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.
Patient charts were reviewed to identify underlying diseases, clinical presentation, the presence of oral candidiasis (thrush), concomitant serologic tests for C immitis, and subsequent clinical course following BAL. Five patients had BALs on two occasions and two patients had three BALs; each of these represented separate episodes of disease. The diagnostic accuracy of BAL was judged by the clinical course and/or response to therapy in 44 cases and by biopsy or autopsy in 16 cases.