Dahiya Sonika, Mathur Sandeep R, Iyer Venkateswaran K, Kapila Kusum, Verma Kusum
Cytopathology Laboratory, Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Chest Dis Allied Sci. 2005 Oct-Dec;47(4):259-65.
Diagnosis of Pneumocystis pneumonia requires morphological demostration of P. carinii (now re-named as P. jiroveci). Although bronchoalveolar lavage (BAL) fluid cytology constitutes a formidable tool for detecting this infection, few studies on the utility of BAL cytology in diagnosing PCP are available from India. The present study reports the clinical spectrum, cytomorphological features and the utility of BAL cytology in diagnosing Pneumocystis infection from a tertiary care centre in India.
Retrospective study of 13 patients with PCP, diagnosed on examination of BAL fluid.
The mean age of the patients was 41.2 years. One patient had human immunodeficiency virus (HIV) infection, while the other 10 were renal transplant receipients on immunosuppressive therapy. The immune status of two patients was unknown. Fever, cough and shortness of breath were the main presenting symptoms. Radiological diagnosis of Pneumocystis pneumonia was offered in only one case. Foamy alveolar casts were present in all cases. Silver methanamine stain enhanced the rounded, helmet or cleft forms of sporozoites. Inflammatory infiltrate was mainly polymorphonuclear.
BAL cytology, thus, constitutes a useful diagnostic modality for morphological documentation and reliable diagnosis of Pneumocystis pneumonia in an immunocompromised host. Pneumocystis pneumonia appears to be a common opportunistic infection in renal transplant receipients in India.
肺孢子菌肺炎的诊断需要对卡氏肺孢子菌（现重新命名为耶氏肺孢子菌）进行形态学证明。虽然支气管肺泡灌洗（BAL）液细胞学是检测这种感染的有力工具，但印度关于BAL细胞学在诊断肺孢子菌肺炎中的应用的研究很少。本研究报告了印度一家三级医疗中心肺孢子菌感染的临床谱、细胞形态学特征以及BAL细胞学在诊断中的应用。
对13例经BAL液检查确诊为肺孢子菌肺炎的患者进行回顾性研究。
患者的平均年龄为41.2岁。1例患者感染了人类免疫缺陷病毒（HIV），另外10例是接受免疫抑制治疗的肾移植受者。2例患者的免疫状态未知。发热、咳嗽和呼吸急促是主要的症状。仅1例患者经放射学诊断为肺孢子菌肺炎。所有病例均可见泡沫状肺泡铸型。甲胺银染色可增强子孢子的圆形、盔形或裂隙形。炎症浸润主要为多形核。
因此，BAL细胞学是免疫功能低下宿主中肺孢子菌肺炎形态学记录和可靠诊断的有用诊断方法。在印度，肺孢子菌肺炎似乎是肾移植受者中常见的机会性感染。
