The case of diagnostics of invasive pulmonary aspergillosis by in vivo probe-based confocal laser endomicroscopy of central and distal airways

Danilevskaya, Olesya; Averyanov, Alexander; Климко, Н Н; Lesnyak, Victor; Sorokina, Anastasia; Sazonov, Dmitry; Забозлаев, Ф Г

doi:10.1016/j.mmcr.2014.07.004

Cited by 16 publications

(11 citation statements)

References 11 publications

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“…However, there have been 2 pathologic types in which we found the same giant highly fluorescent alveolar macrophages using in vivo pCLE, namely, invasive pulmonary aspergillosis 18 and amiodarone-related pneumonia. 14 Our findings correspond to the findings of Morisse et al 19 who used fibered confocal fluorescence microscopy for in vivo and in situ imaging of experimental invasive pulmonary aspergillosis in immunosuppressed rats; they describe a specific fibrillar fluorescence and local infiltration of fluorescent alveolar macrophages in the infected zones.…”

Section: Discussionsupporting

confidence: 53%

Confocal Laser Endomicroscopy for Diagnosis and Monitoring of Pulmonary Alveolar Proteinosis

Danilevskaya

Averyanov

Lesnyak³

et al. 2015

Journal of Bronchology &Amp; Interventional Pulmonology

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Background:The diagnosis of pulmonary alveolar proteinosis (PAP) is based on computed tomography, histology, and antibodies to granulocyte-macrophage colony-stimulating factor. The role of a novel technique for imaging cells and elastin during endoscopy, probe-based confocal laser endomicroscopy (pCLE), has not yet been investigated in PAP patients. The aim of the present study was to estimate the value of pCLE in the PAP diagnosis and treatment in comparison with the findings of high-resolution computed tomography (HRCT) before and after whole-lung lavage.Methods:In vivo pCLE was performed during bronchoscopy in 6 male patients with PAP before and after whole-lung lavage. In certain lung segments, pCLE was followed by HRCT.Results:During the in vivo pCLE, we found characteristic signs of PAP: a fluorescent floating amorphous substance in the alveoli lumen sticking to conglomerates along with alveolar macrophages. These features were present to a lesser extent after a whole-lung lavage. pCLE revealed specific PAP features not only in segments with crazy-paving and ground-glass opacity, but also in segments without HRCT findings.Conclusions:The alveolar imaging in PAP patients is able to reveal characteristic changes, both in the presence and in the absence of HRCT findings. Therefore, pCLE may be a helpful tool for the diagnosis and whole-lung lavage therapy. Our data prove that accumulation of lipoproteinaceous substances within the alveoli at PAP is a diffuse but not a patchy process.

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Section: Discussionsupporting

confidence: 53%

Confocal Laser Endomicroscopy for Diagnosis and Monitoring of Pulmonary Alveolar Proteinosis

Danilevskaya

Averyanov

Lesnyak³

et al. 2015

Journal of Bronchology &Amp; Interventional Pulmonology

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“…Previous clinical studies have shown that this approach can successfully be used to investigate the human airways and lungs based on autofluorescence originating from the elastin network 25 – 28 . To date, applications in the field of fungal lung infections have been limited because of a lack of specific signals originating from the pathogens 29 , 30 . One possible solution to solve the lack of specificity in WT infections is the in vivo use of fluorophores that specifically bind to fungal elements.…”

Section: Discussionmentioning

confidence: 99%

Bronchoscopic fibered confocal fluorescence microscopy for longitudinal in vivo assessment of pulmonary fungal infections in free-breathing mice

