Limited role for bronchoalveolar lavage to exclude COVID-19 after negative upper respiratory tract swabs: a multicentre study

Geri, Pietro; Salton, Francesco; Zuccatosta, Lina; Tamburrini, Mario; Biolo, Marco; Busca, Annalisa; Santagiuliana, Mario; Zuccon, Umberto; Confalonieri, Paola; Ruaro, Barbara; D’Agaro, Pierlanfranco; Gasparini, Stefano; Confalonieri, Marco

doi:10.1183/13993003.01733-2020

Cited by 55 publications

(60 citation statements)

References 7 publications

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“…In the patients that tested negative, we cannot be absolutely certain about the absence of infection because more time had elapsed from symptoms’ onset. Finally, when BAL results were negative for SARS-CoV-2 in 98% of the cases (87/88), we had a double-negative nasopharyngeal swab which confirmed the previously reported data [18]. On the other hand, when the BAL result was positive for SARS-CoV-2 in 76% of cases (33/43), we also had a double-negative nasopharyngeal swab.…”

Section: Discussionsupporting

confidence: 89%

SARS-CoV-2 Detection on Bronchoalveolar Lavage: An Italian Multicenter experience

et al. 2020

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Background: Bronchoscopy with bronchoalveolar lavage (BAL) during the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) pandemic should be reserved to a limited number of clinical indications. The yield of BAL for the diagnosis of suspected or confirmed pulmonary SARS-CoV-2 infection is still unknown. Objectives: We aimed to evaluate the diagnostic ratio of BAL in detecting SARS-CoV-2 pulmonary infection in patients undergoing bronchoscopy for different indications as well as describe the clinical, radiological, and endoscopic characteristics of patients with SARS-CoV-2 on BAL. Method: We conducted a multicenter retrospective study including all patients who underwent bronchoscopy for the detection of SARS-CoV-2 on BAL. Clinical, computed tomography (CT), endoscopic, and microbiologic data were gathered from March 16th to May 27th, 2020. Results: 131 patients were included. Bronchoscopy was performed for suspected SARS-CoV-2 infection (65.5%), alternative diagnosis (12.9%), suspected superinfections (19.8%), and lung atelectasis (1.5%). SARS-CoV-2 was isolated on BAL 43 times (32.8%) and the highest isolation rate was in patients with suspected SARS-CoV-2 infection (74.4%); 76% of positive patients had a double-negative nasopharyngeal swab. Peripheral, posterior and multilobar CT opacities were more frequent in SARS-CoV-2 patients, and the number of CT findings was higher in positive patients, particularly those with suspected SARS-CoV-2 infection. We recorded a progressive reduction of SARS-CoV-2 isolation during the observation period. Conclusions: In our centers, the rate of detection of SARS-CoV-2 on BAL in patients with suspected infection was 37.2%. The agreement of BAL with nasopharyngeal swabs was high; CT alterations could predict the pretest probability of SARS-CoV-2 infection, but suspicion of viral infection should be always considered.

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Section: Discussionsupporting

confidence: 89%

SARS-CoV-2 Detection on Bronchoalveolar Lavage: An Italian Multicenter experience

et al. 2020

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“…In our cohort, bronchoscopy with BAL led to the diagnosis of COVID-19 in 7/27 (26.9%) of the patients. The careful selection of patients through multidisciplinary discussion might explain the higher number of positive cases detected with BAL compared to other BAL series published [ 17 , 18 ]. Timing of BAL could also explain the difference.…”

Section: Discussionmentioning

confidence: 99%

“…Despite these limitations, several groups have shown the presence of SARS-CoV-2 in BAL samples in patients in which viral RNA was not detected in the upper-respiratory tract [ 6 , 13–16 ]. The structural implementation of invasive lower-respiratory tract sampling in the diagnostic work-up of SARS-CoV-2 has been only reported sporadically [ 17 , 18 ]. This manuscript presents the results of a stepwise diagnostic testing protocol for COVID-19 at Ghent University Hospital during the first wave of the epidemic in Belgium.…”

