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The use of mucolysed induced sputum for the identification of pulmonary pathogens associated with human immunodeficiency virus infection.
Arch Pathol Lab Med. 1989 May; 113(5):488-93.AP

Abstract

We describe a system for diagnosis of pulmonary disease in the human immunodeficiency virus-infected patient using induced sputum and other diagnostic procedures. This system has been successfully used at San Francisco (Calif) General Hospital for more than 2 years. It utilizes outpatient facilities and reduces the need for bronchoscopy. Sputum induced by inhalation of 3% saline mist, mucolysed, concentrated by centrifugation, and stained by a rapid modified Giemsa stain was the first diagnostic specimen examined in 404 episodes of suspected human immunodeficiency virus-associated pulmonary disease in 358 patients. Pneumocystis carinii was found in 222 (55%) sputum specimens. In 118 episodes in which the sputum did not contain P carinii, bronchoscopy with transbronchial biopsy and/or bronchoalveolar lavage was performed and P carinii was found in 50 (42%). These 118 bronchoscopy results, as well as evaluation of the subsequent clinical course of those patients who accounted for 64 episodes of lung disease and who did not have bronchoscopy following examination of nondiagnostic induced sputum, indicated a range of sensitivity for detection of P carinii in induced sputum of 74% to 77% and a negative predictive value of 58% to 64%. Mycobacteria were recovered from 11 (6%) of the induced sputum and 6 (12%) of the bronchoscopic specimens containing P carinii. However, only oral or environmental fungi were recovered from P carinii-containing induced sputum or bronchoscopic specimens. For those patients in whom P carinii was not detected, only the bronchoscopic specimens were cultured for Mycobacteria and fungi. Potentially pathogenic Mycobacteria and fungi were recovered from 16 (23.5%) and 34 (50%), respectively, of these P carinii-negative specimens. Analysis of these results, obtained under routine practice conditions, indicates that bronchoscopy should be reserved for those patients whose induced sputum examinations do not show P carinii and that mycobacterial and fungal cultures be performed only on bronchoscopic specimens in which P carinii is not detected.

Authors+Show Affiliations

Department of Laboratory Medicine, General Hospital Medical Center, San Francisco, CA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

2785374

Citation

Ng, V L., et al. "The Use of Mucolysed Induced Sputum for the Identification of Pulmonary Pathogens Associated With Human Immunodeficiency Virus Infection." Archives of Pathology & Laboratory Medicine, vol. 113, no. 5, 1989, pp. 488-93.
Ng VL, Gartner I, Weymouth LA, et al. The use of mucolysed induced sputum for the identification of pulmonary pathogens associated with human immunodeficiency virus infection. Arch Pathol Lab Med. 1989;113(5):488-93.
Ng, V. L., Gartner, I., Weymouth, L. A., Goodman, C. D., Hopewell, P. C., & Hadley, W. K. (1989). The use of mucolysed induced sputum for the identification of pulmonary pathogens associated with human immunodeficiency virus infection. Archives of Pathology & Laboratory Medicine, 113(5), 488-93.
Ng VL, et al. The Use of Mucolysed Induced Sputum for the Identification of Pulmonary Pathogens Associated With Human Immunodeficiency Virus Infection. Arch Pathol Lab Med. 1989;113(5):488-93. PubMed PMID: 2785374.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of mucolysed induced sputum for the identification of pulmonary pathogens associated with human immunodeficiency virus infection. AU - Ng,V L, AU - Gartner,I, AU - Weymouth,L A, AU - Goodman,C D, AU - Hopewell,P C, AU - Hadley,W K, PY - 1989/5/1/pubmed PY - 1989/5/1/medline PY - 1989/5/1/entrez SP - 488 EP - 93 JF - Archives of pathology & laboratory medicine JO - Arch Pathol Lab Med VL - 113 IS - 5 N2 - We describe a system for diagnosis of pulmonary disease in the human immunodeficiency virus-infected patient using induced sputum and other diagnostic procedures. This system has been successfully used at San Francisco (Calif) General Hospital for more than 2 years. It utilizes outpatient facilities and reduces the need for bronchoscopy. Sputum induced by inhalation of 3% saline mist, mucolysed, concentrated by centrifugation, and stained by a rapid modified Giemsa stain was the first diagnostic specimen examined in 404 episodes of suspected human immunodeficiency virus-associated pulmonary disease in 358 patients. Pneumocystis carinii was found in 222 (55%) sputum specimens. In 118 episodes in which the sputum did not contain P carinii, bronchoscopy with transbronchial biopsy and/or bronchoalveolar lavage was performed and P carinii was found in 50 (42%). These 118 bronchoscopy results, as well as evaluation of the subsequent clinical course of those patients who accounted for 64 episodes of lung disease and who did not have bronchoscopy following examination of nondiagnostic induced sputum, indicated a range of sensitivity for detection of P carinii in induced sputum of 74% to 77% and a negative predictive value of 58% to 64%. Mycobacteria were recovered from 11 (6%) of the induced sputum and 6 (12%) of the bronchoscopic specimens containing P carinii. However, only oral or environmental fungi were recovered from P carinii-containing induced sputum or bronchoscopic specimens. For those patients in whom P carinii was not detected, only the bronchoscopic specimens were cultured for Mycobacteria and fungi. Potentially pathogenic Mycobacteria and fungi were recovered from 16 (23.5%) and 34 (50%), respectively, of these P carinii-negative specimens. Analysis of these results, obtained under routine practice conditions, indicates that bronchoscopy should be reserved for those patients whose induced sputum examinations do not show P carinii and that mycobacterial and fungal cultures be performed only on bronchoscopic specimens in which P carinii is not detected. SN - 0003-9985 UR - https://www.unboundmedicine.com/medline/citation/2785374/The_use_of_mucolysed_induced_sputum_for_the_identification_of_pulmonary_pathogens_associated_with_human_immunodeficiency_virus_infection_ DB - PRIME DP - Unbound Medicine ER -