THE DIAGNOSIS OF PNEUMOCYSTIS-CARINII PNEUMONIA BY CYTOLOGIC EVALUATION OF PAPANICOLAOU AND LEISHMAN-STAINED BRONCHOALVEOLAR SPECIMENS IN PATIENTS WITH THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME

The presence of foamy alveolar casts or flocculent material in Papanic olaou and Leishman-stained smears of bronchoalveolar lavage (BAL) flui d is said to be indicative of infection with Pneumocystis carinii. We have investigated the sensitivity and specificity of this method of di agnosing pneumocystis pneumonia in patients with the acquired immunode ficiency syndrome (AIDS). Patients (n = 114) with diffuse lung infiltr ates were submitted to fibreoptic broncoscopy and BAL. Seventy of them were patients with AIDS. The other 44 individuals were not infected b y the human immunodeficiency virus (HIV). Pneumocystis carinii organis ms were identified on Grocott's methenamine silver (GMS)-stained BAL s mears in 30 patients with AIDS. Flocculent material was present in the Papanicolaou and Leishman-stained smears from all of these cases. Con versely, P. carinii were not seen on GMS-stained smears in the remaini ng 84 individuals with or without AIDS. No flocculent material was obs erved in Papanicolaou or Leishman-stained smears in these 84 patients. We concluded that the presence of flocculent material in Papanicolaou or Leishman-stained smears of BAL fluid is indicative of P. carinii p neumonia in patients with AIDS.