The value of flexible bronchoscopy in pulmonary infections of immunosuppressed children

Abstract

Objectives:To demonstrate the value of flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) when determining causes of lung infection in immunocompromised children; to investigate differences in causes and radiological features of lung infections following bone marrow transplantation (BMT) compared to other immunosuppressive conditions; to evaluate the reliability of radiological findings when predicting the pathogen. Methods: We retrospectively evaluated 132 immunosuppressed children who underwent FB and BAL because pulmonary complications between January 1999 and May 2014 at the Hacettepe University Hospital Pediatric Pulmonology Unit. Two groups, Group I (n = 106) and Group II (n = 26), consisted of patients who had primary or secondary immunodeficiency and those who were immunosuppressed because BMT, respectively. Radiological findings before FB and macroscopic and microscopic findings of the procedure were evaluated. Results: FB and BAL were diagnostic in 86/132 patients (65.1%) and the antimicrobial treatment changed for 75/132 patients (56.8%). The most common pathogen was bacteria (Streptococcus pneumoniae was the leading one). Bacteria were more frequent in Group I than Group II (P = .008). No significant difference in radiological findings between Groups I and II was found. Considering all patients, a significant association was detected between viral pathogens and radiologically interstitial infiltration and a ground-glass appearance (P = .003). However, no significant association was detected between bacterial and fungal pathogens and the radiological findings. Conclusion: In immunosuppressed patients, FB and BAL should be evaluated early for clarifying the causative agents. Then, appropriate treatments can be utilised and the side effects and high cost of unnecessary treatment may be mitigated. K E Y W O R D Sbronchoscopy, immunosuppression, paediatrics, pulmonary infection SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section. How to cite this article: Eroglu-Ertugrul NG, Yalcin E, Oguz B, et al. The value of flexible bronchoscopy in pulmonary infections of immunosuppressed children.

The utility of elective flexible bronchoscopy to improve quality of life and clinical outcomes for children: A systematic review

“…39 A study of FB and BAL in immunosuppressed children found the procedure to be diagnostic in 65.1% patients and the antimicrobial treatment changed for 56.8% patients. 40 Furthermore, FB was found to have contributed to a specific diagnosis in almost 89.8% of children with congenital cardiac disease for evaluation of pulmonary disease, 41 and lead to a specific diagnosis in 33% of children who had bronchoscopic evaluation for unexplained recurrent and persistent pneumonia. 42 In another retrospective review consisting of 149 children, FB was described as a crucial diagnostic (confirming, ruling out and discovering unexpected diagnosis) and therapeutic tool.…”

“…One study found it useful in immunocompetent children with unexplained infiltrates on chest radiographs where a specific diagnosis was made in 30% of patients 39 . A study of FB and BAL in immunosuppressed children found the procedure to be diagnostic in 65.1% patients and the antimicrobial treatment changed for 56.8% patients 40 . Furthermore, FB was found to have contributed to a specific diagnosis in almost 89.8% of children with congenital cardiac disease for evaluation of pulmonary disease, 41 and lead to a specific diagnosis in 33% of children who had bronchoscopic evaluation for unexplained recurrent and persistent pneumonia 42 .…”

Pneumocystis jirovecii Pneumonia in Children with Hematological Malignancies: Diagnosis and Approaches to Management

“…Treatment should be initiated immediately after obtaining appropriate samples, that is, nasopharyngeal aspirates in infants [132], sputum in adolescents, and BAL with fiberoptic bronchoscopy in children of all ages [66]. Fiberoptic bronchoscopy is generally a safe and highly diagnostic procedure in the immunocompromised host with pneumonia due to opportunistic pathogens [133].…”

Clinical utility of elective paediatric flexible bronchoscopy and impact on the quality of life: protocol for a single-centre, single-blind, randomised controlled trial

“… 13 FB and BAL are useful in immunocompetent children with unexplained infiltrates on chest radiographs leading to specific diagnosis in 30% of patients, 14 as well as immunosuppressed children (diagnostic in 65.1% of patients and the antimicrobial treatment changed for 56.8%of patients). 15 Furthermore, a specific diagnosis was made in almost 89.8% of children with congenital cardiac disease 16 and 33% of children with unexplained recurrent and persistent pneumonia, 17 after bronchoscopic evaluation. In another retrospective review consisting of 149 children, FB was described as a crucial diagnostic (confirming, ruling out and discovering unexpected diagnosis) and therapeutic tool.…”