Fiberoptic bronchoscopy and bronchoalveolar lavage for the evaluation of pulmonary disease in children with primary immunodeficiency and cancer

Efrati, Ori; Gonik, Udi Sadeh; Bielorai, Bella; Modan‐Moses, Dalit; Neumann, Yoram; Szeinberg, Amir; Vardi, Amir; Barak, Asher; Paret, Gideon; Toren, Amos

doi:10.1002/pbc.20784

Cited by 46 publications

(38 citation statements)

References 19 publications

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“…According to one group of authors, (49) when there is strong clinical suspicion but specific isolation is not possible, the presence of neutrophilia (> 30%), lymphocytosis (> 12%) or an increase in the number of cells can provide indirect evidence of the presence of the infectious agent or can inform decisions regarding empirical antibiotic therapy.…”

Section: Immunodeficiency and Neoplasiamentioning

confidence: 99%

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares

2010

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The objective of this study was to review the literature on bronchoalveolar lavage fluid cell profiles in healthy children and adolescents, as well as on the use of BAL as a diagnostic and follow-up tool for lung disease patients in this age bracket. To that end, we used the Medline database, compiling studies published between 1989 and 2009 employing the following MeSH descriptors (with Boolean operators) as search terms: bronchoalveolar lavage AND cytology OR cell AND child. In healthy children, the cell profile includes alveolar macrophages (> 80%), lymphocytes (approximately 10%), neutrophils (approximately 2%) and eosinophils (< 1%). The profile varies depending on the disease under study. The number of neutrophils is greater in wheezing children, especially in non-atopic children, as well as in those with pulmonary infectious and inflammatory profiles, including cystic fibrosis and interstitial lung disease. Eosinophil counts are elevated in children/adolescents with asthma and can reach high levels in those with allergic bronchopulmonary aspergillosis or eosinophilic syndromes. In a heterogenous group of diseases, the number of lymphocytes can increase. Evaluation of the BAL fluid cell profile, when used in conjunction with clinical and imaging findings, has proven to be an essential tool in the investigation of various lung diseases. Less invasive than transbronchial and open lung biopsies, BAL has great clinical value. Further studies adopting standard international protocols should be carried out. Such studies should involve various age groups and settings in order to obtain reference values for BAL fluid cell profiles, which are necessary for a more accurate interpretation of findings in children and adolescents with lung diseases.Keywords: Bronchoalveolar lavage; Bronchoalveolar lavage fluid/cytology; Child; Adolescent. ResumoEste estudo teve como objetivo rever a literatura existente sobre a celularidade do LBA em crianças e adolescentes saudáveis, bem como sobre sua utilização como método propedêutico e de acompanhamento nas afecções pulmonares neste grupo etário. Para tanto, utilizamos o banco de dados médico Medline com a seleção de artigos publicados entre 1989 e 2009 utilizando os seguintes descritores MeSH com operadores boolianos: bronchoalveolar lavage AND cytology OR cell AND child. Em crianças saudáveis, a celularidade é composta por macrófagos alveolares (> 80%), linfócitos (cerca de 10%), neutrófilos (cerca de 2%) e eosinófilos (< 1%). O perfil celular sofre alterações de acordo com a doença estudada. Ocorre uma elevação no número de neutrófilos em sibilantes, especialmente os não atópicos, bem como em indivíduos com quadros infecciosos e inflamatórios pulmonares, incluindo fibrose cística e doenças intersticiais pulmonares. Os eosinófilos se elevam em crianças/adolescentes com asma e podem atingir níveis acentuados na aspergilose broncopulmonar alérgica e nas síndromes hipereosinofílicas. A elevação dos linfócitos pode ocorrer em um grupo heterogêneo de doenças. Conclui-se que a...

