Chest
Volume 95, Issue 6, June 1989, Pages 1198-1201
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Clinical Investigations
Bronchoalveolar Lavage Eosinophilia Associated with Pneumocystis carinii Pneumonitis in AIDS Patients: Comparative Study with Non-AIDS Patients

https://doi.org/10.1378/chest.95.6.1198Get rights and content

Lower pulmonary tract cell populations collected by bronchoalveolar lavages (BAL) were evaluated in three groups of immunocompromised patients: HIV infected patients with Pneumocystis carinii (PC) pneumonitis (n = 22), or pneumonitis not related to PC (n = 29), and non-HIV-infected, immunocompromised patients with a PC pneumonitis (n = 18). In AIDS patients with PC pneumonitis, the cell populations were 59.3 ±4.5 percent alveolar macrophages (AM), 19.6 ±2.5 percent lymphocytes, 14.6 ±4.4 percent polymorphonuclear cells (PMN), and 10.3 ±3.6 percent eosinophils. In HIV-infected patients without PC pneumonitis, they were 76.5 ± 3.3 percent AM, 13 ± 2.1 percent lymphocytes, 9.2 ± 0.3 percent PMN, and 0.6 ± 0.2 percent eosinophils, and in non-HIV-infected, immunocompromised patients with PC pneumonitis, they were 43.9 ± 5.7 percent AM, 30.2 ± 4.3 percent lymphocytes, 20.4 ± 4.7 percent PMN, and 0.9 ± 0.4 percent eosinophils. The most striking finding was a marked BAL eosinophilia in AIDS patients with PC pneumonitis. The significance of this particular cellular pulmonary response to PC is not clear, and its consequences on the lung structures and/or PC require evaluation.

Section snippets

Patients

All patients entering the present study were required to undergo a diagnostic fiberoptic bronchoscopy and BAL to investigate episodes of pneumonitis. The BAL cell analysis was performed on samples of three groups of patients: HIV-infected patients with (26 BAL in 22 patients HIV+, PC +) and without (38 BAL in 29 patients HIV+, PC–) PC pneumonitis and non-HIV-infected patients with PC pneumonitis (18 BAL in 18 patients HIV –, PC +). Immunocompromised non-HIV-infected patients were investigated

RESULTS

The results of the differential cell counts in the BAL collected in patients from the three groups are expressed in Figures 1 and 2. The group HIV +, PC + was compared successively to the groups HIV +, PC – and HIV–, PC+.

The percentage of alveolar macrophages observed in the two groups with PC (HIV +, PC + and HIV –, PC +) was lower than in the HIV+, PC– group (p<0.05). The percentage of lymphocytes was high in the three groups. It was markedly increased in the HIV–, PC + group (30.2 ± 4.3

DISCUSSION

The importance of BAL in the diagnosis of opportunistic infection, particularly for PC pneumonitis, had been demonstrated.1, 2, 3, 4, 5, 6 Cellular populations collected by BAL are considered to be characteristic of the cellular inflammatory response associated with pneumonitis.7, 8 Previous studies have already reported an increase in BAL lymphocytes associated with PC pneumonitis.7, 8 The present study emphasizes the demonstration of an increase in eosinophils in the BAL of HIV-infected

ACKNOWLEDGMENTS

The authors thank M.J. Pocholle and L. Prudhomme for their excellent technical assistance, Drs. K. Atassi and F. Vera for performing fiberoptic bronchoscopy, and S. Daude for typing the manuscript.

REFERENCES (21)

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Supported in part by crédits universitaires Université, Paris, France.

Manuscript received July 5; revision accepted October 11

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