Fiberoptic bronchoscopy in allogeneic bone marrow transplantation: Findings in the era of serum cytomegalovirus antigen surveillance Journal Article

Authors: Feinstein, M. B.; Mokhtari, M.; Ferreiro, R.; Stover, D. E.; Jakubowski, A.
Article Title: Fiberoptic bronchoscopy in allogeneic bone marrow transplantation: Findings in the era of serum cytomegalovirus antigen surveillance
Abstract: Study objectives: Pulmonary complications occur in half of allogeneic bone marrow transplantation (BMT) patients. The incidence of these complications has been reduced by prophylaxis against Pneumocystis carinii pneumonia, preemptive therapy in patients at high risk for cytomegalovirus (CMV) reactivation, and, more recently, screening for serum CMV antigen. Since fiberoptic bronchoscopy (FOB) has historically been the primary diagnostic test to evaluate BMT patients with pulmonary disease, a review was performed to determine the impact, if any, that current prophylaxis and screening policies may have had on FOB utility. Design: The records of 174 adult patients undergoing BMT between January 1997 and December 1999 were reviewed to determine the diagnostic yield of FOB and the frequency by which FOB altered management. Results: Sixty-one patients underwent 76 bronchoscopies. FOB was diagnostic in 32 patients (42.1% of cases) and directly changed management in 24 patients (31.6% of cases). Half of these changes included the withdrawal of an antimicrobial agent. The most common findings were infection (32 cases) and diffuse alveolar hemorrhage (6 cases). CMV was the most prevalent infection identified, but FOB resulted in the addition of antiviral therapy to only two patients. P carinii pneumonia was not diagnosed in any patient studied. Conclusions: These data suggest a changing spectrum of pulmonary disease in BMT patients. FOB has limited impact on the diagnoses of CMV disease or P carinii pneumonia with current prophylaxis and screening strategies. It may be useful in identifying other infectious etiologies and in eliminating unnecessary antimicrobials.
Keywords: adolescent; adult; middle aged; retrospective studies; transplantation, homologous; major clinical study; drug withdrawal; diagnosis, differential; lung disease; prevalence; allogenic bone marrow transplantation; patient care; antiinfective agent; prophylaxis; predictive value of tests; virus antigen; bronchoscopy; antivirus agent; diagnostic test; bone marrow transplantation; cytomegalovirus infection; cytomegalovirus; opportunistic infections; respiratory failure; lung hemorrhage; pneumonia, bacterial; sulfamethoxazole; trimethoprim; antigens, viral; fiberoptic bronchoscopy; cytomegalovirus infections; pneumonia, viral; humans; human; male; female; priority journal; article; bal
Journal Title: Chest
Volume: 120
Issue: 4
ISSN: 0012-3692
Publisher: American College of Chest Physicians  
Date Published: 2001-10-01
Start Page: 1094
End Page: 1100
Language: English
DOI: 10.1378/chest.120.4.1094
PUBMED: 11591544
PROVIDER: scopus
Notes: Export Date: 21 May 2015 -- Source: Scopus
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