Radio S J, Hansen S, Goldsmith J, Linder J
Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha.
Mod Pathol. 1990 Jul;3(4):462-9.
Pneumocystis carinii is the pre-eminent pulmonary pathogen and leading cause of death in patients with acquired immunodeficiency syndrome (AIDS). The diagnosis of this organism depends upon the morphologic demonstration of the cyst wall, trophozoite, or sporozoite in specimens from the lower respiratory tract. A variety of histochemical stains have been used to identify P. carinii, each with considerable limitations in specificity. Extrapulmonary spread and unusually destructive pulmonary patterns associated with P. carinii, although once considered rare, are seen occasionally in patients with AIDS. Traditional stains have proven to be less reliable in extrapulmonary sites. In 13 patients with AIDS, we stained formalin-fixed paraffin-embedded autopsy lung and other visceral organ sections using monoclonal antibody 3F6 (Dako, Santa Barbara, CA) to P. carinii. The antibody stained P. carinii in the lungs of seven patients with P. carinii pneumonia by Gomori methenamine silver stain (GMS). Numerous aggregates of P. carinii cysts were marked within alveoli, as is usually seen with other stains. No antibody staining was present in autopsy lung sections from non-AIDS patients with viral, fungal, or bacterial pneumonia. Clinically occult extrapulmonary P. carinii infection was seen in 4/7 (57%) patients with P. carinii pneumonia at autopsy. Monoclonal antibody to P. carinii stained organisms in all four (100%) patients with disseminated disease, as compared with 1/4 (25%) staining with GMS. Antibody staining of P. carinii was demonstrated in sections of thyroid, adrenal, and carinal lymph node (one patient), esophagus (one patient), kidney (one patient), and heart, thyroid, kidney, adrenal, liver, stomach, pancreas, spleen, and bone marrow (one patient).(ABSTRACT TRUNCATED AT 250 WORDS)
卡氏肺孢子菌是获得性免疫缺陷综合征（AIDS）患者中最主要的肺部病原体和死亡的主要原因。该病原体的诊断依赖于在下呼吸道标本中发现囊肿壁、滋养体或子孢子的形态学证据。多种组织化学染色已被用于鉴定卡氏肺孢子菌，每种染色在特异性方面都有相当大的局限性。卡氏肺孢子菌的肺外播散以及与之相关的异常破坏性肺部病变，尽管曾经被认为很罕见，但在AIDS患者中偶尔可见。传统染色在肺外部位已被证明可靠性较低。我们用抗卡氏肺孢子菌单克隆抗体3F6（Dako，加利福尼亚州圣巴巴拉）对13例AIDS患者经福尔马林固定、石蜡包埋的尸检肺及其他内脏器官切片进行染色。该抗体在7例经Gomori甲胺银染色（GMS）确诊为卡氏肺孢子菌肺炎患者的肺中染出了卡氏肺孢子菌。肺泡内可见大量卡氏肺孢子菌囊肿聚集体，这与其他染色所见相同。在患有病毒、真菌或细菌性肺炎的非AIDS患者的尸检肺切片中未发现抗体染色。尸检时，在7例卡氏肺孢子菌肺炎患者中有4例（57%）存在临床上隐匿的肺外卡氏肺孢子菌感染。在所有4例（100%）播散性疾病患者中，抗卡氏肺孢子菌单克隆抗体染出了病原体，相比之下，GMS染色仅在1/4例（25%）患者中呈阳性。在甲状腺、肾上腺、气管旁淋巴结（1例患者）、食管（1例患者）、肾脏（1例患者）以及心脏、甲状腺、肾脏、肾上腺、肝脏、胃、胰腺、脾脏和骨髓（1例患者）的切片中均显示有卡氏肺孢子菌的抗体染色。（摘要截取自250词）
