greaves TS, Strigle SM. The recognition of Pneumocystis carinii in routine Papanicolaou-stained smears. Acta Cytol 1985;29:714-20.

8.

8. Price RA, Hughes WT. Histopathology of Pneumocystis carinii infestation and infection in malignant disease in childhood. Hum Pathol 1974;5:737-52.

9.

9. Broaddus C, Dake MD, Stulbarg MS, Blumenfeld W, Hadley WK, Golden JA, et al. Bronchoalveolar lavage and transbronchial biopsy for the diagnosis of pulmonary infections in the acquired immunodeficiency syndrome. Ann Intern Med 1985;102:747-52.

10.

10. Golden JA, Hollander H, Stulbarg MS, Gamsu G. Bronchoalveolar lavage as the exclusive diagnostic modality for Pneumocystis carinii pneumonia. A prospective study among patients with acquired immunodeficiency syndrome. Chest 1986;90:18-22.

11.

11. Orenstein M, Webber CA, Cash M, Heurich AE. Value of bronchoalveolar lavage in the diagnosis of pulmo nary infection in acquired immune deficiency syndrome. Thorax 1986;41:345-9.

12.

12. Chechani V, Allam AA, Haseeb MA, Kamholz SL. Pneumocystis carinii pneumonia in patients with AIDS: evaluation of lavage and staining techniques in diagnosis. J Acquir Immune Defic Syndr 1991;4:250-3.

13.

13. Lee JH, Lee JY, Shin MR, Ahn HK, Kim CW, Kim I. Immunohistochemical identification of pneumocystis jirovecii in liquid-based cytology of bronchoalveolar lavage: nine cases report. Korean J Pathol 2011;45: 115-8.

14.

14. Ziefer A, Abramowitz JA. Pneumocystis carinii pneumonia in HIV-positive and HIV-negative patients. An epidemiological, clinical and histopathological study of 18 patients. S Afr Med J 1989;76:308-13.

15.

15. Burke BA, Good RA. Pneumocystis carinii infection. Medicine (Baltimore) 1973;52:23-51.

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