Although others* have described invasive candidal pneumonia in some patients in whom Candida sp were isolated from BALs, we found no clinical or pathologic evidence that Candida sp were respiratory pathogens in our series. The positive correlation between oral candidiasis and a positive BAL culture for Candida sp suggests that many instances of Candida in BALs represent contamination from the upper respiratory tract. Aspergillus sp similarly can colonize the tracheobronchial tree, as was the case in one AIDS patient whose BAL showed growth of Aspergillus sp and contained Pneumocystis. Transbronchial biopsy specimen showed only Pneumocystis and the clinical course was that of Pneumocystis pneumonia. The recovery of Aspergillus sp from BAL does not indicate invasive disease, and a tissue biopsy specimen may be necessary to evaluate its role as a pathogen. buy asthma inhalers
The recovery of a potentially pathogenic virus, either cytomegalovirus or herpes simplex virus, in more than one third of the cases is a higher percentage than reported by others and underscores the problem cited by Broaddus et al that not all positive viral cultures imply disease. Detection of either cytomegalovirus or herpes simplex virus in BALs by monoclonal antibody staining or culture was far more sensitive in detecting the presence of virus than cytologic study, as others have shown. In 20 instances cytomegalovirus or herpes simplex virus was identified in association with another known pathogen, usually Pneumocystis. It is possible that in some cases the virus was contributing to the patients pneumonia.