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Detection of Fungi and Other Pathogens in Immunocompromised Patients by Bronchoalveolar Lavage: Results (Part 2)

Detection of Fungi and Other Pathogens in Immunocompromised Patients by Bronchoalveolar Lavage: Results (Part 2)Fungi
In 12 of the 60 episodes, fungi were identified as the cause of the pulmonary infiltrates (Table 2), C immitis being found in seven cases. This fungus was grown from culture of five BALs, three of which had previously shown the organism cytologically (Fig 1).
One additional case was diagnosed at autopsy and the other was diagnosed from blood and bronchial brush-ings. Only one of the seven cases of coccidioidomycosis occurred in an AIDS patient. Serologic studies for coccidioidomycosis were obtained during 46 of the 60 episodes, including all seven of those in which such a diagnosis was ultimately confirmed. Five of the seven were positive, with complement-fixing antibody titers (four patients) that ranged from 1:4 to 1:256. In one patient, precipitating antibody was present with a negative complement-fixing titer, and in two others, the titer was positive with a negative precipitating reaction. Serologic studies in the patient whose condition was diagnosed at autopsy were negative two weeks prior to his death. Among the 39 other samples tested, two were positive. In neither case was there evidence of significant active infection. buy diabetes drugs
The three episodes of cryptococcal pneumonia all occurred in AIDS patients; the organism was seen cytologically and cultured in one BAL but it was absent in the two others. Disseminated cryptococcal infection was eventually demonstrated in these latter two patients by lymph node or bone marrow biopsy specimen. Invasive aspergillosis was diagnosed in two non-AIDS patients.

Table 2—Pathogenic Fungi in Immunocompromised Patients Undergoing BAL

Age, y/Sex

Underlying Disease

Organism

BAL

Cytology

BAL

Culture

How Organism Was Detected

33/M

AIDS

Cryptococcus neoformans

+

+

BAL

38/M

AIDS

C neoformans

Lymph node biopsy

27/M

AIDS

C neoformans

Bone marrow biopsy

38/M

AIDS

Coccidioides immitis

+

+

BAL

84/M

Prostatic cancer

C immitis

Blood culture

30/M

Uncontrolled diabetes

C immitis

+

+

BAL

23/F

Hodgkins disease

C immitis

+

BAL

78/M

Myelodysplasia

C immitis

Autopsy

88/F

Treated polymyositis

C immitis

+

BAL

24/M

Hodkins disease,

C immitis

+

+

BAL, skin biopsy

67/M

Leukemia

Aspergillus sp

Open lung biopsy

67/M

Malnutrition

Aspergillus terreus

+

• +

BAL, transbronchial biopsy

Figure_1

Figure 1. Photomicrographs of spherules of Coccidioides immitis in bronchoalveolar lavage (BAL) fluid: A, Small spherule (arrow) phagocvtized by a macrophage. B, Mature spherule with endospores, slightly folded. C, Collapsed empty spherule surrounded by inflammatory cells, (all Papanicolaou stain, X 1135).

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