Medicine of the Future in America

Category Archives: Bronchoalveolar Lavage - Part 2

Detection of Fungi and Other Pathogens in Immunocompromised Patients by Bronchoalveolar Lavage: Results (Part 1)

Thirty-five BALs were examined in 30 patients with a prior diagnosis of AIDS or in whom a diagnosis of AIDS was made following BAL. The 25 BALs in nonAIDS patients (21 patients) were largely in the setting of treated hematologic-lymphoid disease, including eight cases of Hodgkins disease, three of multiple myeloma, three of acute myelogenous leukemia, and one each of myelodysplasia and lymphoid interstitial pneumonia. Two patients had treated carcinomas, one prostate and one lung. Four were patients with organ transplants, two heart-lung and two heart. One case each of severe malnutrition, corticosteroid-treated polymyositis, and uncontrolled diabetes mellitus was noted. Continue reading

Detection of Fungi and Other Pathogens in Immunocompromised Patients by Bronchoalveolar Lavage: Materials and Methods

We identified 63 consecutive BALs from 54 adult (older than 15 years old) immunocompromised patients with bilateral pulmonary infiltrates. Three patients were excluded from further study because no final diagnosis was ever determined, leaving 60 BALs in 51 patients for analysis. Alveolar sampling was achieved by broncho-scopic lavage of a portion of the lung, usually the right middle lobe, with three 50-ml aliquots of normal saline solution. The return was pooled and separate specimens were submitted for cytologic and microbiologic evaluation. birth control pills
Portions of the lavage were cultured for bacteria (including Legionella sp, Mycoplasma sp, and Chlamydia trachomatis, viruses, fungi, and mycobacteria. Occasional specimens were not cultured for all pathogens. Cytologic evaluation was performed on cytocentrifuge preparations of undiluted fluid and prepared with Papanicolaou (Pap) stain, Grocotts methenamine silver (GMS), hematoxylin-eosin, and iron stain in 50 specimens and Pap and GMS stain only in ten. Continue reading

Detection of Fungi and Other Pathogens in Immunocompromised Patients by Bronchoalveolar Lavage

Detection of Fungi and Other Pathogens in Immunocompromised Patients by Bronchoalveolar LavageBronchoalveolor lavage (BAL) is used in many institutions as the initial diagnostic procedure to determine the cause of diffuse pulmonary infiltrates in immunocompromised patients. This procedure is particularly successful in identifying Pneumocystis carinii and various bacterial pathogens, as well as viruses, mycobacteria, and fungi. Specific experience with several pathogenic fungi, such as Cryptococcus sp, Histoplasma capsulatum, Candida sp, and Aspergillus sp, has been described. However, no study has looked systematically at the incidence and ease of detection of Coccidioides immitis, the dimorphic fungus causing coccidioidomycosis, in BAL fluid from immunocompromised hosts. Coccidioides immitis is indigenous to the southwest United States, particularly the Sonoran Dessert, in a zone stretching from western Texas to the valleys of California, including northern Mexico. Tucson, Arizona, the site of the present study, is situated at the approximate geographic center of this distribution. ventolin inhaler
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