Document 0852
 DOCN  M9590852
 TI    Suspected Pneumocystis carinii pneumonia with a negative induced sputum
       examination. Is early bronchoscopy useful?
 DT    9509
 AU    Huang L; Hecht FM; Stansell JD; Montanti R; Hadley WK; Hopewell PC;
       Medicine Service, San Francisco General Hospital Medical Center,;
       California, USA.
 SO    Am J Respir Crit Care Med. 1995 Jun;151(6):1866-71. Unique Identifier :
       AIDSLINE MED/95285042
 AB    In U.S. patients with the acquired immunodeficiency syndrome (AIDS),
       Pneumocystis carinii pneumonia is the most frequent AIDS-defining
       opportunistic infection. Sputum induction and bronchoscopy are effective
       techniques for obtaining specimens used to identify P. carinii although
       debate continues over their optimal use, specifically whether to perform
       bronchoscopy after a negative induced sputum examination for P. carinii.
       To evaluate the usefulness of bronchoscopy in this situation, we
       reviewed all cases of suspected P. carinii pneumonia in which sputum
       induction for P. carinii was performed at San Francisco General Hospital
       during a 4-yr period. Bronchoscopy, performed after a negative induced
       sputum examination, yielded a diagnosis in 50.5% of evaluations. The
       most frequent diagnoses were P. carinii pneumonia (192),
       tracheobronchial Kaposi's sarcoma (93), tuberculosis (28), and
       Cryptococcus neoformans pneumonia (9). Bronchoscopy provided either the
       only or an earlier diagnosis in 64.3% of tuberculosis cases.
       Bronchoscopy with BAL was free of complications, and, importantly, a
       negative BAL examination for P. carinii allowed physicians to
       discontinue empiric P. carinii pneumonia treatment in 95%. In patients
       with suspected P. carinii pneumonia with a negative induced sputum
       examination for P. carinii, early bronchoscopy with BAL should be
       performed.
 DE    AIDS-Related Opportunistic Infections/*DIAGNOSIS/EPIDEMIOLOGY/
       MICROBIOLOGY  Biopsy  Bronchial Neoplasms/DIAGNOSIS/EPIDEMIOLOGY
       Bronchoalveolar Lavage Fluid/MICROBIOLOGY  Bronchoscopy/*UTILIZATION
       Evaluation Studies  Human  Pneumocystis carinii/*ISOLATION & PURIF
       Pneumonia, Pneumocystis carinii/*DIAGNOSIS/EPIDEMIOLOGY  San
       Francisco/EPIDEMIOLOGY  Sarcoma, Kaposi's/DIAGNOSIS/EPIDEMIOLOGY
       Sputum/*MICROBIOLOGY  Support, Non-U.S. Gov't  Support, U.S. Gov't,
       P.H.S.  Time Factors  Tracheal Neoplasms/DIAGNOSIS/EPIDEMIOLOGY  JOURNAL
       ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).