Bilateral bronchoalveolar lavage in the diagnosis of opportunistic pulmonary infections Journal Article

Authors: Meduri, G. U.; Stover, D. E.; Greeno, R. A.; Nash, T.; Zaman, M. B.
Article Title: Bilateral bronchoalveolar lavage in the diagnosis of opportunistic pulmonary infections
Abstract: To further improve the diagnostic value of bronchoscopy in the immunosuppressed population presenting with diffuse pulmonary infiltrates, we prospectively investigated the utility of bilateral bronchoalveolar lavage (BAL). We performed 62 bronchoscopies on 52 immunosuppressed patients. Of the 52 patients, 33 had pulmonary infections. The yield for Pneumocystis carinii pneumonia on bilateral BAL was 94 percent (31/33), compared to the 84 percent (51/61) previously obtained with unilateral BAL in our institution. The recovery of P carinii was unilateral in four of five patients without AIDS and in four of 26 patients with AIDS. Transbronchial biopsy gave a yield of 85 percent (11/13). In ten patients with definitive cytomegalovirus (CMV) pneumonia, recovery of CMV by combined culture and cytology was 100 percent. Of nine bronchoscopies with positive cytology for CMV, five showed cytopathologic changes in the BAL from both sides and four in the BAL from one side only. No complications were seen in the 14 patients with thrombocytopenia or the five patients receiving mechanical ventilation. Our findings indicate that bilateral BAL significantly increases the yield for recovery of P carinii (p<0.02) and CMV (p<0.001) in immunosuppressed patients.
Keywords: adult; aged; major clinical study; diagnostic accuracy; pneumocystis pneumonia; statistical analysis; diagnostic value; immune deficiency; lung infection; cytomegalovirus infection; oxygen saturation; opportunistic infection; respiratory failure; lung lavage; transbronchial biopsy; body temperature; fiberoptic bronchoscopy; aids related complex; human; male; female; priority journal; article
Journal Title: Chest
Volume: 100
Issue: 5
ISSN: 0012-3692
Publisher: American College of Chest Physicians  
Date Published: 1991-11-01
Start Page: 1272
End Page: 1276
Language: English
DOI: 10.1378/chest.100.5.1272
PUBMED: 1657538
PROVIDER: scopus
Notes: Article -- Export Date: 27 September 2019 -- Source: Scopus
Citation Impact
MSK Authors
  1. Muhammad B Zaman
    18 Zaman