Section: Introductionmentioning

confidence: 99%

Diagnosing COVID-19; towards a feasible COVID-19 rule-out protocol

Clercq

Malfait

et al. 2021

Acta Clinica Belgica

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Introduction : We present the results of the COVID-19 rule-out protocol at Ghent University Hospital, a step-wise testing approach which included repeat NFS SARS-CoV-2 rRT-PCR, respiratory multiplex RT-PCR, low-dose chest CT and bronchoscopy with BAL to confirm or rule-out SARS-CoV-2 infection in patients admitted with symptoms suggestive of COVID-19. Results : Between 19 March 2020 and 30 April 2020, 455 non-critically ill patients with symptoms suspect for COVID-19 were admitted. The initial NFS for SARS-CoV-2 rRT-PCR yielded 66.9%, the second NFS 25.4% and bronchoscopy with BAL 5.9% of total COVID-19 diagnoses. In the BAL fluid, other respiratory pathogens were detected in 65% (13/20) of the COVID-19 negative patients and only in 1/7 COVID-19 positive patients. Retrospective antibody testing at the time around BAL sampling showed a positive IgA or IgG in 42.9 % of the COVID-19 positive and 10.5% of the COVID-19 negative group. Follow-up serology showed 100% COVID-19 positivity in the COVID-19 positive group and 100% IgG negativity in the COVID-19 negative group. Conclusion : In our experience, bronchoscopy with BAL can have an added value to rule-in or rule-out COVID-19 in patients with clinical and radiographical high-likelihood of COVID-19 and repeated negative NFS testing. Furthermore, culture and respiratory multiplex PCR on BAL fluid can aid to identify alternative microbial etiological agents in this group. Retrospective analysis of antibody development in this selected group of patients suggests that the implementation of serological assays in the routine testing protocol will decrease the need for invasive procedures like bronchoscopy.

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“…In addition, medical procedures such as bronchoscopy and bronchoalveolar lavage (BAL) are restricted due to generation of aerosols. These procedures are critical to diagnose other or secondary pulmonary infections, including invasive fungal diseases [ 43 , 44 , 45 , 46 , 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Coronavirus Disease 2019 (COVID-19) in a Patient with Disseminated Histoplasmosis and HIV—A Case Report from Argentina and Literature Review

Messina

Marín

Cáceres

et al. 2020

JoF

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The disease caused by the new SARS-CoV-2, known as Coronavirus disease 2019 (COVID-19), was first identified in China in December 2019 and rapidly spread around the world. Coinfections with fungal pathogens in patients with COVID-19 add challenges to patient care. We conducted a literature review on fungal coinfections in patients with COVID-19. We describe a report of a patient with disseminated histoplasmosis who was likely infected with SARS-CoV-2 and experienced COVID-19 during hospital care in Buenos Aires, Argentina. This patient presented with advanced HIV disease, a well-known factor for disseminated histoplasmosis; on the other hand, we suspected that COVID-19 was acquired during hospitalization but there is not enough evidence to support this hypothesis. Clinical correlation and the use of specific Histoplasma and COVID-19 rapid diagnostics assays were key to the timely diagnosis of both infections, permitting appropriate treatment and patient care.

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Limited role for bronchoalveolar lavage to exclude COVID-19 after negative upper respiratory tract swabs: a multicentre study

Cited by 55 publications

References 7 publications

SARS-CoV-2 Detection on Bronchoalveolar Lavage: An Italian Multicenter experience

SARS-CoV-2 Detection on Bronchoalveolar Lavage: An Italian Multicenter experience

Diagnosing COVID-19; towards a feasible COVID-19 rule-out protocol

Coronavirus Disease 2019 (COVID-19) in a Patient with Disseminated Histoplasmosis and HIV—A Case Report from Argentina and Literature Review

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