Alveolar damage in AIDS-related Pneumocystis carinii pneumonia

Objective: Pneumocystis carinii pneumonia is the most common and serious of the pulmonary complications of AIDS. Despite this, many basic aspects in the pathogenesis of HIV-associated P carinii pneumonia are unknown. We therefore undertook a light and electron microscopic study of transbronchial biopsy specimens to compare pathologic features of P carinii pneumonia and other HIV-related lung diseases. Design and patients: Thirty-seven consecutive HIV-infected patients undergoing a diagnostic bronchoscopy. Results: P carinii pneumonia was characterized by an increase in inflammation, edema, exudate, fibrosis, type II pneumocyte proliferation, and cellular infiltration of die alveolar wall when compared with other lung diseases (all p <0.05). Electron microscopy showed apposition of the trophozoite to the type I pneumocyte. Erosion of type I pneumocytes was observed in 13 of 15 patients with P carinii pneumonia, whereas none without P carinii pneumonia had this finding (p <0.05). Erosion of the type II pneumocyte was not observed. Conclusion: Inflammation, interstitial fibrosis, and alveolar epithelial erosion are characteristic features of P carinii pneumonia. The changes may form the pathologic basis for the respiratory failure seen in patients with P carinii pneumonia, Electron microscopy did not show any diagnostic advantage over conventional light microscopy using routine stains.