1. The laboratory evaluation of opportunistic pulmonary infections
- Author
-
Shelhamer, James H., Gill, Vee J., Quinn, Thomas C., Crawford, Stephen W., Kovacs, Joseph A., Masur, Henry, and Ognibene, Frederick P.
- Subjects
Opportunistic infections -- Diagnosis ,Lungs ,Diagnosis, Laboratory -- Methods ,Pneumonia -- Diagnosis ,Health - Abstract
The patient population at risk for opportunistic pulmonary infections has increased during the last decade. The spectrum of organisms causing opportunistic infections has also grown. With an ever broader list of potential therapeutic options and a growing differential diagnosis, a specific diagnosis of the cause of pulmonary disease becomes more important. Recent microbiologic advances have helped to facilitate the laboratory diagnosis of some of these agents. Immunoassays are available for the detection of antigen in nasopharyngeal secretions respiratory syncytial virus, influenza), in serum (Cryptococcus species), and in urine (Legionella or Histoplasma species). Rapid-culture techniques are available for the culture and detection of various viruses, including cytomegalovirus. Molecular probes can now assist in the rapid identification of Mycobacterium tuberculosis and some fungi. In the near future, polymerase chain reaction-based techniques may assist in the detection of Pneumocystis carinii and Legionella, Chlamydia, Mycoplasma, and Mycobacteria species. An expeditious evaluation of pulmonary disease requires an understanding of the differential diagnosis of likely causes of pulmonary disease in specific immunosuppressed patient populations, an understanding of the most appropriate specimens to process for these diagnoses, and an understanding of the limitations (sensitivity and specificity) of these diagnostic tests. An understanding of the most appropriate specimens and tests in a given institution should allow for early, relatively specific treatment of many potentially life-threatening infections., The availability of polymerase chain reaction tests may be helpful in identifying the specific cause of disease but may be costly and as yet impractical for routine use. Polymerase chain reaction tests are tests that rapidly multiply the infectious organism for quicker and more accurate identification. Researchers outlined the current procedures and described the preliminary use of polymerase chain reaction tests for identifying organisms that cause infections in the lung and respiratory tract. Doctors currently use antibody tests on fluid samples from the lung or bronchial tubes to identify Legionella infections. An antibody test called shell vial culture can simply and quickly identify viral infections. Blood tests can identify mycoplasma and chlamydia pneumonia, while staining tests can quickly identify Pneumocystis carinii infections. A fluorescent staining test has proven effective in identifying fungal infections. Individual clinics may wish to invest in using polymerase chain reaction tests that identify organisms prevalent in their clinics.
- Published
- 1996