Quantitation of lipid-laden macrophages in evaluation of lower airway cytology specimens from pediatric patients

Yang, Yi; Steele, Cindy; Anbar, Ran D.; Sinacori, John T.; Powers, Celeste N.

doi:10.1002/1097-0339(200102)24:2<98::aid-dc1018>3.0.co;2-t

Cited by 17 publications

(15 citation statements)

References 8 publications

(9 reference statements)

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“…Furthermore, LLAM indices were found to be elevated in children with pulmonary diseases without clinical evidence of aspiration, and were similar to indices previously reported in children with pulmonary aspiration [19]. The lack of specificity of LLAMs for aspiration was reiterated when the lipid-laden index was found to be higher in children with chronic respiratory symptoms, particularly in those with cystic fibrosis, and had no correlation with the presence or absence of GER determined by intraesophageal pH monitor [52]. Other studies confirmed the lack of correlation between GER and LLAM indices, in the presence of respiratory symptoms [58,62] and in those without lung diseases [63], even when the diagnosis of GER was based on pH monitoring and endoscopy [64].…”

Section: Pathophysiologysupporting

confidence: 76%

“…Subsequently, many studies in adults and children have reported on LLAM as marker of gastric aspiration [49-52]. The association between aspiration and LLAMs was objectively elicited when 24-h esophageal pH-monitoring was used to confirm the suspicion of GER-related aspiration in 20 children with ‘difficult-to-treat’ respiratory symptoms.…”

Section: Pathophysiologymentioning

confidence: 99%

“…LLAM were found in 85% of the GER group and 19% of the non-GER group (p < 0.0001). Published cutoff values, however, greatly varied from 67 to 200 [52,56,57] and it has been suggested that each institution must determine its own LLAM index cutoff value [58]. This recommendation was based on the fact that there was a significant overlap of LLAM indices between patient groups with underlying lung diseases.…”

Section: Pathophysiologymentioning

confidence: 99%

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Biomarkers in the diagnosis of aspiration syndromes

Jaoude

Knight

Ohtake

et al. 2010

Expert Review of Molecular Diagnostics

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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...

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Section: Pathophysiologysupporting

confidence: 76%

Section: Pathophysiologymentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

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Biomarkers in the diagnosis of aspiration syndromes

Jaoude

Knight

Ohtake

et al. 2010

Expert Review of Molecular Diagnostics

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“…Light microscopic examination of BAL fluid using Periodic acid-Schiff (PAS) stain was positive for abundant amorphous material within the pulmonary macrophages and also in larger extracellular aggregates suggesting pulmonary alveolar proteinosis (Figure 2). The lipid-laden macrophage (LLM) index was 120 [9]. …”

Section: Case Reportmentioning

confidence: 99%

Pulmonary Alveolar Proteinosis in Association with Congenital Dyserythropoietic Anemia: A Case Report

Carden

Barman

Massey

2012

Case Reports in Pediatrics

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A two-year-old girl with congenital dyserythropoietic anemia (CDA) acutely developed fever, tachypnea, and increased oxygen requirement. Chest X-ray revealed bilateral interstitial infiltrates and mild cardiomegaly. Blood cultures grew no infectious agents, while pulmonary specimens grew cytomegalovirus (CMV). Treatment with intravenous ganciclovir was initiated but without response. Final cytologic preparations of bronchoalveolar lavage (BAL) fluid revealed eosinophilic amorphous material consistent with pulmonary alveolar proteinosis (PAP). CDA and PAP are extremely rare disorders in pediatrics. PAP should be considered in patients with hematological disorders who present with acute interstitial pneumonia, after infectious causes are ruled out.

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“…Since that time, other methods of LLM quantitation have been reported, still with mixed results. Yang et al23 reported that a proposed two‐grade scoring system was more reproducible than the four‐grade system that Corwin and Irwin24 reported in adults and Colombo and Hallberg25 reported in children. They reported a significant difference in LLM (228 vs. 79) between patients with high versus low risk of aspiration based on multiple diagnostic criteria.…”

mentioning

confidence: 98%