PNEUMOCYSTIS CARINII BY INDUCED SPUTUM IN IMMUNOSUPPRESSED PEDIATRIC PATIENTS

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技术上 更难在儿科患者中进行。正因为如此， 安全可靠的替代诊断方法必须 测定我们继续对以下方面的效用进行前瞻性评估： 痰液诱导对小儿卡氏肺孢子虫肺炎的诊断价值一个 使用高渗氯化钠超声雾化技术， 无论是咳痰，口咽或鼻咽吸痰， 就业。初步数据表明，卡氏肺孢子虫可以可靠地 在一岁以下的儿童中通过这种技术进行诊断。的 技术是支气管镜检查一种非常安全和有效的替代方法， 孩子这项研究的初步数据发表在《生物医学杂志》上。 儿科.该项目正在进行中，一个主要目标是进一步改善 采样技术，以提高灵敏度。诊断数据 在最初的手稿之后，正在收集并将 综述这些数据将从技术改进的角度进行分析， 诊断率、灵敏度、特异性和患者安全性。的目标 本课题的主要目的和意义在于优化诊断方法， 该技术对卡氏肺孢子虫的敏感性， 尽可能地减少患者的发病率。特别值得注意的是 药物预防（口服和气雾剂）对卡氏肺孢子虫的影响 技术的敏感性。此外，一个特别的重点是， 该项目的目的是确定可以进行这一手术的最低年龄， 基于所采用的技术修改。 该项目扩展了诊断的临床适用性， 程序，主要由NIH开发，现在为许多中心提供 一种更便宜、侵入性更小、 与支气管镜检查的并发症有关。

Immunocompromised pediatric patients with HIV infection and other immunosuppressive disorders are susceptible to Pneumocystis carinii pneumonia. Bronchoscopy with bronchoalveolar lavage may be technically more difficult to perform in pediatric patients. Because of this, an alterative diagnostic method which was safe and reliable had to be determined. We have continued our prospective assessment of the utility of sputum induction for the diagnosis of P. carinii pneumonia in children. An ultrasonic nebulization technique using hypertonic sodium chloride with either expectoration, oropharyngeal or nasopharyngeal suctioning has been employed. Preliminary data indicate that P. carinii can be reliably diagnosed by this technique in children younger than one year. The technique is a very safe and effective alternative to bronchoscopy for children. Initial data from this study have appeared in the Journal of Pediatrics. The project is ongoing, and a major goal is to further improve the sampling technique in order to increase sensitivity. Diagnostic data subsequent to the initial manuscript are being collected and will be reviewed. The data will be analyzed in terms of technical improvements, diagnostic yield, sensitivity, specificity, and patient safety. The goals and significance of this project are to optimize the diagnostic sensitivity of this technique for P. carinii and to modify the technique as possible to limit patient morbidity. Of particular attention will be the impact of chemoprophylaxis (oral and aerosol) against P. carinii on the sensitivity of the technique. In addition, a special focus of this project is to identify the lowest age in which this procedure is possible, based on the technical modifications employed. This project has extended the clinical applicability of a diagnostic procedure, developed largely by NIH, which now offers many centers the option of a test that is less expensive, less invasive, and less associated with complications than bronchoscopy.