Am. J. Respir. Crit. Care Med., Vol 150, No. 5, 11 1994, 1456-1459.
Persistence of Pneumocystis carinii in patients with AIDS receiving chemoprophylaxis
LJ Epstein, RD Meyer, S Antonson, SM Strigle and Z Mohsenifar
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90049.
Pneumocystis carinii organisms have been shown to persist throughout
therapy in the majority of patients with Pneumocystis carinii pneumonia
(PCP). This study evaluated the relationship between persistence of
organisms and recurrence of disease, and the effect of chemoprophylaxis on
bronchoalveolar lavage specimens. Seven patients receiving PCP
chemoprophylaxis underwent serial bronchoalveolar lavage (BAL) examinations
at 1, 4, and 7 mo after recovery from a first episode of PCP. Specimens
were examined for persistent organisms with Gomori's methenamine silver
stain and immunofluorescent antibody staining. There were no persistent
organisms 1 mo after completion of antimicrobial treatment in six of the
seven patients. The one patient with persistent organisms demonstrated
clearance of organisms by 4 mo and had no recurrence of PCP. One patient
had a recurrence of PCP at 4 mo, after a negative 1-mo BAL. We conclude
that a positive BAL result by silver stain or immunofluorescent antibody
staining more than a month after ending treatment may indicate clinical
recurrence of PCP and not just persistence of nonpathologic cysts. These
findings suggest that recurrences of PCP are more likely due to new
infection than to relapse of prior disease.
