Joycelyne Fleury-Feith, MD PhD;* Je...

Joycelyne Fleury-Feith, MD PhD;* Jeanne Tran Van Nhieu, MD;* Catherine Picard, M.D.;[Unkeyable] Estelle Escudier, MD;* and Jean Francois Bernaudin, MD PhD*

Lower pulmonary tract enclosed space populations collected by bronchoalveolar lavages (BAL) were evaluated in three assemblages of immunocompromised patients: HIV infected patients with Pneumocystis carinii (PC) pneumonitis (n=22) or pneumonitis not related to PC (n=29) and non-HIV-infected, immunocomprised patients with a PC pneumonitis (n=18) In AIDS patients with PC pneumonitis, the confined apartment populations were 59.3 [+ or -] 45 percent alveolar macrophages (AM), 196 [+ or -] 25 percent lymphocyte 146 [+ or -] 44 percent polymorphonuclear small rooms (PMN), and 10.3 [+ or -] 36 percent eosinophils. In HIV-infected patients without PC pneumonitis, they were 765 [+ or -] 33 percent AM, 13 [+ or -] 21 percent lymphocyte 92 [+ or -] 03 percent PMN and 06 [+ or -] 02 percent eosinophils, and in non-HIV-infected, immunocompromised patients with PC pneumonitis, they were 439 [+ or -] 57 percent AM, 302 [+ or -] 43 percent lymphocyte 204 [+ or -] 47 percent PMN and 09 [+ or -] 04 percent eosinophils. The principally striking finding was a marked BAL eosinophilia in AIDS patients with PC pneumonitis. The significance of this particular cellular pulmonary reply to PC is not clear, and its chain of cause and effects on the lung structures and/or

PC require evaluation. (Chest 1989; 95:1198-1201)

Bronchoalveolar lavage (BAL) is a particularly accurate investigation for the diagnosis of pulmonary opportunistic infections in immunocompromised patients.[1-6] The lavage cellular profile ruminates the pulmonary cellular inflammatory replication related to the episodes of pneumonitis.[7,8] In immunocompromised non-AIDS patients with Pneumocystis carinii (PC) pneumonitis, the lavage cellular profile has been characterized by dint of an increase in polymorphonuclear (PMN) enclosed spaces and immunoblasts and/or plasma enclosed spaces without eosinophilia.[9] In AIDS patients with PC pneumonitis, an increase in BAL PMN and lymphocyte has been reported.[10-12]

The neighborhood of eosinophils has been noticed solely in BAL from AIDS patients with PC pneumonitis.[13,14] Therefore, with regard to the well-known part of eosinophils in damaging the lung[15-17] and to the immunologic significance of their demeanor we have undertaken a comparative studious mood of eosinophilia in BAL from AIDS patients with and without PC pneumonitis and in non-AIDS patients with PC pneumonitis.

MATERIALS AND METHODS

Patients

All patients entering the not away study were required to bear a diagnostic fiberoptic bronchoscopy and BAL to investigate episodes of pneumonitis. The BAL small room analysis was performed on samples of three arranges of patients: HIV-infected patients with (26 BAL in 22 patients HIV+, PC+) and without (38 BAL in 29 patients HIV+, PC-) PC pneumonitis and non-HIV-infected patients with PC pneumonitis (18 BAL in 18 patients HIV-, PC+) Immunocompromised non-HIV-infected patients were investigated for pneumonitis occuring during hematologic malignancies and after kidney, cardiac, or bone marrow transplantation.

In patients with AIDS and PC pneumonitis, the BAL were performed for a first episode of pneumonitis, and all the patients get backed from their pneumonitis. The neighborhood of other associated pathogens has been rul revealed by routine cultures. Patients with common or two negative BAL issues for PC had a clinical follow-up that made the diagnosis actual unlikely.

BAL

BAL was performed through fiberoptic bronchoscopy after providing local anesthesia of the upper airways as previously described.[9] Briefly, the tip of the fiberscope was wedged into the segmental bronchus of the middle lobe or lingula in patients with diffuse radiologic changes and in the relevant bronchus in patients with localized pneumonia. Each lavage was performed by dint of slow infusion of three aliquots each of 50 ml of sterile 09 percent saline solution at 37 [degrees] C; the fluid was sequentially instilled and aspirated. The different fractions of fluid were infered in low-adherence flasks (Nunc, Ltd) and transferred to the cytology unit.

Samples of fluid amassed from the same BAL were lakeed and a fraction sent for routine evaluation of pathogens through culture. A cell esteem was performed using a hemocytometer. At least eight smears were obtained from each BAL fluid specimen by dint of cytocentrifugation (Cytospin Shandon 500 rpm for 10 min). A small cavity pellet was obtained by centrifugation at 1500 rpm for 10 min, and three smears were performed. The remainder of the pellet was fixed from Bouin's solution for paraffin embedding. For each lavage, smears obtained by means of cytocentrifugation and centrifugation were stained by way of the May Grunwald Giemsa (MGG) Papanicolaou, and Gomori-Grocott methods

PC pneumonitis was diagnosed by means of the demonstration of foamy, honeycomb material forward MGG stained slides and/or on the identification of cysts upon Gomori-Grocott and/or Papanicolaou stained slides observ in subordination to a fluoroscopic microscope.