The purpose of this study was to determine if the measurement of surfactant protein A (SP-A) in bronchoalveolar lavage (BAL) fluid predicts survival in patients with idiopathic pulmonary fibrosis (IPF). We performed BAL on 44 patients with IPF and 33 healthy volunteers. SP-A and total phospholipid (PL) were measured in the surfactant pelleted by centrifugation and expressed as a ratio to account for differences in the alveolar surface area sampled. The mean SP-A/PL was lower in patients with IPF than in healthy volunteers (31.8 +/- 2.8 versus 63.9 +/- 6.4 micrograms/mumol, p = 0.006) and in patients who died within 2 yr than in those who survived (23.4 +/- 2.6 versus 37.5 +/- 4.2 micrograms/mumol, p = 0.015). Using Cox's proportional hazard model, we found that SP-A/PL modeled continuously was associated with survival time (p = 0.002). The 5-yr survival of patients with SP-A/PL above the median level for all patients with IPF (29.7 micrograms/mumol) was more than twice that of patients below the median (68 versus 30%, p = 0.007). SP-A/PL improved upon prediction of survival modeled by most routine physiologic variables with the exception of percent predicted TLC or the multifarious clinical-radiographic-physiologic score (CRP). Cellular analysis of lavage did not predict survival in this cohort of patients. We conclude that SP-A/PL is a biochemical marker in lavage that predicts survival in patients with IPF.

In CMV high risk patients, additional CMV-IG administration seems to be effective to reduce CMV-related morbidity and to avoid CMV-related mortality. Reduced incidence of BOS may result from improved CMV prevention, although randomized trials are warranted.

The accuracy of the (1,3)β-D-glucan test is marginal so that its utility as a clinical test for early diagnosis of IFI is questionable in the lung transplant population. Although the high negative predictive value of the Fungitell assay in both, BALs and sera, may support exclusion of pulmonary IFI in solid-organ transplantation patients, the low positive predictive value limits its utility as a screening tool for early diagnosis of IFI.

The coronavirus disease 2019 (COVID-19) pandemic is currently a challenge worldwide. In Austria, a crisis within the healthcare system has so far been prevented. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV-2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic; however, COVID-19 specific adjustments are useful. The treatment of patients with chronic lung diseases

BackgroundInvasive fungal diseases (IFD) are an important cause of morbidity and mortality in immunocompromised patients, and early diagnosis and management are a challenge. We evaluated the clinical utility of computed tomography (CT)-guided percutaneous lung biopsies in diagnosing IFD.MethodsBetween 2003 and 2014, we analyzed 2671 CT-guided lung biopsies, from which 157 were IFD associated; we aimed to determine microbiological-based diagnostic accuracy of calcofluor white staining (CFWS), culture, Aspergillus antigen detection (GM), broad-range fungal PCR, and Aspergillus PCR per sample.Results127 (81%) specimens were microscopically positive for any fungal elements, 30 (19%) negative. Aspergillus and non-Aspergillus like hyphae were obtained in 85 (67%) and 42 (33%) specimens, respectively. CFWS positivity was defined as proof of infection. Sensitivity, specificity, and positive (PPV) and negative predictive (NPV) values for CT scan were 100, 44, 80, and 100%, for Aspergillus PCR 89, 58, 88, and 58%, for broad-range fungal PCR 90, 83, 95, and 90%, and for GM 94, 83, 95, and 90%. The most common CT features were patchy opacifications with central necrosis (78%) or cavern defects (50%), less common were air bronchograms (39%) or ground glass halos (39%), and all other features were rare. The overall pneumothorax rate subsequent to biopsy was 19%, but in only 2% of all cases the placement of a chest tube was indicated. One case of fatal air embolism occurred.ConclusionsCT-guided lung biopsies have high diagnostic accuracy in terms of microscopic examination, and complication rates are low. Molecular-based and antigen tests applied on fungal hyphae-positive specimens showed comparable results.