Diagnoses Unveiled by Early Bronchoscopy in Children With Leukemia and Pulmonary Infiltrates

Abstract

Pulmonary complications in children with leukemia often display nonspecific clinical and radiologic manifestations that lead to a delay in diagnosis. The role of fiberoptic bronchoscopy (FOB) and the proper time for its performance are controversial. The aim of our study was to evaluate the frequency and nature of specific diagnoses revealed by FOB. Children with leukemia submitted to FOB because of suspicion of pulmonary involvement (mainly pneumonia) were retrospectively analyzed. A total of 33 FOB procedures performed in 31 patients (20 males) with an average age of 9.4 years (range, 3.5 to 15 y) were evaluated. Microorganisms isolated from 21 (63.6%) bronchoalveolar lavage samples were mainly fungi including Candida in 13 cases (39.4%) and Aspergillus in 3 cases (9.1%). Isolation rate in 10 procedures performed within the first 3 days was 90%. Tracheobronchitis was present in > 50% of patients, pulmonary hemorrhage was seen in 7 (21.0%) patients, and leukemic infiltration was demonstrated in 2 patients (6.1%), among other conditions visualized by FOB. Complications of FOB were minimal and transient. Our study suggests that FOB is a useful and safe procedure in patients with leukemia and pulmonary infiltrates. The earlier the FOB was performed, the higher the isolation rate of causative agents. In addition, this procedure allowed the identification of noninfectious airway comorbidities. Further studies in regard to this issue are warranted.

Safety and Benefits of Bronchoalveolar Lavage and Lung Biopsy in the Management of Pulmonary Infiltrates in Children With Leukemia

“…Our BAL yield is similar to that reported previously in 2 pediatric cohorts with leukemia and hematologic malignancies. BAL microbiologic yield was 63.6% and 54% in Furuya et al cohort of 31 children with leukemia and Rao et al cohort of 33 children with hematological malignancy respectively [1,2]. In a recent metanalysis that examined 53 previously published studies of BAL in patients (both adults and children with cancer or post-HSCT), infectious etiology was identified in 53% [3].…”

Case Report of a Child after Hematopoietic Cell Transplantation with Acute Aspergillus Tracheobronchitis as a Cause for Respiratory Failure

“…Bronchoscopy has been reported to be a risky procedure in patients with invasive pulmonary aspergillosis, as Aspergillus invades tissue and removal of infected material can lead to massive hemorrhage [3]. However, bronchoscopy has recently been reported to be a safe procedure in children with leukemia and respiratory symptoms, where complications seemed rare and transient, but it should be noted that only 3 of the 31 patients in this report were infected with Aspergillus [8]. Bronchoscopy is the only method available for endobronchial disease assessment, and it also enables tracheal and bronchial tissue sampling for microscopic analysis and culture, allowing early diagnosis [2, 9].…”

Acute Aspergillus Laryngotracheobronchitis in a Child with Acute Lymphoblastic Leukemia

“…İmmünitesi baskılanmış hastalarda ateş ile birlikte hava yolu obstrüksiyonu, hışıltı ve bronkospazm geliştiğinde ideal olarak bronkoskopi ile Aspergillus trakeobronşiti açısından da değerlendirme önerilmektedir (8,9). Lösemili çocuklarda akciğer komplikasyonlarında erken fleksibl fiberoptik bronkoskopi yapılan 31 olgunun değerlendirildiği çalışmada olguların %51.5'inde trakeobronşit ve %6.1'inde membranöz trakeobronşit saptandığı, bronkoalveoler lavaj kültüründe %39.4 olguda Candida ve %9.1 olguda Aspergillus ile en sık mantar izolasyonu yapıldığı ve membranöz trakeobronşit saptanan iki olgudan birinde Aspergillus, diğerinde Pseudomonas aeruginosa ürediği bildirilmiştir (5). Hastamıza bronkoskopi yapılamadı, ancak laringeal yapılarda psödomembran yapıları entübasyon sırasında görüldü.…”