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Utility of Gomori methenamine silver stains in bronchoalveolar lavage specimens
S S Raab1, J C Cheville, K Bottles
1Department of Pathology, University of Iowa, Iowa City.
Abstract:
Bronchoalveolar lavage (BAL) with Gomori methenamine silver (GMS) stain is commonly used to detect Pneumocystis carinii and fungal organisms as causes of infectious pulmonic disease in immunosuppressed patients. However, several reports have indicated that GMS stains are not any more sensitive than conventional cytologic stains in detecting Pneumocystis organisms in select patient populations, such as those with acquired immunodeficiency syndrome (AIDS). To examine the utility of GMS stains in our laboratory, we retrospectively reviewed 243 BALs from 188 patients. Sensitivity of the GMS stain for Pneumocystis and for fungi detection was 100%. Sensitivity for Pneumocystis and for fungi detection by Papanicolaou stain alone was 79% and 88%, respectively; by Diff-Quik stain alone it was 68% and 88%, respectively; and by combined Papanicolaou and Diff-Quik stains it was 79% and 100%, respectively. In four additional cases, fungi were detected by other methods (culture, biopsy) and not by BAL. The GMS stain result was correlated with a number of risk variables to determine which variables were associated with GMS positivity. Using stepwise logistic regression, Pneumocystis positivity by GMS stain correlated (P < 0.0001) only with the variable of history of AIDS or AIDS risk factors. Fungal organism positivity by GMS stain correlated (P = 0.02) only with the variable of history of BAL positivity for fungus. Cost savings analyses were performed, estimating the cost of the GMS stain at $45 (total cost of GMS in 243 BALs was $10,935).(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Gomori methenamine silver (GMS) stain shows 100% sensitivity for detecting Pneumocystis and fungi in bronchoalveolar lavage (BAL) samples. This diagnostic method is particularly valuable for immunosuppressed patients, including those with acquired immunodeficiency syndrome (AIDS).
Area of Science:
- Medical diagnostics
- Infectious disease pathology
- Pulmonology
Background:
- Bronchoalveolar lavage (BAL) with Gomori methenamine silver (GMS) stain is a standard method for identifying Pneumocystis and fungal infections in immunocompromised individuals.
- Previous studies questioned the superior sensitivity of GMS stains compared to conventional cytologic stains, especially in patients with acquired immunodeficiency syndrome (AIDS).
Purpose of the Study:
- To evaluate the diagnostic utility and sensitivity of GMS stains in detecting Pneumocystis and fungal organisms in bronchoalveolar lavage (BAL) samples within a specific laboratory setting.
- To correlate GMS stain results with patient risk factors and compare its sensitivity against conventional stains.
Main Methods:
- Retrospective review of 243 BAL samples from 188 patients.
- Calculation of sensitivity for GMS stain, Papanicolaou stain, and Diff-Quik stain for Pneumocystis and fungi detection.
- Correlation analysis using stepwise logistic regression to identify risk factors associated with GMS positivity.
- Cost analysis of the GMS stain.
Main Results:
- GMS stain demonstrated 100% sensitivity for detecting both Pneumocystis and fungi.
- Conventional stains showed lower sensitivity: Papanicolaou (79% for Pneumocystis, 88% for fungi) and Diff-Quik (68% for Pneumocystis, 88% for fungi). Combined conventional stains reached 79% for Pneumocystis and 100% for fungi.
- Pneumocystis positivity by GMS stain significantly correlated with a history of AIDS or AIDS risk factors (P < 0.0001).
- Fungal positivity by GMS stain correlated with prior positive BAL fungal results (P = 0.02).
Conclusions:
- GMS stain is a highly sensitive and effective diagnostic tool for Pneumocystis and fungal infections in BAL samples.
- The GMS stain's utility is strongly supported, particularly in identifying Pneumocystis in patients with AIDS or related risk factors.
- The study highlights the diagnostic value of GMS stains, justifying its continued use in clinical practice for immunocompromised patients.