TRANSTHORACIC NEEDLE ASPIRATION IN THE STUDY OF PULMONARY INFECTIONS IN PATIENTS WITH HIV

Study objective: To evaluate the safety and efficacy of transthoracic aspiration with an ultrathin needle in the microbiologic diagnosis of pulmonary infections in HIV-infected patients. Design: Retrospective r eview of cases. Setting: A 500-bed teaching hospital in Lleida, Spain. Patients: Forty-five HIV-infected patients admitted between March 198 9 and March 1993 with clinical and roentgenographic evidence of pulmon ary infection and without contraindications for transthoracic needle a spiration (TNA). Interventions: Forty-seven TNAs were performed in the emergency room (20) or during hospitalization (27). The TNA procedure s were done without premedication and without fluoroscopic guidance. S pecimens were processed using routine microbiologic and cytologic tech niques; in addition, polymerase chain reaction (PCR) for Pneumocystis carinii was carried out since March 1992. Development of adverse effec ts was carefully evaluated. Results: The TNA was effective in 29 (62 p ercent) out of 47 procedures. The diagnosis was obtained for 14 of 15 patients with P carinii pneumonia, 8 out of 14 patients with bacterial pneumonia, and 4 out of 12 patients with tuberculosis. Other pathogen s recovered were Nocardia asteroides, Cryptococcus neoformans, Rhodoco ccus equi, and Mycobacterium avium. No false-positive results were obt ained. Pneumothorax developed in eight (17 percent) procedures, but on ly one procedure resulted in a pleural drainage; the incidence of othe r adverse effects was low and clinically irrelevant. Conclusion: Our s tudy suggests that TNA can be a useful technique in establishing the e tiologic diagnosis of pulmonary infections in HIV-infected patients, w ith a good sensitivity, high specificity, and relatively low incidence of serious complications, with TNA appearing as a reliable alternativ e to more uncomfortable methods.