Role of bronchoalveolar lavage in the evaluation of interstitial pneumonitis in recipients of bone marrow transplants.

Abstract

Forty episodes of pneumonitis in 30 recipients of allogeneic bone marrow transplants were investigated by fibreoptic bronchoscopy and bronchoalveolar lavage. A positive diagnosis was made in 32 episodes of pneumonitis (24 patients), giving a diagnostic yield of 80%. In 31 of these the diagnosis was made within 24 hours of bronchoscopy and this enabled the appropriate treatment to be instituted early. Eighteen patients recovered from their primary infection, although two died subsequently of respiratory failure due to postpneumonic lung destruction. Ten patients later developed a second episode of pneumonitis and a diagnosis was made in nine of these. Only three survived a second episode. Bronchoalveolar lavage was well tolerated by all patients and there was no morbidity or mortality that could be directly attributed to the procedure. Bronchoalveolar lavage is a safe and valuable early diagnostic procedure for the investigation of pulmonary complications in patients who have received bone marrow transplants.

Use of first line bronchoalveolar lavage in the immunosuppressed oncology patient

“…The result of six of these studies from 1984 to 1995 5,7,[11][12][13][14] are summarised in Table 3. BAL is less invasive than TBB, is well tolerated and is essentially devoid of direct complications. BAL appears to have an equivalent diagnostic yield to TBB when the underlying diagnosis is infection as in PCP (90%) and Aspergillus (40-50%).…”

The clinical importance of bronchoalveolar lavage in allogeneic SCT patients with pneumonia

“…5,8,22,23 Other studies have shown diagnostic yields of 51-80%. 3,19,[24][25][26] In total, 7 BALs were performed in children and contributed to the diagnosis in four of these. There are some difficulties associated with bronchoscopies in children, such as the frequent need for general anesthesia and difficulties in performing the procedure because of their small airways.…”

“…The Grocott (methenamine silver) procedure was used to detect P. jiroveci and other fungal species. 19,21 The viral and fungal cultures were most often combined with the more sensitive and rapid techniques such as PCR.…”

“…18 BAL procedure BAL was performed with a flexible fiber-optic bronchoscope (Olympus Company, Tokyo, Japan), according to the previously described procedures. [19][20][21] Transbronchial biopsies in these patients can be hazardous because of the risk of bleeding and pneumothorax. BAL with protected brush was therefore preferred in most cases.…”

The status of CMV as a human pathogen

“…Histologically, it resembles interstitial pneumonitis seen in patients with collagen vascular disease (Hammer et al 1983) and is characterized by a mononuclear cell infiltrate in the lung septae with perivascular cuffing and endothelial cell swelling (Beschorner et al 1980;Hammer et al 1983). Radiologic changes may or may not be present (Milburn, Prentice & du Bois, 1987). Cytomegalovirus pneumonitis in transplant recipients has a case-fatality rate of approximately 85 % and has been reported to be the single most common cause of death in bone marrow transplant patients (Watson, 1983;Meyers, Flournoy & Thomas, 1986).…”