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Analysis of odontogenic keratocyst fluids for preoperative diagnosis.

We read with interest the paper on diagnosis of Pneumocystis carinii in bronchoalveolar lavage specimens by Young et al,1 and we agree with the conclusions drawn. P carinii can be identified in smears after routine Papanicolaou staining, but the diagnosis must be confirmed by showing the presence of the organism with a siiver impregnation technique. In the cases we have seen we have not been struck by the biphasic staining described but found the frothy spongy aggregates of cysts and mucus very distinctive. Although we agree that specimens obtained by thorough bronchoalveolar lavage give excellent results most consistently, it is worth noting that good results may be obtained in patients with acquired immune deficiency syndrome, but not in immunosuppressed patients, by examining the sputum.2 Grocott's methenamine silver method is, as suggested, a rather long technique and we now no longer use it but rely routinely on Pintozzi's modification.3 We found that a slightly modified form of this method gave consistent results. The modifications introduced by one of us (JMcC), are the inclusion of 01% dimethylsulphoxide in the silver solution and the reduction of the incubating temperature of this solution from 80°C to between 70 to 75°C. Addition of DMSO at this low concentration gives a more precise deposition of silver on to the organisms without the presence of the precipitate mentioned by Mahan and Sale.4 Reducing the incubating temperature, even by a few degrees, ensures a greater degree of control during staining and does not unduly prolong the staining time. Figure Pneumocystis carinii. Mature cysts and sporozoites are shown. Bronchoalveolar lavagefluid. (Gram Weigert stain.) Original magnification x 500.