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Clearance of Pneumocystis carinii Cysts in Acute P carinii Pneumonia : Assessment by Serial Sputum Induction

Walter J. O'Donnell; Walter Pieciak; Glenn M. Chertow; Jose Sanabria; Karen C. Lahive
Author and Funding Information

Affiliations: From the Pulmonary/Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,  From Microbiology Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,  From Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,  From Harvard Community Health Plan, Boston, MA.

Walter J. O'Donnell, MD, FCCP, Department of Medicine, AUH Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212; e-mail: wodonnel@aherf.edu


1998 by the American College of Chest Physicians


Chest. 1998;114(5):1264-1268. doi:10.1378/chest.114.5.1264
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Abstract

Study objectives: To determine the feasibility of repeat sputum induction in acute Pneumocystis carinii pneumonia (PCP) and to define the rate of clearance of P carinii cysts from the respiratory tract of HIV-seropositive patients with acute PCP.

Design: Prospective cohort evaluation.

Setting: University medical center.

Participants: Twenty-four HIV-seropositive subjects with acute PCP.

Measurements: Sputum induction for P carinii 2, 3, 4, and 6 weeks after initial diagnosis, and follow-up for 1 year.

Results: Eighty-eight percent of subjects had residual cysts at 2 weeks, 76% at 3 weeks, 29% at 4 weeks, and 24% at 6 weeks postdiagnosis. A prior AIDS-defining illness (p = 0.033) or prior PCP (p = 0.004) predicted relapse within 6 months, but persistent cysts at 3 weeks did not; 8 of 16 sputum-positive subjects and 1 of 5 sputum-negative subjects experienced a relapse within 6 months (p = 0.34). Secondary prophylaxis with trimethoprim-sulfamethoxazole was associated with a reduced risk of relapse.

Conclusions: Serial sputum induction coupled with direct fluorescent antibody staining is a feasible, noninvasive method of respiratory tract surveillance for the eradication of P carinii during and after acute PCP. Three-quarters of HIV-seropositive patients with acute PCP have persistent cysts in their lungs at the end of antimicrobial treatment, despite clinical recuperation, but only one quarter have residual cysts 6 weeks postdiagnosis. A prior AIDS-defining illness and prior PCP are positively associated, and subsequent trimethoprim-sulfamethoxazole prophylaxis is negatively associated, with relapse within 6 months, while persistent organisms at 3 weeks do not appear to be a significant predictor of relapse risk.


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