PNEUMOCYSTIS CARINII BY INDUCED SPUTUM IN IMMUNOSUPPRESSED PEDIATRIC PATIENTS

免疫抑制儿科患者诱发痰引起的卡氏肺囊虫

• 批准号: 2571297
• 负责人: F P OGNIBENE
• 金额: --
• 依托单位: CLINICAL CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/2571297
• 关键词: HIV infections; Pneumocystis carinii; Pneumocystis pneumonia; child (0-11); clinical research; communicable disease diagnosis; diagnosis design /evaluation; diagnosis procedure safety; dosage forms; expectorant /mucolytic; human subject; immunosuppression; pediatric AIDS; respiratory disorder diagnosis; sodium chloride; sputum; ultrasonography

Immunocompromised pediatric patients with HIV infection and other immunosuppressive disorders are susceptible to Pneumocystis carinii pneumonia. Bronchoscopy with bronchoalveolar lavage (BAL) may be technically more difficult in pediatric patients. Therefore, an alternative, yet safe and reliable, diagnostic method had to be determined. We have continued our prospective assessment of the utility of sputum induction to diagnose P. carinii pneumonia in children. An ultrasonic nebulization technique using hypertonic sodium chloride with expectoration, oropharyngeal, or nasopharyngeal suctioning has been employed. The ongoing project's major goal was to further improve the sampling technique in order to increase sensitivity. The medical records of 121 patients aged 4 months to 18 years who underwent sputum induction from January 1990 to December 1994 were reviewed. Of 196 sputum inductions in 121 patients; 28 were positive for P. carinii, 167 were negative, and one collection was insufficient. Of the 167 negative sputum inductions, 57 were followed by BAL, of which 10 were P. carinii positive. The remaining 157 patient encounters that were negative for P. carinii by sputum induction or BAL were followed for 1 month: 150 remained negative for P. carinii, 2 became P. carinii positive, and 5 had no information available. The overall sensitivity of sputum induction was 70 percent; the negative predictive value was 93 percent. We concluded that sputum induction is effective and fairly sensitive in this group of pediatric patients and should be the initial diagnostic procedure in immunosuppressed pediatric patients suspected of having P. carinii pneumonia. This project has extended the clinical applicability of a diagnostic procedure, developed largely by the National Institutes of Health, which now offers many centers the option of a test that is less expensive, less invasive, and less associated with complications than bronchoscopy.

HIV感染和其他免疫功能低下的儿科患者 免疫抑制性疾病易感染卡氏肺孢子虫 肺炎支气管镜检查和支气管肺泡灌洗（BAL）可能 在儿科患者中技术上更困难。所以一间 替代的，但安全可靠的诊断方法必须是 测定 我们继续对以下方面的效用进行前瞻性评估： 痰诱导诊断小儿卡氏肺孢子虫肺炎一个 使用高渗氯化钠的超声雾化技术 有痰，口咽，或鼻咽吸痰， 被雇用了。正在进行的项目的主要目标是进一步 改进取样技术，以提高灵敏度。的 121例4个月至18岁的患者的病历， 从1990年1月至1994年12月进行了痰诱导， 综述在121例患者的196次痰诱导中，28例阳性 对于卡氏肺孢子虫，167例为阴性，1例为 不足在167例阴性痰诱导中， 其次为BAL，其中10例卡氏肺孢子虫阳性。其余 157例患者痰液卡氏肺孢子虫阴性 诱导或BAL随访1个月：150例保持阴性 卡氏肺孢子虫阳性2例，阴性5例 information available.痰诱导的总体敏感性 是70%;阴性预测值是93%。我们 结论痰诱导是有效的，相当敏感， 这组儿科患者，应该是最初的 免疫抑制儿科患者的诊断程序 疑似卡氏肺孢子虫肺炎该项目已扩展到 诊断程序的临床适用性，开发 主要是由美国国立卫生研究院，现在提供许多 集中了一种更便宜，更少侵入性的测试， 并且与支气管镜检查相比并发症较少。