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技术上可以 在儿科患者中更难执行。正因为如此，一个 必须有安全可靠的替代诊断方法 下定决心。我们继续对这项技术的效用进行前瞻性评估 诱导痰对儿童卡氏肺炎的诊断价值。一个 高渗氯化钠超声雾化技术 无论是咳痰，口咽还是鼻咽吸痰 受雇的。初步数据表明，卡氏肺吸虫可以可靠地 通过这项技术在一岁以下的儿童中诊断出。这个 该技术是一种非常安全和有效的替代支气管镜检查的方法 孩子们。这项研究的初步数据已经发表在 儿科。该项目正在进行中，一个主要目标是进一步改进 为了提高灵敏度而采用的采样技术。诊断数据 在最初的手稿之后正在收集，并将 已审阅。数据将从技术改进的角度进行分析， 诊断效率、敏感性、特异性和患者安全性。目标 本项目的意义和意义在于优化诊断 该技术对卡氏肺孢子虫的敏感性及改进 尽可能地限制患者的发病率。特别值得注意的是 卡氏肺孢子虫化学预防(口服和气雾剂)对人类免疫功能的影响 这项技术的敏感性。另外，这个特别关注的是 该项目的目的是确定这一程序可能的最低年龄， 基于所采用的技术改造。 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 比支气管镜检查更容易引起并发症。

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.