Role of bronchoscopy in diagnosis of pulmonary infections in non-HIV immune compromised host

Abstract

Background: The occurrence of pulmonary infections is a common life threatening complication in immunocompromised patients, necessitating timely diagnosis and specific treatment. In our study bronchoscopic diagnostic techniques that include fiber optic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) were applied in non-HIV immunocompromised conditions to determine the aetiology infectious microorganisms and comparing the clinical characteristics with bronchoscopic yield and to assess the influence of these methods on therapeutic outcome in this population.Methods: This prospective observational study was conducted at Rajiv Gandhi Government General Hospital, Park Town, Chennai, for a period of 8 months from January 2016 – August 2016.After meeting the requirements of eligibility criteria, the study included 65 immunocompromised patients consecutively who presented with pulmonary diseases. The primary outcome measure was the diagnostic yield of bronchoscopy among non-HIV immunocompromised patients. The secondary outcome measures were collecting the data including etiology of different microorganisms and non-infectious causes of pulmonary diseases among non- HIV immunocompromised patients, comparing the symptoms at the time of presentation, different radiological pattern with bronchoscopic yield and comparing the different subgroups of non-HIV immunocompromised patients with regards to presenting symptoms, radiological patterns, bronchoscopic yield, treatment modification, different spectrum of infections and complications.Results: The mean age of the patients was 41.91 ranging from 15-74 years. Majority (n=36) patients showed chest symptoms alone. On bronchoscopy, 52 cases (80%) out of 65 showed positive results and negative result was noticed in 13 cases (20%). Among them bacterial infections were predominant with 24%. After BAL culture bacterial culture was positive in 23 (35%) patients and fungal culture was positive in 15 (23%) cases. After bronchoscopy, current treatment plan was changed in 37 patients and clinical improvement was seen in 26 cases i.e. yield of bronchoscopy was 71%. Minor complications were noticed in 16 cases after bronchoscopy.Conclusion: Our study concludes, in clinically stable patients FOB was the preferred technique for finding the cause of lung infiltrates in non-HIV immunocompromised patients. Because our results signifies that the yield of bronchoscopy was high (80%) despite empirical antimicrobial therapy.