Document Detail

Utility of reflex Gomori methenamine silver staining for Pneumocystis jirovecii on bronchoalveolar lavage cytologic specimens: a review.
MedLine Citation:
PMID:  17041954     Owner:  NLM     Status:  MEDLINE    
Pneumocystis jiroveci (Pj; formerly Pneumocystis carinii) is an opportunistic pathogen causing life-threatening pneumonia (Pneumocystis pneumonia) in immunosuppressed individuals. Its diagnosis is dependent on identification in bronchoalveolar lavage (BAL) specimens. Gomori's methenamine silver nitrate (GMS) stain has been advocated to highlight the organisms in BAL specimens. This study was performed to determine the utility of reflex GMS staining on all BAL specimens for identifying Pj.All BAL specimens from years 2000 to 2004 were processed as cytospins and stained with Papanicolaou (Pap) and GMS stains. A total of 2,984 BAL specimens were identified. A total of 116 (3.9% of total BAL) BAL specimens were diagnostic of Pj. The diagnostic specimens were grouped as follows: 103 (88.8% of total positive cases) Pj identified with both Pap and GMS staining; 11 (9.5% of total positive cases) Pj identified only with Pap staining; and 2 (1.7% of total positive cases) Pj identified only with GMS staining. In conclusion, the prevalence of Pj in BAL specimens is 3.9%, which can be attributed to improved management of immunocompromised patients. Performing reflex GMS staining on all BAL specimens does not improve the diagnostic identification of Pj since the majority (98.3%) of diagnoses can be rendered on Pap stained slides. A cost analysis for GMS staining on 2,879 GMS-negative BAL specimens was estimated at $143,950. Thus, from diagnostic and cost benefit perspectives, GMS staining can be recommended only on cases where Pap stain is negative, and the clinical presentation is consistent with Pneumocystis pneumonia.
Aziza Nassar; Mauricio Zapata; James V Little; Momin T Siddiqui
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diagnostic cytopathology     Volume:  34     ISSN:  8755-1039     ISO Abbreviation:  Diagn. Cytopathol.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-19     Completed Date:  2007-01-04     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  8506895     Medline TA:  Diagn Cytopathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  719-23     Citation Subset:  IM    
Copyright Information:
(c) 2006 Wiley-Liss, Inc.
Department of Pathology and Laboratory Medicine, School of Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA.
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MeSH Terms
Aged, 80 and over
Bronchoalveolar Lavage / methods*
False Negative Reactions
Methenamine / metabolism*
Middle Aged
Pneumocystis jirovecii / cytology*,  isolation & purification*
Pneumonia, Pneumocystis / diagnosis*,  microbiology*
Retrospective Studies
Silver Staining / methods*
Reg. No./Substance:

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