Chest, Vol 100, 1345-1349, Copyright © 1991 by American College of Chest Physicians

ARTICLES

Diagnostic approach to Pneumocystis carinii pneumonia in the setting of prophylactic aerosolized pentamidine

ML Metersky and A Catanzaro
Division of Pulmonary and Critical Care Medicine, University of California, San Diego Medical Center.

Recurrent Pneumocystis carinii pneumonia is common in patients with the acquired immunodeficiency syndrome who receive prophylaxis with aerosolized pentamidine. In this setting, the number of organisms is reduced and the clinical presentation may be altered. These observations have led to doubts regarding the use of induced sputum to diagnose PCP in patients receiving prophylactic AP. To determine if the examination of induced sputum is useful for patients receiving prophylactic AP, we examined our results over a 12-month period. We also examined several clinical criteria to ascertain if they could predict the likelihood of a positive induced sputum. As assessed by P(A- a)O2, need for admission and mortality, patients receiving AP presented with less severe disease than those not receiving AP. Twelve of 19 (63 percent) patients who developed PCP while receiving prophylactic AP were diagnosed by induced sputum. Induced sputum was positive for 35 of 55 (64 percent) patients who developed PCP and had not been receiving AP. However, there were no clinical characteristics which predicted a positive induced sputum. We conclude that induced sputum is an effective method for diagnosing PCP in patients receiving prophylactic AP.

This article has been cited by other articles:

				S. L. Boswell and M. van Gorder Case 27-1997- A 38-Year-Old Man with the Acquired Immunodeficiency Syndrome and Cavitary Pulmonary Lesions N. Engl. J. Med., August 28, 1997; 337(9): 619 - 627. [Full Text] [PDF]

				M. L. Metersky, D. Wlody, G. N. Cohen, and S. E. Weinberger Recent Advances in Pulmonary Medicine N. Engl. J. Med., October 21, 1993; 329(17): 1278 - 1279. [Full Text]