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Diagnosis of Pneumocystis carinii pneumonia by cytologic evaluation of Papanicolaou-stained bronchial specimens.
Diagn Cytopathol. 1988; 4(2):106-12.DC

Abstract

To evaluate the sensitivity and specificity of diagnosing Pneumocystis carinii pneumonia (PCP) by Papanicolaou-stained bronchial brushing and wash/lavage specimens obtained by fiberoptic bronchoscopy, the cytologic preparations and clinical records from 58 immunocompromised patients were reviewed. Bronchial brushings and wash/lavage specimens were examined using methenamine silver (Grocott) and Papanicolaou stains. Pneumocystis carinii pneumonia was recognized with Papanicolaou stain by identifying distinctive alveolar casts, which frequently contained collections of encysted sporozoites. Thirty cases of PCP were identified, and Grocott-stained bronchial wash/lavage specimens were positive in 29 instances (97%). Grocott staining of the transbronchial biopsy was positive for PCP in 18 of 22 specimens (82%). Bronchial brushings were insensitive, yielding a positive specimen in only 30% of cases of PCP. Alveolar casts of PCP were identified by Papanicolaou-stained slides of wash/lavage specimens in 83% of cases of Pneumocystis pneumonia. These proteinaceous alveolar casts were not seen in other pulmonary disorders. Encysted sporozoites were found in 56% of cases in which Papanicolaou-stained alveolar casts were identified. We conclude that the diagnosis of PCP can be made rapidly and reliably on the Papanicolaou-stained bronchial wash/lavage or bronchial brush specimens by detecting the characteristic alveolar casts, which contain P. carinii-encysted sporozoites. The presence of encysted sporozoites within alveolar casts is pathognomonic for PCP, and methenamine silver stains can be eliminated in those cases in which encysted sporozoites are identified.

Authors+Show Affiliations

Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

2468459

Citation

Dugan, J M., et al. "Diagnosis of Pneumocystis Carinii Pneumonia By Cytologic Evaluation of Papanicolaou-stained Bronchial Specimens." Diagnostic Cytopathology, vol. 4, no. 2, 1988, pp. 106-12.
Dugan JM, Avitabile AM, Rossman MD, et al. Diagnosis of Pneumocystis carinii pneumonia by cytologic evaluation of Papanicolaou-stained bronchial specimens. Diagn Cytopathol. 1988;4(2):106-12.
Dugan, J. M., Avitabile, A. M., Rossman, M. D., Ernst, C. S., & Atkinson, B. F. (1988). Diagnosis of Pneumocystis carinii pneumonia by cytologic evaluation of Papanicolaou-stained bronchial specimens. Diagnostic Cytopathology, 4(2), 106-12.
Dugan JM, et al. Diagnosis of Pneumocystis Carinii Pneumonia By Cytologic Evaluation of Papanicolaou-stained Bronchial Specimens. Diagn Cytopathol. 1988;4(2):106-12. PubMed PMID: 2468459.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis of Pneumocystis carinii pneumonia by cytologic evaluation of Papanicolaou-stained bronchial specimens. AU - Dugan,J M, AU - Avitabile,A M, AU - Rossman,M D, AU - Ernst,C S, AU - Atkinson,B F, PY - 1988/1/1/pubmed PY - 1988/1/1/medline PY - 1988/1/1/entrez SP - 106 EP - 12 JF - Diagnostic cytopathology JO - Diagn Cytopathol VL - 4 IS - 2 N2 - To evaluate the sensitivity and specificity of diagnosing Pneumocystis carinii pneumonia (PCP) by Papanicolaou-stained bronchial brushing and wash/lavage specimens obtained by fiberoptic bronchoscopy, the cytologic preparations and clinical records from 58 immunocompromised patients were reviewed. Bronchial brushings and wash/lavage specimens were examined using methenamine silver (Grocott) and Papanicolaou stains. Pneumocystis carinii pneumonia was recognized with Papanicolaou stain by identifying distinctive alveolar casts, which frequently contained collections of encysted sporozoites. Thirty cases of PCP were identified, and Grocott-stained bronchial wash/lavage specimens were positive in 29 instances (97%). Grocott staining of the transbronchial biopsy was positive for PCP in 18 of 22 specimens (82%). Bronchial brushings were insensitive, yielding a positive specimen in only 30% of cases of PCP. Alveolar casts of PCP were identified by Papanicolaou-stained slides of wash/lavage specimens in 83% of cases of Pneumocystis pneumonia. These proteinaceous alveolar casts were not seen in other pulmonary disorders. Encysted sporozoites were found in 56% of cases in which Papanicolaou-stained alveolar casts were identified. We conclude that the diagnosis of PCP can be made rapidly and reliably on the Papanicolaou-stained bronchial wash/lavage or bronchial brush specimens by detecting the characteristic alveolar casts, which contain P. carinii-encysted sporozoites. The presence of encysted sporozoites within alveolar casts is pathognomonic for PCP, and methenamine silver stains can be eliminated in those cases in which encysted sporozoites are identified. SN - 8755-1039 UR - https://www.unboundmedicine.com/medline/citation/2468459/Diagnosis_of_Pneumocystis_carinii_pneumonia_by_cytologic_evaluation_of_Papanicolaou_stained_bronchial_specimens_ DB - PRIME DP - Unbound Medicine ER -