Medicine of the Future in America

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.
Findings at BAL and final diagnoses are shown in Table 1. In general, BAL provided an accurate diagnosis of a specific process in 43 of 60 episodes that ultimately had a definite clinical or anatomic diagnosis. In nine instances a BAL that showed no abnormalities (“negative” BAL) correlated with the clinical impression and accurately ruled out infectious and/or other causes (vide infra). In these nine patients, serologic studies for coccidioidomycosis were negative at the time of BAL in seven and not done in two. Cultures of blood, sputum, and urine showed no pathogens to explain the pulmonary infiltrates. Autopsy in three cases and open lung biopsy in one case ruled out infection and neoplasm that could have been reflected in the BAL. In eight instances either Pneumocystis (two cases), lymphoma (one case), or a pathogenic fungus (five cases) was missed in the BAL. Thus, the overall diagnostic accuracy (sensitivity) of BAL in this population was 52/60 or 87 percent. There was no significant difference in sensitivity between AIDS and non-AIDS cases.

Table 1—Final Diagnosis for 60 BALs

AIDS:

36 Specimens

Non-AIDS: 25 Specimens

Pneumocystis

27 (l)

2 (1)

Fungi

4 (2)

8 (3)

Bacteria

5

3

Viruses

0

1

Neoplasm

1 (1)

4

Radiation pneumonia

0

5

Drug reaction

1

2

Allograft rejection

0

2

Adult respiratory

distress syndrome

0

2

Total diagnoses

38

29

 

This entry was posted in Bronchoalveolar Lavage and tagged Bronchoalveolar Lavage, Cytomegalovirus, Pathogens, Pneumonia.
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