The Role of Bronchoalveolar Lavage in the Diagnosis of Suspected Opportunistic Pneumonia

Abstract

We report 50 immunocompromised patients with pulmonary infiltrates who underwent fibreoptic bronchoscopy, including bronchoalveolar lavage, on 56 occasions. The underlying diseases were mostly lymphoma, leukemia, other malignancies and renal failure. The commonest immunodeficiency factors were chemotherapy, steroids and neutropenia. A positive diagnosis could be made from analysis of the bronchoalveolar lavage on 59% (33/56) occasions. This was a comparable yield to transbronchial lung biopsy 57% (16/27), and superior to proximal airways wash 24% (13/55), or bronchial brushings 29% (10/34). Open lung biopsy added additional diagnostic information in three of the four cases in which it was performed. The most common final diagnoses were bacterial, viral or Pneumocystis carinii pneumonia and recurrent malignancy. We conclude that bronchoalveolar lavage is a safe procedure with a high diagnostic yield in the immunocompromised host with suspected opportunistic pneumonia.

Utility of Bronchoscopy with Bronchoalveolar Lavage in Diagnosing Pulmonary Infection in Hospitalized Patients with Underlying Malignancy

“…This is the first study to assess the impact value of a positive microbiological finding from BAL on antimicrobial therapy in this patient population. Our overall raw diagnostic yield is comparable with those previously reported (2,3,(17)(18)(19). The variation in the previously reported diagnostic yields (from 32% to 66%) can be attributed to several factors.…”

“…Reports of this technique used in patients supported by mechanical ventilation and in patients with underlying malignancy who have increased incidence of hypoxemia, thrombocytopenia and coagulapathy have proven bronchoscopy with BAL to be safe and useful (2,13,16). In an immunocompromised population, the diagnostic yield of bronchoscopy with BAL has been reported to vary from 32% to 66% (2,3,(17)(18)(19). It is the policy at Princess Margaret and Wellesley Hospital, Toronto, Ontario to pursue aggressively a diagnosis in patients with underlying malignancy and new pulmonary symptoms.…”

Differential cell count and lymphocyte subsets in bronchoalveolar lavage during pneumonia with and without peripheral neutropenia

“…Lavage studies have been performed in immunocompromised patients for the diagnosis of opportunistic infection [1,4,8,12,14,16,20,23]. There are several reports on the cellular inflammatory response of HIV positive patients but only a few on HIV negative immunosuppressed patients during episodes of pneumonia.…”

Fibreoptic Bronchoscopy in the Diagnosis of Pulmonary Disease in the Immunocompromised Host in Northern Alberta

“…The di ag nos tic yield of BAL alone was 50%, with sheathed brushes con trib ut ing ad di tional in for ma tion in three cases, brush cy tology in one case and TBB in seven cases. A re view of other reports in the lit era ture in di cates a di ag nos tic yield for BAL in simi lar pa tient groups rang ing from 39 to 87% (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). This vari abil ity may in part be re lated to dif fer ences in pa tient popu la tions, as sug gested by Pi sani and Wright (2).…”

“…Clini cal and ra dio graphic fea tures are of ten non spe cific, and fi bre op tic bron cho scopy is fre quently used as a pri mary means of evalua tion. Pre vi ous stud ies have as sessed the util ity of bron cho scopy in the di agno sis of pul mo nary dis ease in the im mu no com pro mised host with var ied re sults de pend ing on the tech niques em ployed, popu la tion stud ied and di ag nos tic cri te ria used (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). The ob jec tive of this study was to de ter mine the di ag nos tic util ity of bron cho scopy in a popu la tion of im mu no com pro mised hosts in north ern Al berta by com par ing bron choal veo lar lavage (BAL) with pro tected double-sheathed brushes, cy tology brushes and trans bron chial lung bi opsy (TBB).…”