Biomarkers in the diagnosis of aspiration syndromes

Abstract

Recognizing and managing the different types of aspiration events remain a challenging task due to the lack of distinguishing clinical or laboratory characteristics. Numerous biomarkers in serum, sputum and bronchoalveolar lavage have been studied, and their role in the recognition of aspiration remains controversial at this time. Recent animal investigations using an array of biomarkers based on distinct pathogenic features of each aspiration event have produced promising results; however, they have not been validated in humans. Newer markers are being introduced as diagnostic and prognostic tools in conditions such as community-acquired pneumonia and sepsis, but they have not been examined in aspiration. The present review summarizes the different biomarkers that have been studied in aspiration and those who might have a potential clinical use in the future. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript. NIH Public Access Author ManuscriptExpert Rev Mol Diagn. Author manuscript; available in PMC 2011 February 1. Published in final edited form as:Expert Rev Mol Diagn. 2010 April ; 10(3): 309-319. doi:10.1586/erm.10.7. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript with gastrointestinal (GI) and esophageal abnormalities [5], as well as patients with neuro logic and neuromuscular diseases [6]. The clinical manifestation of an aspiration event falls within a wide spectrum ranging from subclinical manifestations, such as dry cough or dysphonia to a fulminant life-threatening condition, such as the acute respiratory distress syndrome (ARDS). The pathogenic process can be further complicated by superimposed secondary infection, lung abscess, airway obstruction, exogenous lipoid pneumonia and progression into chronic interstitial fibrosis [7]. However, the most challenging task for medical practitioners is the ability to differentiate between the two most common presentations of the aspiration syndromes: the gastric aspiration pneumonitis and the bacterial aspiration pneumonia. The distinction between the two entities is important because while bacterial aspiration pneumonia needs to be treated with antibiotics, treatment of aspiration pneumonitis is supportive [8]. Routine use of anti biotics for aspiration-induced lung injury offers no benefits and promotes colonization with drug-resistant bacteria. There is overwhelming epidemiologic evidence to suggest that indiscriminate administration of antibiotics has immediate-and long-term consequences contributing to emergence of multiresistant pathogens and an increased risk of super-infection [9]. In addition, previous exposure to antibiotics is an independent risk factor for development of bacterial pneumonia in the intensive care unit (ICU) [10]. Furthermore, the us...

Official American Thoracic Society Technical Standards: Flexible Airway Endoscopy in Children

“…The utility of a quantitative scoring system such as the lipid-laden macrophage index is controversial because published studies have used different diagnostic cutoff scores and different gold standards to diagnose aspiration (Table 8) (72)(73)(74)(75)(76)(77). The test result may be a useful adjunct to diagnosis as long as it is interpreted appropriately within the clinical context.…”

Aspiration-induced lung injury

“…Numerous biomarkers have been studied in the context of aspiration-induced lung injury in humans and animals(61). Additionally, similar markers have been investigated in the context of other lung injuries such as community acquired pneumonia, hospital acquired pneumonia and sepsis, though not examined in human subjects with aspiration pneumonitis.…”

An irregular pulmonary nodule was confirmed diagnosis of aspiration pneumonia by finding plant cells through rapid on‐site evaluation

“…Some scholars have established some methods to evaluate swallowing and cough reflex, such as swallowing provocation test, WST and videofluoroscopy (11,12). In our case, the WST was suspected to be positive.…”