PNEUMOCYSTIS CARINII BY INDUCED SPUTUM IN IMMUNOSUPPRESSED PEDIATRIC PATIENTS

免疫功能低下的儿童HIV感染患者和其他 免疫抑制障碍易受卡氏肺孢子虫感染 肺炎。支气管镜联合支气管肺泡灌洗(BAL)可能是 从技术上讲，儿科患者更难接受。因此，一个 另一种但安全可靠的诊断方法必须是 下定决心。 我们继续对这项技术的效用进行前瞻性评估 痰诱导诊断儿童卡氏肺孢子虫肺炎。一个 高渗氯化钠超声雾化技术 有咳痰、口咽或鼻咽部吸痰的患者 已经被雇佣了。正在进行的项目的主要目标是进一步 改进采样技术，提高灵敏度。这个 121例4个月~18岁儿童住院患者病历分析 1990年1月至1994年12月接受诱导痰治疗的患者 已审阅。在121名患者的196次诱导痰中，28次为阳性 对于卡氏肺孢子虫，167例为阴性，其中一例为阴性 还不够。在167例阴性诱导痰中，57例为 其次是BAL，其中10例卡氏肺孢子虫阳性。剩下的 157次痰检卡氏肺孢子虫阴性的患者 诱导或BAL随访1个月：150例仍为阴性 卡氏肺孢子虫有2例呈阳性，5例无。 可用的信息。诱导痰的总体敏感性 是70%；阴性预测值是93%。我们 结论：诱导痰是有效且相当敏感的 这一组儿科患者应该是初诊 儿科免疫抑制患者的诊断程序 疑似感染卡氏肺炎者。这个项目已经延期了 开发的一种诊断程序的临床适用性 主要由国家卫生研究院提供，该机构现在提供许多 集中选择一种成本更低、侵入性更小的测试， 与支气管镜检查相比，并发症的发生率更低。

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.