Chest
Pulmonary Alveolar Proteinosis Associated with Pneumocystis carinii: Ultrastructural Identification in Bronchoalveolar Lavage in AIDS and Immunocompromised Non-AIDS Patients
Section snippets
Patients
An ultrastructural study of the BAL fluid was performed in 37 patients. In these patients, BAL was undertaken to investigate episodes of pneumonitis. Pneumonitis was suspected because of pulmonary symptoms and/or fever and/or abnormal chest roentgenogram.
Twenty-six patients had a PC pneumonitis, 19 with AIDS and seven with an immunodeficiency related to heart (n = 3) or kidney (n = 4) transplantation fiable 1). The chest roentgenogram revealed a diffuse reticulonodular pattern in 21 patients, a
Light Microscopy
In each of the 26 cases, the identification in the BAL fluid of PC cysts by Gomori-Grocott staining confirmed the diagnosis of PC pneumonitis.
On MGG- or Papanicolaou-stained slides from BAL with PC, foamy honeycombed material containing PC cysts and trophozoites was observed in 23 of these 26 BAL fluid samples. In nine cases, an extracellular material with a different pattern was observed associated with the honeycombed material (Fig la). This extracellular material was pale, homogeneous, and
DISCUSSION
The present systematic ultrastructural investigation of a series of BAL fluid samples collected in patients with PC pneumonitis demonstrated in all of them, in addition to the aggregates of PC cysts and trophozoites, the presence of an extracellular material composed of an accumulation of phospholipids and lipoproteinaceous substance with the characteristic pattern of surfactant. This material was detected by light microscopic examination in nine cases due to the amount of the extracellular
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This investigation was supported by Crédits Universitaires, Université Paris XII, France.
Manuscript received October 20; revision accepted March 29.