Bronchoalveolor lavage (BAL) is used in many institutions as the initial diagnostic procedure to determine the cause of diffuse pulmonary infiltrates in immunocompromised patients. This procedure is particularly successful in identifying Pneumocystis carinii and various bacterial pathogens, as well as viruses, mycobacteria, and fungi. Specific experience with several pathogenic fungi, such as Cryptococcus sp, Histoplasma capsulatum, Candida sp, and Aspergillus sp, has been described. However, no study has looked systematically at the incidence and ease of detection of Coccidioides immitis, the dimorphic fungus causing coccidioidomycosis, in BAL fluid from immunocompromised hosts. Coccidioides immitis is indigenous to the southwest United States, particularly the Sonoran Dessert, in a zone stretching from western Texas to the valleys of California, including northern Mexico. Tucson, Arizona, the site of the present study, is situated at the approximate geographic center of this distribution. ventolin inhaler
Coccidioidomycosis has long been recognized as an important fungal infection in this area, even in those with normal immune status. With the emergence of acquired immunodeficiency syndrome (AIDS), disseminated coccidioidomycosis has been identified as a significant contributor to mortality in this setting. The ease of identifying C immitis in bronchial secretions has been documented previously. In this report we describe the usefulness of BAL in the diagnosis of coccidioidomycosis in an immunocompromised population with diffuse pulmonary infiltrates and compare the diagnostic yield in AIDS vs non-AIDS patients. Also, we determined the relative frequency of Pneumocystis, bacterial, viral, and other fungal isolates, and other infiltrative diseases in the two patient groups.