Cytokines derived from alveolar macrophages induce fever after bronchoscopy and bronchoalveolar lavage.

Abstract

As much as one-third of patients develop fever and flu-like symptoms after fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) for yet unknown reasons. The aim of the present study was to investigate factors mediating these side effects. Fifty consecutive patients with various pulmonary diseases who underwent FOB without further interventions (n = 30) or combined with BAL (n = 20) were enrolled. Serum levels of the proinflammatory cytokines IL-1beta, IL-6, and TNF-alpha were determined directly prior to (t0), directly after (t1), and 6 h after (t2) the procedures by ELISA. In parallel, blood cultures were drawn at t2. At to and t1, generally only low cytokine concentrations could be detected. At t2, however, significant increases of cytokine levels were found. IL-6 and TNF-alpha were significantly higher in patients after BAL than in patients after FOB. Comparing patients who developed fever (n = 12) with those who did not (n = 38), irrespective of the endoscopic procedures performed, dramatic increases of all three cytokines were detected in febrile patients that were significantly higher than in patients without fever. In the FOB group only patients who received local anesthesia by prilocaine bolus injection into the airways via the working channel of the bronchoscope developed fever and increases of IL-6 and IL-beta, whereas patients anaesthetized by inhalation of a prilocaine aerosol remained afebrile and had slight IL-6 increases only. There was a highly significant correlation between IL-6 values at t2 and the number of BAL alveolar macrophages (r = 0.98). All blood cultures remained sterile. These results indicate that fever after FOB and BAL is induced by proinflammatory cytokines derived from alveolar macrophages activated by instillation of fluid into the airways.

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

“…However, only the final diagnosis of pulmonary tuberculosis and the severity of bleeding were identified as independent risk factors for fever by multivariate analysis [24]. According to previous studies, postbronchoscopy fever is associated with advanced age [25][26][27]. Our results do not support these findings [24].…”

Systemic inflammatory response after bronchoalveolar lavage in critically ill patients

“…mL -1 ) compared to the baseline median (3.71 pg . mL -1 ) reported in the study by KRAUSE et al [4] (table 2). In addition, TNF-a levels and particularly IL-6 levels were already well above the normal upper limits for healthy controls at baseline.…”

“…In a report of a normal healthy volunteer who underwent bronchoscopy and BAL, STANDIFORD et al [8] showed rising TNF-a levels associated with clinical symptoms after the intervention. KRAUSE et al [4] systematically compared the systemic inflammatory response after bronchoscopy with and without BAL in 50 patients, with a variety of pulmonary conditions including pulmonary metastasis or bronchial carcinoma. They found an increase of systemic levels of IL-1b and IL-6 at 6 h in all patients, although the increase seemed to be more pronounced in the BAL group.…”

“…However, in some cases, BAL may be followed by myalgia, headache or even fever [3]. A systematic follow-up after bronchoscopically guided BAL suggested that this systemic inflammatory response, or sepsis-like syndrome, is caused by a proinflammatory cytokine release [4]. This study in noncritically ill patients, however, excluded patients with pneumonia, and did not assess the bacterial burden of the lungs.…”

Efficacy of Antibiotic Prophylaxis after Endobronchial Ultrasound-guided Transbronchial Needle Aspiration: A Preliminary Prospective Study

“…The elevation of serum levels of inflammatory cytokines such as interleukin (IL)-1β, IL-6, and tumor necrosis factor alpha (TNF-α) have also been reported in patients who developed a fever above 38°C after bronchoscopy. There was a highly significant correlation between IL-6 value and the number of alveolar macrophages in BAL fluid [24]. On the other hand, it have been demonstrated that the frequency of bacteremia were 6.5%-8.2% after conventional fiberoptic bronchoscopy [20,25,26] and 7.0% after EBUS-TBNA (26), including some febrile patients.…”