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Pathological characteristics for the diagnosis of Pneumocystis carinii pneumonia
Author(s) -
Genner JØRGEN,
Settnes OSVALD PETER
Publication year - 1990
Publication title -
apmis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 88
eISSN - 1600-0463
pISSN - 0903-4641
DOI - 10.1111/j.1699-0463.1990.tb05040.x
Subject(s) - pathology , medicine , lung , pneumonia , autopsy , diffuse alveolar damage , edema , fibrosis , acute respiratory distress
The clinical records of 63 patients who during the period 1980 ‐ 1983 showed pneumocysts in lung specimen imprints obtained at autopsy have been reviewed in order to establish possible characteristics for the diagnosis of Pc pneumonia. Autopsies were performed at 2 Copenhagen hospitals, Rigshospitalet and the Finsen Institute. The 63 Pc‐positive cases included 9 with blood diseases, 27 with solid tumors, 5 with immunological disorders and 22 with other diseases. The characteristic extensive changes in the lungs in Pc pneumonia included increased firmness, dark red/brown or black/grey colour of sectioned areas, stasis and edema sometimes excessive, and foci of white/grey or red/brown areas giving the lung a marbled or speckled appearance. The content of air was always decreased. The microscopic changes reported included intra‐alveolar eosinophilic material, an intra‐alveolar transudate containing macrophages and very few neutrophilic granulocytes, dilated capillary tubes, stasis and edema, thickened alveolar septae and peri‐alveolar or diffuse fibrosis. The chest X‐rays showed no specific features, and the infection had been subclinical in all cases; the only evidence of Pc infection was the demonstration of pneumocysts in imprints of lung specimens stained with toluidine blue in combination with observations during pathology. The diagnosis depends to a great extent upon a keen alertness in addition to the information given in the clinical record.