Role of flexible bronchoscopy in the diagnosis of invasive fungal infections

Abstract

Background There are sparse data on the role of flexible bronchoscopy (FB) in diagnosing invasive mould infections (IMIs). Objective To investigate the safety and usefulness of FB in IMI. We evaluate the factors associated with a successful diagnosis of IMI using FB. Further, we compare subjects of invasive pulmonary aspergillosis (IPA) with pulmonary mucormycosis (PM). Methods We retrospectively reviewed the clinical features, imaging data, bronchoscopy, microbiology and pathology details of subjects who underwent FB for suspected IMI. We categorised FB as diagnostic if it contributed to the diagnosis of IMI. We performed a multivariate analysis to identify the factors associated with a diagnostic bronchoscopy. Results Of the 3521 FB performed over 18 months, 132 (3.7%) were done for suspected IMIs. We included 107 subjects for the final analysis. The risk factors for IMI included renal transplantation (29.0%), diabetes (27.1%), haematological malignancy (10.3%) and others. We found bronchoscopic abnormalities in 33 (30.8%) subjects, and these were more frequent in those with confirmed PM (67%) than IPA (27%). IMI was confirmed in 79 (14 proven, 48 probable and 17 possible) subjects. FB was diagnostic in 71%. We experienced major complications in three cases (2.7%), including one death. On multivariate analysis, the visualisation of endobronchial abnormalities during FB (OR [95%, CI], 8.5 [1.4–50.4]) was the only factor associated with a diagnostic FB after adjusting for age and various risk factors. Conclusions Flexible bronchoscopy is a useful and safe procedure in diagnosing IMIs. The presence of endobronchial abnormalities predicts a successful diagnostic yield on FB.

Definition, diagnosis, and management of COVID-19-associated pulmonary mucormycosis: Delphi consensus statement from the Fungal Infection Study Forum and Academy of Pulmonary Sciences, India

“…Notably, the bronchoscopy unit should be equipped to handle emergencies, such as severe bleeding following diagnostic bronchoscopies. 54 The choice of additional procedures, such as transbronchial lung biopsy (TBLB), endobronchial biopsy, brush cytology, and others, needs to be individualised, depending on the imaging abnormalities, bronchoscopical findings, and the patient's status. 54 In general, performing more than one procedure increases the diagnostic yield of bronchoscopy in CAPM, as with other diseases.…”

“… 54 The choice of additional procedures, such as transbronchial lung biopsy (TBLB), endobronchial biopsy, brush cytology, and others, needs to be individualised, depending on the imaging abnormalities, bronchoscopical findings, and the patient's status. 54 In general, performing more than one procedure increases the diagnostic yield of bronchoscopy in CAPM, as with other diseases. Flexible bronchoscopy can be used for peripheral and non-peripheral lung lesions.…”

Pulmonary Artery Pseudoaneurysm in COVID-19-Associated Pulmonary Mucormycosis: Case Series and Systematic Review of the Literature

“…Further, diagnostic modalities such as bronchoscopy may also result in severe bleeding in patients with PM. [ 26 ] Additionally, COVID-19 poses difficulties in diagnosing PM. [ 5 ] Early initiation of appropriate antifungal therapy (amphotericin B) and timely surgery are key factors determining the outcome.…”

Multidrug Resistance in Mammals and Fungi—From MDR to PDR: A Rocky Road from Atomic Structures to Transport Mechanisms

“…The mammalian ABCGs are the closest orthologues of yeast PDR transporters [ 216 , 245 , 250 , 251 , 321 ], especially Pdr5 and Cdr1 [ 166 , 322 , 323 ] ( Supplementary Figure S1 ). To identify conserved regions of fungal ABC proteins based on mammalian ABC structures, we determined a conservation score for the fungal PDR family, and mapped conserved residues into the atomic structures of mammalian orthologues ( Figure 2 B).…”

“…The mammalian ABCGs are the closest orthologues of yeast PDR transporters [216,245,250,251,321], especially Pdr5 and Cdr1 [166,322,323] (Supplementary Figure S1). To identify conserved regions of fungal ABC proteins based on mammalian ABC struc- 1 and 2 were generated for all subfamilies.…”