PNEUMOCYSTIS CARINII BY INDUCED SPUTUM IN IMMUNOSUPPRESSED PEDIATRIC PATIENTS

免疫功能低下的儿童HIV感染者 感染和其他免疫抑制障碍容易患上 卡氏肺孢子虫肺炎。支气管镜检查 支气管肺泡灌洗(BAL)在技术上可能更困难 儿科病人。正因为如此，另一种诊断方法 这是安全和可靠的，必须确定。我们继续 我们对诱导痰治疗效果的前瞻性评估 儿童卡氏肺炎性肺炎的诊断。一台超声波 使用氯化钠的雾化技术 咳痰，或口咽部或鼻咽部吸痰 已经被雇佣了。该项目正在进行中，一个主要目标是 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月行诱导痰 已有文献进行了综述。121例患者共进行了196次引痰： 28例卡氏肺孢子虫阳性，167例阴性，1例 收集的资金不足。在167例阴性诱导痰中， 57例为BAL，其中10例卡氏肺孢子虫阳性。这个 157次痰检卡氏肺孢子虫阴性的病人 诱导或BAL后1个月：仍有150人 卡氏肺孢子虫阴性，2人卡氏肺孢子虫阳性，5人无 可用的信息。诱导痰的总体敏感性 是70%，阴性预测值是93%。 我们得出的结论是，诱导痰是一种有效和公平的 敏感的诊断技术在这一组儿科患者和 应该是免疫抑制的初始诊断程序 怀疑患有卡氏肺炎的儿科病人。这 项目已经扩展了一种诊断方法的临床适用性 程序，主要由美国国立卫生研究院开发。它现在提供了许多中心 选择一种成本更低、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。该项目是 已完成，并已提交了手稿。

Immunocompromised pediatric patients with HIV infection and other immunosuppressive disorders are susceptible to Pneumocystis carinii (P. 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, or oropharyngeal or nasopharyngeal suctioning has been employed. The project was ongoing, and a major goal was to further improve the sampling technique 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. 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 which were negative for P. carnii 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, and the negative predictive value was 93 percent. 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. It now offers many centers the option of a test that is less expensive, less invasive, and less associated with complications than bronchoscopy. The project is completed, and a manuscript has been submitted.