       Document 0337
 DOCN  M9490337
 TI    Laboratory diagnosis and occurrence of Pneumocystis carinii.
 DT    9411
 AU    Elvin K; Microbiology and Tumorbiology Center, Karolinska Institute,;
       Stockholm, Sweden.
 SO    Scand J Infect Dis Suppl. 1994;94:1-34. Unique Identifier : AIDSLINE
       MED/94337185
 AB    Pneumocystis carinii is an opportunistic pathogen causing life
       threatening pneumonia (PCP) in immunosuppressed patients and
       particularly among AIDS patients. Whether the infection results from
       reactivation or reinfection is debated. Since methods for in vitro
       cultivation still are not successful, the diagnosis is dependent on
       direct demonstration of the organism in respiratory specimen. In this
       thesis laboratory diagnostic methods in terms of staining, sampling,
       antibody detection and DNA amplification are evaluated. Furthermore, the
       occurrence of the organism in the Western world versus Africa, and in
       symptomatic and asymptomatic HIV infected patients is studied and
       discussed. The use of a monoclonal antibody (MAb), 3F6 in an indirect
       immunofluorescence assay (IFL) was compared to the two most commonly
       used chemical stains, silver methenamine and toluidine blue. The IFL
       method detected both cyst and trophozoite stages of P. carinii and was
       more sensitive than the chemical stains when applied to sputum samples.
       Among commercialised MAbs for P. carinii detection by IFL, only the
       indirect tests were readily applicable to ethanol treated HIV
       inactivated samples. In contrast to the MAb 3F6, (Dakopatts), the MAb
       from Northumbria stained only a selection of the cysts and no
       trophozoites. The relative sensitivity of IFL in detecting the organism
       in sputum samples compared to bronchoalveolar lavage (BAL) samples was
       estimated to be at least 70%. The polymerase chain reaction (PCR), which
       can amplify specific DNA fragments, was used for the demonstration of P.
       carinii in sputum and BAL specimens. The PCR was shown to be specific
       and more sensitive than IFL. However, P. carinii DNA was found in a few
       patients without clinical evidence of present, past or future PCP. Thus
       the possibility of PCR to detect colonization must be considered.
       Detection of antibodies to P. carinii by indirect IFL was studied in HIV
       versus non-HIV patients. A titer rise was seen in 45% of non-HIV
       patients versus only 3% in HIV patients during a PCP episode. No humoral
       response was seen in AIDS patients, whereas the serology did support the
       clinical PCP diagnosis in a proportion of the otherwise immunosuppressed
       patients. Serology may however not be of help in the acute setting. In
       the beginning of 1988 PCP had not yet been reported from Central Africa
       where the AIDS epidemic by then was growing fast. The occurrence of P.
       carinii in Central Africa was evaluated by a comparative study on
       induced sputum samples from HIV infected patients with pulmonary
       infection in Stockholm, Sweden and Lusaka, Zambia.(ABSTRACT TRUNCATED AT
       400 WORDS)
 DE    Acquired Immunodeficiency Syndrome/BLOOD/*MICROBIOLOGY  Adolescence
       Adult  Antibodies, Fungal/BLOOD  Bronchoalveolar Lavage
       Fluid/MICROBIOLOGY  Comparative Study  Female  Fluorescent Antibody
       Technique  Human  HIV Infections/BLOOD/*MICROBIOLOGY  Male  Methenamine
       Pneumocystis carinii/*ISOLATION & PURIF  Pneumonia, Pneumocystis
       carinii/BLOOD/EPIDEMIOLOGY/*MICROBIOLOGY  Polymerase Chain Reaction
       Prospective Studies  Sensitivity and Specificity  Sputum/MICROBIOLOGY
       Support, Non-U.S. Gov't  Sweden/EPIDEMIOLOGY  Time Factors  Tolonium
       Chloride  Zambia/EPIDEMIOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

