DIAGNOSIS OF PNEUMOCYSTIS-CARINII PNEUMONIA IN HIV-POSITIVE PATIENTS - BRONCHOALVEOLAR LAVAGE VS. BRONCHIAL BRUSHING

OBJECTIVE: To evaluate the contribution of bronchoalveolar lavage (BAL ) and bronchial brushing (BB) and the use of different tinctorial stai ns in the detection of Pneumocystis carinii (PC) in human immunodefici ency virus(HIV)-positive patients. STUDY DESIGN: In a retrospective st udy, 195 HIV-positive patients suspected of a pulmonary infection unde rwent bronchoscopy with BAL. In 143 cases subsequent BE was performed. On 135 BAL fluid cytocentrifuge preparations four staining techniques were applied simultaneously: May-Grunwald-Giemsa (MGG), toluidine blu e-O (TOL), Papanicolaou (PAP) and Grocott methenamine silver (GRO). RE SULTS: PC was recovered in 79 (40.5%) cases. The yields of MGG and TOL were identical (33.3%). PAP and GAO showed lower results, 31.1% and 2 9.6%, respectively. These differences were not statistically significa nt. The combination of BAL and BE revealed 64 cases of PC infection. B AL was positive in the vast majority of cases (63, 44.1%). BE was posi tive in 54 (37.8%). The combination of positive BE with negative BAL w as present ill one case. However, 10 cases of PC were found with the u se of BAL and not detected by BE (P<.01). CONCLUSION: The results of t his study indicate that to confirm a PC infection in HIV-positive pati ents, the use of bronchoalveolar lavage with a single staining techniq ue is appropriate. Bronchial brushing seems to be of limited additiona l value.