Analysis of Induced Sputum in the Diagnosis of Pneumocystis carinii Pneumonia

Kirsch, Carl M.; Azzi, Raymond L.; Yenokida, G G; Jensen, William A.

doi:10.1097/00000441-199006000-00006

Cited by 22 publications

(12 citation statements)

References 18 publications

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“…Eleven studies were excluded because bronchoscopy with BAL was performed only in subsets of patients (usually in patients with negative induced sputum results) [6,16,46,51,[55][56][57][58][59][60][61]. Fifteen studies (seven case-control [48,[62][63][64][65][66][67] and eight retrospective and/or nonconsecutive [51,[68][69][70][71][72][73][74]) were excluded on the basis of design and/or because they did not permit direct comparison of accuracy for every individual in the sample.…”

Section: Appendixmentioning

confidence: 99%

Meta-analysis of diagnostic procedures forPneumocystis cariniipneumonia in HIV-1-infected patients

Cruciani¹,

Marcati²,

Malena³

et al. 2002

Eur Respir J

102

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Sputum induction is a simple and noninvasive procedure for Pneumocystis carinii pneumonia (PCP) diagnosis in human immunodeficiency virus-1-positive patients, although less sensitive than bronchoalveolar lavage (BAL). In order to obtain an overview of the diagnostic accuracy of sputum induction, a systematic review and meta-analysis of studies reporting the comparative sensitivity and specificity of BAL (the "gold standard") and sputum induction was performed.The odds ratio and related 95% confidence interval were calculated using summary receiving operating characteristic curves as well as fixed-effect and random-effect models. Based on pooled data, the negative and positive predictive values were calculated for a range of PCP prevalence using a Bayesian approach.Seven prospective studies assessed the comparative accuracy of BAL and sputum induction. On the whole, sputum induction demonstrated 55.5% sensitivity and 98.6% specificity. The sensitivity of sputum induction was significantly higher with immunofluorescence than with cytochemical staining (67.1 versus 43.1%). In settings of 25-60% prevalence of PCP, the positive and negative predictive values ranged 86-96.7 and 66.2-89.8, respectively, with immunofluorescence, and 79-94.4 and 53-83.5% with cytochemical staining.In conclusion, in a setting of low prevalence of Pneumocystis carinii pneumonia, sputum induction, particularly with immunostaining, appears to be adequate for clinical decision-making. Eur Respir J 2002; 20: 982-989.

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Section: Appendixmentioning

confidence: 99%

Meta-analysis of diagnostic procedures forPneumocystis cariniipneumonia in HIV-1-infected patients

Cruciani¹,

Marcati²,

Malena³

et al. 2002

Eur Respir J

102

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“…With mucolysed-induced sputum specimens, the sensitivity for detection of P carinii has ranged from 66% to 78% for conventional stains, 13 " 1719 and 86% to 97% for commercially available fluorescent antibody stains. Before the examination of induced sputum for P carinii, the standard method has been to mucolyze the specimen.…”

Section: Discussionmentioning

confidence: 99%

A Rapid and Inexpensive Method for Processing Induced Sputum for Detection ofPneumocystis carinii

