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Alveolar Damage in AIDS-Related Pneumocystis carinii Pneumonia

Thomas L. Benfield; Poul Prentø; Jette Junge; Jørgen Vestbo; Jens D. Lundgren
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From the Departments of Infectious Diseases and Pathology, EM Division, University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark


1997 by the American College of Chest Physicians


Chest. 1997;111(5):1193-1199. doi:10.1378/chest.111.5.1193
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Abstract

Objective: Pneumocystis carinii pneumonia is the most common and serious of the pulmonary complications of AIDS. Despite this, many basic aspects in the pathogenesis of HIV-associated P carinii pneumonia are unknown. We therefore undertook a light and electron microscopic study of transbronchial biopsy specimens to compare pathologic features of P carinii pneumonia and other HIV-related lung diseases.

Design and patients: Thirty-seven consecutive HIV-infected patients undergoing a diagnostic bronchoscopy.

Results: P carinii pneumonia was characterized by an increase in inflammation, edema, exudate, fibrosis, type II pneumocyte proliferation, and cellular infiltration of the alveolar wall when compared with other lung diseases (all p<0.05). Electron microscopy showed apposition of the trophozoite to the type I pneumocyte. Erosion of type I pneumocytes was observed in 13 of 15 patients with P carinii pneumonia, whereas none without P carinii pneumonia had this finding (p<0.05). Erosion of the type II pneumocyte was not observed.

Conclusion: Inflammation, interstitial fibrosis, and alveolar epithelial erosion are characteristic features of P carinii pneumonia. The changes may form the pathologic basis for the respiratory failure seen in patients with P carinii pneumonia. Electron microscopy did not show any diagnostic advantage over conventional light microscopy using routine stains.


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