Tuberc Respir Dis.  2011 Nov;71(5):322-327.

Value of Bronchoalveolar Lavage Fluid Cytology in the Diagnosis of Pneumocystis jirovecii Pneumonia: A Review of 30 Cases

• Sung JY
• Han J
• Oh YL
• Suh GY
• Jeon K
• Kim T

Abstract

BACKGROUND
Pneumocystis jirovecii is a fungus that has become an important cause of opportunistic infections. We present a summary of the clinical status and findings from bronchoalveolar lavage (BAL) of patients with Pneumocystis jirovecii pneumonia (PJP).
METHODS
We selected 30 cases of PJP that were proven through a surgical specimen evaluation. BAL fluid cytology was reviewed, and agreement with the initial diagnosis was evaluated.
RESULTS
All 30 cases of PJP occurred in immunocompromised patients. Only 15 of the 30 cases were initially diagnosed as PJP. We found PJP in 13 of the 15 cases that were negative at the initial diagnosis. The most characteristic finding of PJP was frothy exudates, and BAL fluid tended to show rare neutrophils. Two of seven patients with PJP and diffuse alveolar damage (DAD) revealed no frothy exudates in BAL fluid.
CONCLUSION
BAL fluid cytology was reconfirmed as a sensitive and rapid method to diagnose PJP. We must be aware of the possibility of PJP to maintain high diagnostic sensitivity. We cannot exclude PJP in cases of PJP with DAD, even if frothy exudates are not observed in the BAL fluid.

Keyword

Pneumocystis carinii; Pneumocystis jirovecii; Bronchoalveolar Lavage Fluid; Pathology

MeSH Terms

Bronchoalveolar Lavage
Bronchoalveolar Lavage Fluid
Exudates and Transudates
Fungi
Humans
Immunocompromised Host
Neutrophils
Opportunistic Infections
Pneumocystis
Pneumocystis carinii
Pneumocystis jirovecii
Pneumonia

Figure

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  Figure 1 Characteristic PJP findings in surgical specimens (A~D) and bronchoalveolar fluid (E~H). (A, B) Frothy, foamy, or honeycomb exudates (arrow) within the alveolar spaces (A, H&E, ×100; B, H&E, ×200). (C, D) GMS staining and immunohistochemistry for Pneumocystis highlights PJP organisms (C, GMS, ×400; D, immunohistochemistry, ×400). (E~H) Scattered frothy exudates intermixed with inflammatory cells (E, H&E, ×40; F, H&E, ×100; H, H&E, ×400). PJP: Pneumocystis jirovecii pneumonia; GMS: gomori methenamine-silver.

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