Alveolar damage in AIDS-related Pneumocystis carinii pneumonia.

OBJECTIVE Pneumocystis carinii pneumonia is the most common and serious of the pulmonary complications of AIDS. Despite this, many basic aspects in the pathogenesis of HIV-associated P carinii pneumonia are unknown. We therefore undertook a light and electron microscopic study of transbronchial biopsy specimens to compare pathologic features of P carinii pneumonia and other HIV-related lung diseases. DESIGN AND PATIENTS Thirty-seven consecutive HIV-infected patients undergoing a diagnostic bronchoscopy. RESULTS P carinii pneumonia was characterized by an increase in inflammation, edema, exudate, fibrosts, type II pneumocyte proliferation, and cellular infiltration of the alveolar wall when compared with other lung diseases (all p < 0.05). Electron microscopy showed apposition of the trophozoite to the type I pneumocyte. Erosion of type I pneumocytes was observed in 13 of 15 patients with P carinii pneumonia, whereas none without P carinii pneumonia had this finding (p < 0.05). Erosion of the type II pneumocyte was not observed. CONCLUSION Inflammation, interstitial fibrosis, and alveolar epithelial erosion are characteristic features of P carinii pneumonia. The changes may form the pathologic basis for the respiratory failure seen in patients with P carinii pneumonia. Electron microscopy did not show any diagnostie advantage over conventional light microscopy using routine stains.

[1]  S. T. Pottratz.  Adjunctive corticosteroid therapy for Pneumocystis carinii pneumonia. , 1998, Chest.

[2]  S. J. Levine.  Pneumocystis carinii. , 1996, Clinics in chest medicine.

[3]  A. Phillips,et al.  Factors associated with the development of Pneumocystis carinii pneumonia in 5,025 European patients with AIDS. AIDS in Europe Study Group. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  J. Shelhamer,et al.  Interleukin-8 and eicosanoid production in the lung during moderate to severe Pneumocystis carinii pneumonia in AIDS: a role of interleukin-8 in the pathogenesis of P. carinii pneumonia. , 1995, Respiratory medicine.

[5]  J. Lundgren,et al.  Prognostic value of interleukin-8 in AIDS-associated Pneumocystis carinii pneumonia. , 1995, American journal of respiratory and critical care medicine.

[6]  J. Lundgren,et al.  Differential effect on serum neopterin and serum beta 2-microglobulin is induced by treatment in Pneumocystis carinii pneumonia. , 1994, The Journal of infectious diseases.

[7]  J. Lundgren,et al.  Serum type III procollagen peptide in patients with Pneumocystis carinii infection. The Copenhagen-Amsterdam PCP-Prednisolone Study Group. , 1993, The American review of respiratory disease.

[8]  P. Walzer.  Pneumocystis carinii: recent advances in basic biology and their clinical application. , 1993, AIDS.

[9]  J. Lundgren,et al.  Amount of Pneumocystis carinii and degree of acute lung inflammation in HIV-associated P carinii pneumonia. , 1993, Chest.

[10]  H. Masur.  Prevention and treatment of pneumocystis pneumonia. , 1992, The New England journal of medicine.

[11]  J. Lundgren,et al.  Adjunctive corticosteroid therapy for Pneumocystis carinii pneumonia in AIDS: a randomized European multicenter open label study. , 1992, Journal of acquired immune deficiency syndromes.

[12]  P. Millard,et al.  A sequential ultrastructural study of rat lungs infected with Pneumocystis carinii to investigate the appearances of the organism, its relationships and its effects on pneumocytes. , 1990, International journal of experimental pathology.

[13]  L. La Voie,et al.  Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A double-blind, placebo-controlled trial. , 1990, The New England journal of medicine.

[14]  D. Richman,et al.  A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. California Collaborative Treatment Group. , 1990, The New England journal of medicine.

[15]  J. Montaner,et al.  Corticosteroids prevent early deterioration in patients with moderately severe Pneumocystis carinii pneumonia and the acquired immunodeficiency syndrome (AIDS) , 1990, Annals of internal medicine.

[16]  F. Ognibene,et al.  Atypical Pathologic Manifestations of Pneumocystis carinii Pneumonia in the Acquired Immune Deficiency Syndrome: Review of 123 Lung Biopsies from 76 Patients with Emphasis on Cysts, Vascular Invasion, Vasculitis, and Granulomas , 1990, The American journal of surgical pathology.

[17]  J. Goedert,et al.  The risk of Pneumocystis carinii pneumonia. , 1990, The New England journal of medicine.

[18]  J. Phair,et al.  The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1. Multicenter AIDS Cohort Study Group. , 1990, The New England journal of medicine.

[19]  J. Murray,et al.  Pulmonary infectious complications of human immunodeficiency virus infection. Part I. , 1990, The American review of respiratory disease.

[20]  Marshall Gj,et al.  Ultrastructural morphology and staining characteristics of Pneumocystis carinii in situ and from bronchoalveolar lavage. , 1988 .

[21]  J. Murray,et al.  Alveolar-capillary block in patients with AIDS and Pneumocystis carinii pneumonia. , 1988, The American review of respiratory disease.

[22]  F. Ognibene,et al.  Prognostic factors and life expectancy of patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia. , 1987, The American review of respiratory disease.

[23]  J. Murren,et al.  Early predictors of in-hospital mortality for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. , 1987, Archives of internal medicine.

[24]  Smith Js,et al.  Attachment of Pneumocystis carinii to rat pneumocytes. , 1986 .

[25]  E. G. Long,et al.  Attachment of Pneumocystis carinii to rat pneumocytes. , 1986, Laboratory investigation; a journal of technical methods and pathology.

[26]  A. M. Collier,et al.  Ultrastructural observations of Pneumocystis carinii attachment to rat lung. , 1985, The Journal of infectious diseases.

[27]  S. Fligiel,et al.  Pathologic features of the lung in the acquired immune deficiency syndrome (AIDS): an autopsy study of seventeen homosexual males. , 1984, American journal of clinical pathology.

[28]  K. Yoneda,et al.  Interaction of Pneumocystis carinii with host lungs: an ultrastructural study. , 1980, Infection and immunity.

[29]  A. Fishman,et al.  Alveolar response to experimental Pneumocystis carinii pneumonia in the rat. , 1980, The American journal of pathology.

[30]  F. Askin,et al.  Lung biopsy in Pneumocystis carinii pneumonia: a histopathologic study of typical and atypical features. , 1977, American journal of clinical pathology.

[31]  B. Burke,et al.  PNEUMOCYSTIS CARINII INFECTION , 1973, Medicine.

[32]  J. Vávra,et al.  Pneumocystis carinii delanoë, its ultrastructure and ultrastructural affinities. , 1970, The Journal of protozoology.