Silva Rosemeri Maurici da, Bazzo Maria Luiza, Borges Alessandra Abel
University of South of Santa Catarina, Florianópolis, Brazil.
Braz J Infect Dis. 2007 Dec;11(6):549-53. doi: 10.1590/s1413-86702007000600005.
Induced sputum is a useful technique for assessing airway inflammation, but its role in the diagnosis of lung disease in immunosuppressed patients needs further investigation. This study compared the use of induced sputum and BAL in the diagnosis of pneumocystosis, in HIV patients. From January 1, 2001, to December 30, 2002, HIV-positive patients older than 14 were evaluated at a hospital in Florianópolis, Santa Catarina, Brazil. Patients with respiratory symptoms for seven days or longer, with a normal or abnormal chest X-ray, and those without respiratory symptoms but with an abnormal chest X-ray, were included in the study. All patients were submitted to clinical, radiological and laboratory evaluation, after which induced sputum and bronchoscopy with bronchoalveolar lavage were carried out. The samples were subjected to the following techniques: Gram and Ziehl-Neelsen staining, quantitative culture growth for pyogenic bacteria, direct staining for fungi, culture growth for mycobacteria and fungi, and Grocott-Gomori staining for Pneumocystis jiroveci, as well as total and differential cell counts. The samples with P. jiroveci were selected, as well as the samples for which no etiologic agents were observed. Forty-five patients with a mean age of 34.6, 38 male and 40 Caucasian, comprised the subjects. Interstitial infiltrate was the most frequent radiological pattern (53.3%). The induced sputum sensitivity was 58.8%, specificity 81.8%, predictive positive value 90.9%, predictive negative value 39.1% and accuracy 64.4%, for the diagnosis of pneumocystosis, compared with BAL. Based on these data, induced sputum is a useful technique for the diagnosis of pneumocystosis in HIV patients.
诱导痰是评估气道炎症的一种有用技术，但其在免疫抑制患者肺部疾病诊断中的作用尚需进一步研究。本研究比较了诱导痰和支气管肺泡灌洗（BAL）在HIV患者肺孢子菌病诊断中的应用。2001年1月1日至2002年12月30日，巴西圣卡塔琳娜州弗洛里亚诺波利斯市一家医院对14岁以上的HIV阳性患者进行了评估。有七天或更长时间呼吸道症状、胸部X线正常或异常的患者，以及无呼吸道症状但胸部X线异常的患者被纳入研究。所有患者均接受临床、放射学和实验室评估，之后进行诱导痰检查和支气管镜下支气管肺泡灌洗。样本采用以下技术：革兰氏和齐-尼氏染色、化脓性细菌定量培养生长、真菌直接染色、分枝杆菌和真菌培养生长、针对耶氏肺孢子菌的格罗特-戈莫里染色，以及细胞总数和分类计数。选取了耶氏肺孢子菌阳性的样本以及未观察到病原体的样本。45名患者构成研究对象，平均年龄34.6岁，男性38名，白种人40名。间质性浸润是最常见的放射学表现（53.3%）。与BAL相比，诱导痰诊断肺孢子菌病的敏感性为58.8%，特异性为81.8%，阳性预测值为90.9%，阴性预测值为39.1%，准确率为64.4%。基于这些数据，诱导痰是诊断HIV患者肺孢子菌病的一种有用技术。