Vanherp

Poelmans

Hillen

et al. 2018

Sci Rep

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Respiratory diseases, such as pulmonary infections, are an important cause of morbidity and mortality worldwide. Preclinical studies often require invasive techniques to evaluate the extent of infection. Fibered confocal fluorescence microscopy (FCFM) is an emerging optical imaging technique that allows for real-time detection of fluorescently labeled cells within live animals, thereby bridging the gap between in vivo whole-body imaging methods and traditional histological examinations. Previously, the use of FCFM in preclinical lung research was limited to endpoint observations due to the invasive procedures required to access lungs. Here, we introduce a bronchoscopic FCFM approach that enabled in vivo visualization and morphological characterisation of fungal cells within lungs of mice suffering from pulmonary Aspergillus or Cryptococcus infections. The minimally invasive character of this approach allowed longitudinal monitoring of infection in free-breathing animals, thereby providing both visual and quantitative information on infection progression. Both the sensitivity and specificity of this technique were high during advanced stages of infection, allowing clear distinction between infected and non-infected animals. In conclusion, our study demonstrates the potential of this novel bronchoscopic FCFM approach to study pulmonary diseases, which can lead to novel insights in disease pathogenesis by allowing longitudinal in vivo microscopic examinations of the lungs.

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“…Bronchoscopy is a minimally invasive procedure that allows pCLE but can also obtain respiratory secretions and bronchoalveolar lavage allowing their analyses identifying other potential microorganisms. We do not defend the replacement of lesser invasive techniques but we stress a new inclusion of pCLE indication besides pulmonary aspergillosis, alveolar proteinosis, drug pneumonitis and lung cancer [15,16,17,18,38,39]. …”

Section: Discussionmentioning

confidence: 99%

Usefulness of Bronchoscopic Probe-Based Confocal Laser Endomicroscopy in the Diagnosis of <b><i>Pneumocystis jirovecii</i></b> Pneumonia

Shafiek

Fiorentino²,

Cosío³

et al. 2016

Respiration

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Background: Probe-based confocal laser endomicroscopy (pCLE) is a novel technique that provides in vivo microscopic imaging of the distal lung. We hypothesized that the intra-alveolar exudates characterizing Pneumocystis jirovecii pneumonia (PJP) can be identified by pCLE in vivo and help in its diagnosis. Objectives: We aimed toassess the usefulness of pCLE for the in vivo diagnosis of PJP. Methods: Thirty-two human immunodeficiency virus (HIV)-positive patients with new pulmonary infiltrates and fever were studied using pCLE. Real-time alveolar images were recorded during the bronchoscopy for off-line analysis by two independent observers. Bronchoalveolar lavage samples were also obtained and processed for microbiology and cytological evaluation, including Grocott stain for P. jirovecii. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of pCLE for the diagnosis of PJP in these patients were calculated. Results: Fourteen patients (44%) were confirmed to have PJP by cultures/staining. pCLE was well tolerated in all patients. It identified intra-alveolar exudates in 13 of them (41%), where 11 of them (85%) had positive Grocott stain for P. jirovecci, with 93% concordance between observers. Sensitivity, specificity, PPV and NPV of pCLE for the diagnosis of PJP were 79, 89, 85 and 84%, respectively. In smokers, these figures improved to be 92, 88, 85 and 94%. Conclusions: pCLE is a quick and safe procedure for on-site diagnosis of PJP in HIV+ patients with excellent specificity and sensitivity mainly in smokers.

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The case of diagnostics of invasive pulmonary aspergillosis by in vivo probe-based confocal laser endomicroscopy of central and distal airways

Cited by 16 publications

References 11 publications

Confocal Laser Endomicroscopy for Diagnosis and Monitoring of Pulmonary Alveolar Proteinosis

Confocal Laser Endomicroscopy for Diagnosis and Monitoring of Pulmonary Alveolar Proteinosis

Bronchoscopic fibered confocal fluorescence microscopy for longitudinal in vivo assessment of pulmonary fungal infections in free-breathing mice

Usefulness of Bronchoscopic Probe-Based Confocal Laser Endomicroscopy in the Diagnosis of <b><i>Pneumocystis jirovecii</i></b> Pneumonia

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