et al. 1996

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The authors describe a method to process induced sputum specimens for detection of Pneumocystis carinii which is simple, rapid and inexpensive. Induced sputum and bronchoalveolar lavage (BAL) were obtained within a 24-four hour period from 41 patients who were HIVpositive and had pulmonary symptoms suspicious for P carinii pneumonia. Induced sputum or BAL fluid was placed into Saccomanno's fixative, blended, and centrifuged. The sediment was stained for P carinii cysts by a modified method with Fungi-Fluor Solution A (Polysciences, Warington, PA) and the Genetic Systems Pneumocystis carinii Immunofluorescence Antibody (Genetic Systems, Seattle, WA). The Genetic Systems stain on the BAL specimen was positive in 35 patients and was the standard for comparison. With a single induced sputum, the Genetic Systems stain detected 31 (89%) positive patients, whereas the Fungi-Fluor stain detected 21 (60%). The sensitivity for detecting P carinii cysts in induced sputum was significantly greater (P <.O5) for the Genetic Systems stain. (Key words: Pneumocystis carinii; Induced sputum; Saccomanno's fixative) Am J Clin Pathol 1996; 105: 52-57.In the United States, an estimated 40,000 to 60,000 patients with HIV presented with their first episode of Pneumocystis carinii pneumonia (PCP) in 1993.' Pneumocystis carinii pneumonia is a direct cause of death in up to 24% of patients with AIDS. Without prophylaxis, 60% to 80% of HIV-infected patients will have at least one episode of PCP during their illness.2 Because of the widespread use of primary PCP prophylaxis, the incidence of PCP has been declining, even in patients with CD 4 counts below 200/mm 3 . 3 However, PCP still remains a common opportunistic infection in patients with AIDS.Bronchoalveolar lavage (BAL) performed with the fiberoptic bronchoscope has an excellent yield in the diagnosis of PCP in patients with AIDS.4 "" As the number of patients with AIDS continues to increase, efforts are being made to find alternative methods to BAL for the detection of PCP. Although less sensitive, induced sputum is considerably less invasive, time consuming, and expensive than BAL for detection of P carinii. thermore, it is safer and has less morbidity than fiberoptic bronchoscopy (FOB).Calcofluor white and commercial immunofluorescence antibodies have been used for detection of P carinii. However, there is limited data available on the capability of calcofluor white to detect P carinii in induced sputa, with only seven positive specimens being evaluated. 2021 For immunofluorescent antibody kits that are commercially available, the sensitivity for detection of P carinii in induced sputa has ranged from 86% to 97%. "23 However, in none of the previously mentioned studies have the recovery of P carinii in both induced sputum and BAL specimens from the same patient been compared.In this study, we have collected both a single induced sputum and a BAL specimen from each patient within a 24-hour period. We describe a method to process induced sputum specimens that is simple, rapid, and i...

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“…Estimates of sensitivity and specificity of diagnostic procedures used in the model are shown in Table 1 and are based on reports from the literature (chest x-ray alone, oral wash with DQ, PCR, nested PCR, and rtPCR; expectorated sputum with GMS, TBO, CW; induced sputum with DQ, GMS, TBO, IS, IFA, PCR, nPCR; BAL with DQ, GMS, TBO, CW, IFA, PCR, nPCR, rtPCR) [29], [30], [31], [36], [38], [39], [40], [44], [47], [48], [49], [50], [52], [54], [55], [57], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], or estimated by the authors (oral wash with IFA, GMS, CW, TBO; expectorated sputum with DQ, IFA, PCR, nPCR, or rtPCR; induced sputum with rtPCR). Although all of the above-referenced literature was consulted, for diagnostic procedures involving any form of PCR, only studies which targeted the mitochondrial large subunit ribosomal RNA were used for estimations of sensitivity and specificity [28], [29], [36], [48], [51], [54], [55], [57], [63], [64], [67], …”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness Analysis of Diagnostic Options for Pneumocystis Pneumonia (PCP)

et al. 2011

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BackgroundDiagnosis of Pneumocystis jirovecii pneumonia (PCP) is challenging, particularly in developing countries. Highly sensitive diagnostic methods are costly, while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented.Methods and FindingsWe compared cost-effectiveness, as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated, of 33 PCP diagnostic options, involving combinations of specimen collection methods [oral washes, induced and expectorated sputum, and bronchoalveolar lavage (BAL)] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR)], or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory, HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence, diagnostic procedures involving expectorated sputum with any PCR method, or induced sputum with nested or real-time PCR, were all highly cost-effective, successfully treating 77–90% of patients at $26–51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit, successfully treating 68–90% of patients at costs of $189–232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained, successfully treating 68% of patients). Diagnosis using chest x-rays alone resulted in successful treatment of 77% of patients, though cost-effectiveness was reduced ($109 per life-year gained) compared with several molecular diagnostic options.ConclusionsFor diagnosis of PCP, use of PCR technologies, when combined with less-invasive patient specimens such as expectorated or induced sputum, represent more cost-effective options than any diagnostic procedure using BAL, or chest x-ray alone.

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Analysis of Induced Sputum in the Diagnosis of Pneumocystis carinii Pneumonia

Cited by 22 publications

References 18 publications

Meta-analysis of diagnostic procedures forPneumocystis cariniipneumonia in HIV-1-infected patients

Meta-analysis of diagnostic procedures forPneumocystis cariniipneumonia in HIV-1-infected patients

A Rapid and Inexpensive Method for Processing Induced Sputum for Detection ofPneumocystis carinii

Cost-Effectiveness Analysis of Diagnostic Options for Pneumocystis Pneumonia (PCP)

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