Hemorrhagic necrotizing aspergillosis was diagnosed both cytologically and by culture from a BAL and confirmed by transbronchial biopsy. However, a case of granulomatous aspergillosis was not detected by BAL, but it was diagnosed subsequently by open lung biopsy. Aspergillus sp was also grown from a BAL in one AIDS patient with Pneumocystis pneumonia, but there was no evidence of pulmonary infection clinically or in a transbronchial biopsy specimen. Fungi consistent with Candida sp, including Toru-lopsis glabrata and yeast not otherwise identified (not Cryptococcus) were detected cytologically in nine BALs and cultured in 23. The ability to culture the Candida-like organism from BAL was positively correlated with the presence of thrus h (x2 = 6.61; p = 0.01). However, in no case was it apparent, clinically or pathologically, that Candida was a cause of lower respiratory tract infection.
Pneumocystis carinii was the most frequent pathogen isolated from BAL fluid. The organism was seen cytologically in 27 of the 60 specimens, 26 of which were from the AIDS population. In one AIDS patient with a negative BAL, Pneumocystis pneumonia was diagnosed clinically by lack of other identifiable causes for pulmonary infiltrates coupled with complete response to trimethoprim-sulfamethoxazole. Although this drug may be therapy for other infections as well, we would regard the case as one of Pneumocystis because of the high likelihood of this organism being present. One non-AIDS patient had a negative BAL but sputum positive for Pneumocystis. In each case positive by Pap stain, the presence of the organism was confirmed by GMS stain, and in no case was an additional identification of Pneumocystis made with this special stain.