ANALYSIS OF PNEUMOCYSTIS-CARINII ORGANISM BURDEN, VIABILITY AND ANTIGENS IN BRONCHOALVEOLAR LAVAGE FLUID IN AIDS PATIENTS WITH PNEUMOCYSTOSIS - CORRELATION WITH DISEASE SEVERITY
Ag. Smulian et al., ANALYSIS OF PNEUMOCYSTIS-CARINII ORGANISM BURDEN, VIABILITY AND ANTIGENS IN BRONCHOALVEOLAR LAVAGE FLUID IN AIDS PATIENTS WITH PNEUMOCYSTOSIS - CORRELATION WITH DISEASE SEVERITY, AIDS, 8(11), 1994, pp. 1555-1562
Objectives: We examined 96 bronchoalveolar lavage fluid (BALF) specime
ns from AIDS patients with proven Pneumocystis carinii pneumonia (PCP)
in order to compare the relationship of organism burden, viability an
d antigen expression with disease severity at the time of clinical pre
sentation. Methods: Tinctorial analysis of BALF specimens with proven
PCP using Diff-Quik, cresyl echt violet and erythrosin B stains to eva
luate organism burden and viability. P. carinii antigen examination wa
s performed by Western blot analysis. Results: P. carinii cluster rati
os were more sensitive than cyst counts as an indicator of organism bu
rden, and correlated well with the alveolar-arterial oxygen gradient a
s a measure of disease severity. Erythrosin B, the vital stain used to
measure P. carinii viability, displayed a wide range of values and pr
ovided little useful information. Antigens of 35-45 and 95 kD, which w
ere specific for P. carinii, were found by immunoblot analysis in BALF
cellular fraction of most patients with pneumocystosis. By contrast,
antigens of 52 and 66 kD, which were found in both BALF supernatant an
d cellular fractions of P. carinii patients and controls, most likely
represented albumin and immunoglobulin G heavy chain, respectively, of
host origin. The 35-45 kD antigen was found in 88% of the BALF specim
ens and appeared to represent an important marker of P. carinii infect
ion. The 95 kD antigen was detected in 49% of the specimens. Conclusio
ns: We conclude that analysis of P. carinii characteristics in BALF sp
ecimens of patients with pneumocystis may provide additional informati
on. These data will also be helpful in developing more sensitive assay
s and in targeting specific P. carinii factors for future investigatio
n.