DETECTION OF PNEUMOCYSTIS-CARINII IN TRACHEAL ASPIRATES OF INTUBATED PATIENTS USING CALCOFLUOR-WHITE (FUNGI-FLUOR(R)) AND IMMUNOFLUORESCENCE ANTIBODY (GENETIC SYSTEMS) STAINS

Objective: To compare the detection rate of Pneumocystis carinii in en dotracheal aspirates with that rate in bronchoalveolar lavage fluid, u sing calcofluor white (Fungi Fluor(R)) and immunofluorescence antibody (Genetic Systems) staining methods. Design: Prospective, consecutive cases, Setting: Medical intensive care unit at Ben Taub General Hospit al. Patients: Thirty-one intubated patients admitted with respiratory failure and suspected P. carinii pneumonia. Interventions: An endotrac heal aspirate specimen was obtained after maximally advancing a closed system suction catheter, instilling aliquot portions of saline, and s uctioning the lavage fluid, This procedure was followed within 30 mins by fiberoptic bronchoscopy and bronchoalveolar lavage. Measurements a nd Main Results: Endotracheal aspirate and bronchoalveolar lavage spec imens from each patient were mixed with Saccomano's fixative, blended, and centrifuged. Using a modified method for P. carinii cysts, the se diment was stained with the test calcofluor-white stain Solution A and the test antibody stain, The test antibody stain on the bronchoalveol ar lavage specimens was positive for P. carinii for 13 patients and wa s used as the standard for comparison, In the endotracheal aspirate sp ecimens, the test antibody stain detected 12 (92%) P. carinii-positive patients while the test calcofluor-white stain detected ten (77%) P, carinii-positive patients, Conclusions: We described a simple method f or obtaining, processing, and staining endotracheal aspirate specimens for P, carinii. Obtaining an endotracheal aspirate specimen did not r equire specially trained personnel or a specialized and more expensive catheter, and was not associated with any complications.