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A RAPID NONINVASIVE TEST FOR PNEUMOCYSTIS CARINII PNEUMONIA.

The techniques for diagnosing Pneumocystis carinii pneumonia via sputum examination -- Giemsa and toluidine blue O stains -- are at best able to detect only about half the cases in patients with AIDS or HIV infection. Furthermore, these tests require skilled technicians, and they produce false-positive results. In such cases, bronchoscopy with lavage is often required to establish the diagnosis; this places greater demands on pulmonary physicians and adds considerably to the patient's expense and discomfort.

This report from the NIH shows that a new immunofluorescent stain using monoclonal antibodies was much more sensitive (92 percent sensitivity) in detecting P. carinii pneumonia in 63 patients than was toluidine blue (80 percent) or a Giemsa-like stain (76 percent). The new test did not produce any false-positive results.

It appears that the new test will supplant the older tests and thus reduce the need for many bronchoscopies. However, any test for pneumocystis may produce misleading results unless it is applied to selected patients at high risk for P. carinii pneumonia (such as patients at high risk for HIV infection who have nonproductive cough and diffuse interstitial markings on chest X-ray).

— ALK

Published in Journal Watch General Medicine March 18, 1988

Citation(s):

Kovacs J A; Ng V L; Masur H et al. Diagnosis of Pneumocystis carinii pneumonia: improved detection in sputum with use of monoclonal antibodies. N Engl J Med 1988 Mar 10 318 589-593.

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