The diagnostic role of fiberoptic bronchoscopy in AIDS patients with suspected Pneumocystis carinii pneumonia.

Fiberoptic bronchoscopy was carried out in 17 consecutive AIDS patients with suspected opportunistic infections. A total number of 23 bronchoscopies were performed and a comparison was made about the effectiveness of the available diagnostic techniques, which included bronchoalveolar lavage, transbronchial lung biopsy and bronchial brushings. The most common cause of pulmonary parenchymal disease was Pneumocystis carinii (7 patients). In 6 of these HIV-positive patients the detection of infection was decisive in making a diagnosis of AIDS. The most effective procedure for diagnosing P. carinii pneumonia was transbronchial lung biopsy (5 patients), while bronchoalveolar lavage and bronchial brushings showed P. carinii and 5 and 4 patients respectively. Complications were minor and occurred only in those patients subjected to transbronchial biopsy. Our findings showed that transbronchial biopsy has the highest yield in the diagnosis of P. carinii infection. When all diagnostic components of the bronchoscopic procedures are carried out, very few cases with these infections should be missed.