PNEUMOCYSTIS CARINII BY INDUCED SPUTUM IN IMMUNOSUPPRESSED PEDIATRIC PATIENTS

工作总结：免疫功能低下的儿童HIV感染患者 和其他免疫抑制疾病易受肺孢子虫感染 卡里尼氏肺炎。支气管镜联合支气管肺泡灌洗(BAL)可 在儿科患者中从技术上讲更加困难。正因为如此， 必须有一种安全可靠的替代诊断方法 下定决心。我们继续对公用事业进行前瞻性评估 诱导痰对卡氏肺炎性肺炎的诊断价值 孩子们。一种使用氯化钠的超声雾化技术 有咳痰、口咽吸痰或鼻咽症状 已经采用了吸引法。该项目正在进行中，主要目标是 是进一步改进抽样技术，以增加 敏感度。121例4个月至18岁儿童的病历 1990年1月至1994年12月接受诱导痰的人数 已有文献进行了综述。121例患者共进行了196次引痰：28例 卡氏肺孢子虫检测呈阳性，167例为阴性，其中一例为 还不够。在167例阴性诱导痰中，有57例获得了随访 BAL，其中10例卡氏肺孢子虫阳性。157名患者遭遇 经痰诱导或BAL检测卡氏肺孢子虫呈阴性的有 随访一个月：150人卡氏肺孢子虫仍为阴性，2人变为 卡氏肺孢子虫阳性，5例无资料可查。整体而言 诱导痰的敏感性为70%，阴性预测值为 价值93%。我们得出的结论是，诱导痰是一种有效的 在这组儿童中相当敏感的诊断技术 患者，并应作为初始诊断程序 怀疑患有卡氏肺孢子虫的免疫抑制的儿科患者 肺炎。 该项目扩展了一种诊断方法的临床适用性 程序，主要由NIH开发，现在为许多中心提供 选择成本更低、侵入性更小和更少的测试 与支气管镜检查相关的并发症。

Summary of Work: 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. Because of this, an alternative diagnostic method that 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 sodium chloride with either expectoration, oropharyngeal suctioning, or nasopharangeal suctioning has been employed. The project was ongoing, and a major goal was to further improve the sampling technique in order to increase sensitivity. The medical records of 121 patients aged four months to 18 years who underwent sputum induction from January 1990 to December 1994 were reviewed. There were 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 157 patient encounters that were negative for P. carinii by sputum induction or BAL were followed for one 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%, and the negative predictive value was 93%. We concluded that sputum induction is an effective and fairly sensitive diagnostic technique 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 NIH, which now offers many centers the option of a test that is less expensive, less invasive, and less associated with complications that bronchoscopy.