Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates

Choo, Randall; Naser, Naser Salman Hamza; Nadkarni, Nivedita; Anantham, Devanand

doi:10.1186/s12890-019-0801-2

Cited by 28 publications

(32 citation statements)

References 30 publications

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“…Our case illustrates the continued clinical relevance and utility of BAL in aiding microbiological diagnosis of pulmonary infections during advanced HIV infections, with BAL results yielding positive microbiology for bacterial, viral and fungal microorganisms. The diagnostic yield of BAL in this setting is very high and often leads to treatment modification [36,37].…”

Section: Discussionmentioning

confidence: 99%

A rare case of CMV pneumonia in HIV-infection

Poh

Zheng

2019

Respiratory Medicine Case Reports

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A B S T R A C T Cytomegalovirus (CMV) pneumonia is a rare opportunistic infection in the setting of HIV (Human Immunodeficiency Virus)-infection. Establishing accurate diagnosis of CMV pneumonia in HIV-infection can be challenging. Co-infections by multiple opportunistic pathogens are common and a high degree of clinical vigilance to evaluate for multiple infections, including CMV pneumonia, should be maintained. As there can be a degree of overlap in clinical and radiological features amongst different opportunistic infections affecting the lungs, definitive microbiological and cytohistologic evidences are needed. Reliance on microbiological evidence of CMV in respiratory specimens alone for the diagnosis of CMV pneumonia will lead to an over-diagnosis of the condition and unnecessary treatment.In our case report, we describe a 53-year-old man with recently diagnosed HIV-infection who presented with non-resolving pneumonia. A diagnosis of CMV pneumonia was reached through consistent clinical, radiological, microbiological and cytologic investigations. The patient made a full clinical recovery after being started on anti-CMV treatment.

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Section: Discussionmentioning

confidence: 99%

A rare case of CMV pneumonia in HIV-infection

Poh

Zheng

2019

Respiratory Medicine Case Reports

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“…Neuropathy, seizures, or even coma has been reported due to local anesthetics overdose [ 4 ]. Other medication-related complications include prolonged neuromuscular paralysis, hyperthermia, and hemodynamic instability [ 4 , 5 ]. On the other hand, procedural complications such as pneumothorax and bleeding can happen [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Flexible Fiberoptic Bronchoscopy: Indications, Diagnostic Yield and Complications

Qanash¹,

Hakami²,

Al-Husayni³

et al. 2020

Cureus

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Objective Flexible fiberoptic bronchoscopy (FFB) has become an essential procedure for diagnosing and managing various respiratory conditions. We aimed to assess the main indications, diagnostic yield, and safety of FFB in our institute. Methods A total of 216 patients who underwent FFB between July 2009 and June 2012 at King Abdul-Aziz Medical City, Jeddah, Saudi Arabia, were reviewed retrospectively. Indications of the procedure, the diagnostic yield of variable respiratory diseases, and complications were reported. Result Out of 216 patients, 210 (97.2%) completed FFB. One hundred and ninety-eight (91.7%) bronchoscopies were for diagnostic purposes, and the remaining 12 (5.6%) were for therapeutic aim. The mean age of patients was 50 years ± 20 years and patients. Respiratory infection, malignancy, pulmonary infiltrate in febrile neutropenia (FN), and hemoptysis in order of frequency were the main indications. The overall diagnostic yield was 46%. Mycobacterium tuberculosis (MTB) was the most common indication (26.8%) and was identified in 37.7%, whereas pneumonia was confirmed in 46.3% of the patients. Malignancy was established in 35.3% of suspected cases, while eosinophilic pneumonia was diagnosed in 100%. The diagnostic yield in pulmonary infiltrates of human immunodeficiency viral (HIV) was 85.7%. Alveolar hemorrhage was the most common cause of hemoptysis. Out of therapeutic bronchoscopy, lung collapse was the main indication. There is no mortality and complications occurred in 1.5% of the cases. Conclusion MTB was the most common indication of FFB, followed by malignancy. It has a high diagnostic yield in eosinophilic pneumonia and pulmonary infiltrates in HIV patients. FFB is shown to be a safe modality for diagnostic and therapeutic purposes.

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“…Bronchoscopy is a crucial diagnostic modality in the evaluation of pneumonia in immunosuppressed individuals. A few studies address the role of bronchoscopy in the evaluation of febrile neutropenia with pulmonary infiltrates 7,8 . However, IMIs are challenging to diagnose and thus remain poorly studied 9,10 .…”

Section: Discussionmentioning

confidence: 99%

Role of flexible bronchoscopy in the diagnosis of invasive fungal infections

Muthu

Gandra

Dhooria

et al. 2021

Mycoses

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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.

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Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates

Cited by 28 publications

References 30 publications

A rare case of CMV pneumonia in HIV-infection

A rare case of CMV pneumonia in HIV-infection

Flexible Fiberoptic Bronchoscopy: Indications, Diagnostic Yield and Complications

Role of flexible bronchoscopy in the diagnosis of invasive fungal infections

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