Bronchoalveolar lavage fluid cytology in patients with Pneumocystis carinii pneumonia

Objective: To evaluate bronchoalveolar lavage (BAL) cytology and organmism burden in patients with Pneumocystis carinii pneumonia (PCP) who were infec ted with the human immunodeficiency virus (HIV) and in those with other imm unodefiencies. STUDY DESIGN: BAL fluid samples from patients with PCP were selected (HIV-i nfected patients, n = 15; patients with other immunodefiencies, n = 11). Ma y-Grunwald-Giemsa-strained cytoceentrifuge preparations were evaluated. Foa my alveolar casts (FACs) and P carinii clusters were counted. RESULTS: The numbers of FACs and P carinii clusters in BALs fluid samples o f HIV-infected patients were significantly higher as compared to those in s amples from patients with other immunodeficiencies. Stricking cytologic fin dings observed in half the samples from both patients groups included the p resence of foamy alveolar macrophages, activated lymphocytes, plasma cells and reactive type II pneumocytes. Furthermore, a peculiar cell type, "nonid entified cell" (NIC), was observed almost exclusively in BAL fluid samples from HIV-infected patients. CONCLUSION: BAL fluid samples from HIV-infected patients with PCP displayed higher organism burdens as compared to those from patients with other immu nodefiencies. Moreover, cytologic findings suggestive of noninfectious lung conditions were common in BAL fluid samples obtained from patients with PC P. Further studyis required to elucidate the identity of the NIC cell type.