Pneumocystis carinii pneumonia

High resolution computed tomography of Pneumocystis carinii pneumonia in AIDS

High resolution computed tomography (CT) was performed on 11 homosexual men with the Acquired Immune Deficiency Syndrome (AIDS). All had bronchoscopically proven Pneumocystis carinii pneumonia (PCP). Six patients were re-scanned following treatment and symptomatic recovery. All the scans were abnormal, most showing fine diffuse bilateral alveolar consolidation with bronchial wall thickening, despite having a normal or near-normal chest radiograph in three cases. A variety of unexpected changes such as peripheral consolidation only, upper or lower zone predominance, unilaterality, bronchial dilatation, cystic air spaces and sub-pleural sparing were also seen. Following therapy, resolution of CT changes was shown to be incomplete despite clinical recovery, and whilst all the cases showed a reduction in alveolar consolidation, other findings such as new interstitial shadowing, peripheral predominance, and persistent cystic changes were observed, suggesting the healing process to be complex. Whilst the changes of PCP and its progression following treatment are well described on the plain chest radiograph, this is the first specific documentation of its appearances on narrow section CT, and its response to therapy. The usefulness of high resolution CT scanning to show early infection with PCP in the face of a normal chest radiograph is discussed, and the wide variety of CT changes occurring once the disease is established is emphasized.

Pulmonary manifestations of the acquired immunodeficiency syndrome

Between 1983 and 1985, 71 patients with the acquired immunodeficiency syndrome (AIDS) were evaluated. Pulmonary manifestations were present in 42 patients (59%). Pneumocystis carinii pneumonia (PCP) was the most common pulmonary manifestation, present in 32 patients (45%). Other pulmonary findings were cytomegalovirus pneumonia (one patient), Candida pneumonia (one patient), cryptococcal pneumonia (one patient), bacterial pneumonia (three patients), nonspecific pneumonitis (three patients), Kaposi's sarcoma (one patient), and non-Hodgkin's lymphoma (one patient). The presenting features of PCP were reviewed and in seven patients the chest X-ray and blood gases were normal at the time of diagnosis of PCP. Bronchoscopy was a safe and useful technique for obtaining specimens for diagnosis promptly, and a combination of samples obtained by bronchial washings/brushings and transbronchial biopsy was found to give a higher diagnostic yield than any single sample. Drug side-effects were common during therapy, requiring change of therapy in 16 patients. At one month after diagnosis 16% of patients with PCP had died. PCP is a common pulmonary manifestation in patients with AIDS which is treatable and has an initially favourable outcome.

Diagnosing Pneumocystis carinii pneumonia by cytological examination of bronchoalveolar lavage fluid: report of 15 cases

Sixty episodes of pneumonia occurring in 53 immunosuppressed patients were investigated by bronchoalveolar lavage. Pneumocystis carinii was diagnosed on 15 (25%) occasions. In all cases the Papanicolaou stained lavage fluid presented a distinctive appearance and contained abundant, often biphasic, staining, "honeycomb" debris, and few alveolar macrophages. The Grocott methenamine silver technique confirmed the presence of characteristic cystic organisms in the debris in all 15 instances. Cysts containing internal sporozoites were identified in Gram stained material only with difficulty. Neither May-Grünwald-Giemsa stain nor fluorescence microscopy under ultraviolet light were effective for routine investigation.