Immunoscintigraphy of Pneumocystis Carinii Pneumonia in AIDS Patients

The diagnosis of Pneumocystis carinii pneumonia (PCP) currently relies upon cytological demonstration of the organism in sputum or bronchoscopy specimens. The purpose of this study was to develop a radiolabeled monoclonal antibody (Mab) against Pneumocystis carinii (P. carinii) and to evaluate its use for imaging PCP. We studied 16 HIV-infected patients with pneumonia in order to evaluate a new Mab-based imaging method for diagnosing PCP. Most patients were managed for opportunistic pneumonia associated with AIDS, including standard cytological tests, and, in all cases, intensive chemotherapy. Prior to the clinical study, the Mab raised to P. carinii was shown to react with human P. carinii but not with rat P. carinii or human white blood cells. After labeling a 1-mg Mab Fab' fragment with 30 mCi of 99mTc, the presence or absence of PCP could be confirmed in six of seven or seven of eight assessable patients, respectively, by external photoscanning within 24 hr. This shows a sensitivity of 85.7% and a specificity of 86.7%. Our findings suggest that PCP can be diagnosed by a noninvasive imaging method employing a small dose of a 99mTc-labeled Mab showing specificity for the infectious organism, since patients with P. carinii-free pneumonia were correctly negative in 87.5% of cases. Rapid diagnosis and organ-localization of other infectious lesions with organism-specific, radiolabeled Mabs may be feasible.