engleski

Screening difficulties in detection of Pneumocystis (carinii) jiroveci

Introduction: Pneumocystis (carinii) jiroveci (PC) is a frequent cause of pneumonia in immunocompromised patients. Aim of the study: To analyse difficulties of PC detection in routinely obtained bronchoscopic samples. Material and methods: In the study were included 284 patients with clinical suspected PC pneumonia and bronchoscopic examination. Each sample of non - filtered bronchoalveolar lavage fluid (BAL) and bronchoscopic aspirate was centrifuged and stained with MGG, Kwik Diff and Rapid Papa. Slides were analysed by light microscope under magnification 400 and 1000 x. Trophozoites and cyst stage aggregations of PC were searched. Results: During five year observation period 284 samples were analysed. The results numbered 241 (84, 86%) BAL and 43 (15, 14%) bronchoscopic aspirates. PC forms were revealed in cytology slides of 11 (3, 87%) BAL samples. MGG stained trophozoites were presented as red dot like inclusions surrounded by pale blue cytoplasm. Kwik Diff more clearly represented trophozoites over standard MGG method. Rapid Papa represented clusters of PC cysts embedded in the foamy exudates providing honeycomb appearance. MGG, Kwik Diff and Rapid Papa didn’t stain cyst walls. Conclusion: BAL is a sample of choice for PC detection providing content of lower respiratory tract. Non adequate BAL containing erythrocytes, detritus and bacteria may cause screening difficulties. Background staining may also interfere with clarity and complicate screening. Clusters of stained mucus may look like PC clusters. Tumour cells, various fungal and viral infection cell changes may be found with PC and mislead interpretation.

Screening ; Pneumocystis (carinii) jiroveci ; cytology

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