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Section: Immunodeficiency and Neoplasiamentioning

confidence: 99%

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares

2010

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“…El rendimiento del LBA por FBC en pacientes pediátri-cos con cáncer cursando una infección respiratoria aguda baja en distintos reportes oscila entre 30 y 53% 5,7,8,14 . En el presente estudio se obtuvo un rendimiento de 32,4% en 37 LBA, resultados comparables a lo señalado en la literatura médica.…”

Section: Discussionunclassified

“…El procedimiento es seguro en pacientes oncológicos incluso en condiciones de insuficiencia respiratoria; sin embargo, en este estudio no se realizó un análisis acabado de las complicaciones menores que pudieran haberse presentado, como hipoxemia leve o fiebre 8 . En suma, el LBA tiene un importante papel en la evaluación de los infiltrados pulmonares en pacientes pediátricos con cáncer y neutropenia febril, en quienes un diagnóstico rápido y seguro es crucial en la sobrevida.…”

Section: Discussionunclassified

“…Se ha demostrado que el LBA por fibro-broncoscopia (FBC) en niños es un procedimiento eficiente que permite confirmar la etiología de cuadros infecciosos pulmonares en forma rápida y confiable, con pocas complicaciones, las que de producirse son usualmente leves y sin mortalidad [3][4][5] . El procedimiento es efectivo y bien tolerado en pacientes oncológicos incluso en condiciones de insuficiencia respiratoria [6][7][8][9] . El objetivo de este trabajo fue evaluar en forma sistematizada los hallazgos microbiológicos de muestras de LBA, sumando el aporte de métodos diagnósticos por biología molecular, en cuadros de infiltrado pulmonar de niños en tratamiento de quimioterapia por cáncer, conocer su rendimiento, seguridad y utilidad clínica, ya que existe poca información al respecto en nuestro medio.…”

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Cáncer, neutropenia febril e imágenes pulmonares: Hallazgos en el lavado broncoalveolar en niños

Avilés

Silva

Zubieta³

et al. 2012

Rev. chil. infectol.

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“…Diagnostic procedures should only be performed if results have the potential to be of benefit to the patients. Bronchoalveolar lavage (BAL), although relatively noninvasive, fails to provide a diagnosis in up to two thirds of patients [4,5]. Surgical lung biopsy (SLB) is the gold standard for obtaining the biopsy specimens used for the diagnosis of pulmonary disease and leads to an accurate diagnosis in 80-100% inadult patients [6,7,8,9,10].…”

Section: Introductionmentioning

confidence: 99%

Do Immunocompromised Children Benefit from Having Surgical Lung Biopsy Performed?

Gal¹,

Keller

Bilik

et al. 2014

Acta Haematol

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Background: Surgical lung biopsy is considered a gold standard for the evaluation of pulmonary disease in immunocompromised children. However, in the literature, its accuracy and the rate of complications vary. Objective: We aimed to evaluate the yield of surgical lung biopsies in the management of persistent pulmonary findings in immunocompromised children. Methods: We performed a retrospective review of clinical records of immunocompromised children who underwent surgical lung biopsies, and evaluated the impact that preoperative factors had on outcomes. Results: Twenty-five patients underwent 27 surgical lung biopsies. The underlying immunodeficiency included allogeneic stem cell transplantation (n = 12), chemotherapy for solid tumors(n = 6), hematologic malignancy (n = 4), primary immunodeficiency (n = 4) and chronic steroid use (n = 1). Biopsies provided a specific histopathologic or microbiologic diagnosis in 10 cases (37%). No preoperative factor predicted a diagnostic biopsy. Five of the 27 biopsies werebeneficialfor the patients (18%). A major complication related to the procedure was reported for 1 biopsy (4%). Conclusions: We conclude that surgical lung biopsy in pediatric immunocompromised patients appears to be safe, but has a relatively low diagnostic yield and an even lower yield with regards to the benefit it provides. © 2014 S. Karger AG, Basel

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Fiberoptic bronchoscopy and bronchoalveolar lavage for the evaluation of pulmonary disease in children with primary immunodeficiency and cancer

Cited by 46 publications

References 19 publications

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares

Cáncer, neutropenia febril e imágenes pulmonares: Hallazgos en el lavado broncoalveolar en niños

Do Immunocompromised Children Benefit from Having Surgical Lung Biopsy Performed?

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