Kovacs J A, Ng V L, Masur H, Leoung G, Hadley W K, Evans G, Lane H C, Ognibene F P, Shelhamer J, Parrillo J E
Critical Care Medicine Department, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892.
N Engl J Med. 1988 Mar 10;318(10):589-93. doi: 10.1056/NEJM198803103181001.
With the dramatic increase in the frequency of Pneumocystis carinii pneumonia associated with human immunodeficiency virus infection, there has been a need for more rapid and less invasive diagnostic techniques. Recent studies have shown that examination of induced sputum can establish the diagnosis of P. carinii pneumonia in about 55 percent of cases. To assess whether a recently developed indirect immunofluorescent stain using monoclonal antibodies was more sensitive than Giemsa or toluidine blue O stains in detecting P. carinii in sputum, we undertook two prospective studies. Of 63 patients at one institution from whom sputum specimens were obtained, 49 were ultimately given a diagnosis of P. carinii pneumonia, 46 of them by staining of sputum. The sensitivity of the three stains in detecting P. carinii was 45 of 49 (92 percent) for immunofluorescence; 37 of 49 (76 percent) for Diff-Quik (a Giemsa-type stain); and 39 of 49 (80 percent) for toluidine blue O. There were no false positive immunofluorescent stains. In a similar study of a series of 25 patients at another institution, a diagnosis of P. carinii pneumonia was made in 23 of 25 patients by staining of induced sputum. We conclude that examination of induced sputum is a rapid, sensitive, and inexpensive method for diagnosing P. carinii pneumonia and that indirect immunofluorescence is a practical and highly sensitive staining technique for establishing this diagnosis.
随着与人类免疫缺陷病毒感染相关的卡氏肺孢子虫肺炎发病率急剧上升，对更快速、侵入性更小的诊断技术的需求也随之增加。最近的研究表明，对诱导痰进行检查可在约55%的病例中确诊卡氏肺孢子虫肺炎。为了评估一种最近开发的使用单克隆抗体的间接免疫荧光染色法在检测痰液中的卡氏肺孢子虫时是否比吉姆萨染色法或甲苯胺蓝O染色法更敏感，我们进行了两项前瞻性研究。在一所机构获取痰液标本的63例患者中，49例最终被诊断为卡氏肺孢子虫肺炎，其中46例通过痰液染色确诊。三种染色法检测卡氏肺孢子虫的敏感性分别为：免疫荧光法49例中有45例（92%）；Diff - Quik（一种吉姆萨类染色法）49例中有37例（76%）；甲苯胺蓝O法49例中有39例（80%）。免疫荧光染色没有假阳性结果。在另一所机构对25例患者进行的类似研究中，25例患者中有23例通过诱导痰染色被诊断为卡氏肺孢子虫肺炎。我们得出结论，检查诱导痰是诊断卡氏肺孢子虫肺炎的一种快速、敏感且廉价的方法，间接免疫荧光法是用于确诊该病的一种实用且高度敏感的染色技术。
