SUSPECTED PNEUMOCYSTIS-CARINII PNEUMONIA WITH A NEGATIVE INDUCED SPUTUM EXAMINATION

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 identity 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 Fl carinii pneumonia in which sputum induction for Fl 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 Fl 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 Fl carinii allowed physicians to discontinue empiric Fl carinii pneumonia treatment in 95%. In patients with suspected Fl carinii pneumonia with a negative induced sputum examination for Fl carinii, early bronchoscopy with BAL should be performed.