HSV-1 occurred more in critically ill patients and high loads in BALF were associated with an increased mortality. The higher mortality observed in patients with HSV-1 load>10(5) ge/ml enforces its clinical relevance and necessitates to start randomized medical intervention studies.

There is no single cell type present in bronchoalveolar lavage (BAL) fluid that appears to be predictive for sarcoidosis. However, BAL fluid analysis can be very helpful in the differential diagnosis. A grouping of features, an elevated total cell count, predominantly lymphocytes, together with a nearly normal percentage of eosinophils and polymorphonuclear neutrophils and the absence of plasma cells, distinguish the most likely diagnosis of sarcoidosis from the most common interstitial lung diseases, extrinsic allergic alveolitis (EAA), nonspecific interstitial pneumonia (NSIP), and idiopathic pulmonary fibrosis (IPF). In sarcoidosis the majority of cases have an increased number of lymphocytes and a normal amount of eosinophils and neutrophils. Disease presentation or activity at the time the BAL is performed as well as the smoking status is crucial for interpretation of individual BAL fluid analysis results. In severe cases the number of neutrophils can be increased as well. For an individual case the CD4:CD8 ratio is of less importance because it can be increased, normal, and even decreased. In the follow-up depicting prognosis and response to treatment, BAL fluid analysis has less clinical relevance.

Pneumocystis jiroveci pneumonia (PCP) is an opportunistic infection affecting immunocompromised patients. While conventional diagnosis of PCP by microscopy is cumbersome, the use of PCR to diagnose PCP has great potential. Nevertheless, inter-laboratory validation and standardization of PCR assays is lacking. The aim of this study was to evaluate the inter-laboratory agreement of three independently developed real-time PCR assays for the detection of P. jiroveci in bronchoalveolar lavage fluid samples. Therefore, 124 samples were collected in three tertiary care laboratories (Leiden University Medical Center, Maastricht Infection Center and Radboud University Nijmegen Medical Centre) and were tested by both microscopy and real-time PCR. Of 41 samples positive for P. jiroveci by microscopy, 40 were positive in all three PCR assays. The remaining sample was positive in a single assay only. Out of 83 microscopy-negative samples, 69 were negative in all three PCR assays. The other 14 samples were found positive, either in all three assays (n=5), in two (n=2) or in one of the assays (n=7). The data demonstrate high inter-laboratory agreement among real-time PCR assays for the detection of P. jiroveci.

Purpose: Soluble Triggering Receptor Expressed on Myeloid cells-1 (sTREM-1) has proven to be a good biomarker for sepsis. For the diagnosis ventilator-associated pneumonia (VAP), however, there have only been a few, relatively small, studies on the role of this receptor. The aim of the study was to evaluate the usefulness of sTREM-1 in bronchoalveolar lavage fluid (BALF) from Intensive Care Unit patients as rapid diagnostic test for VAP. Methods: The concentration of sTREM-1 in 240 BALF samples was measured using a quantitative sandwich enzyme immunoassay. Two researchers who were blind to the assay results determined whether a VAP was present or not. Clinical suspicion of a VAP was confirmed by the presence of C2% cells containing intracellular organisms and/or a quantitative culture result of C10 4 colony forming units per millilitre BALF. Results: The mean concentration of sTREM-1 was significantly higher in the BALF of patients with confirmed VAP than in that of patients without confirmed VAP. However, the area under the receiveroperating characteristic curve was 0.58 (95% confidence interval 0.50-0.65, P = 0.04). Conclusions: The results imply that the sTREM-1 assay in BALF may not be discriminative for VAP.

Background: Diagnosis of ventilator-associated pneumonia (VAP) is difficult. The usefulness of high-sensitivity procalcitonin (ProCa-S) and high-sensitivity C-reactive protein (CRPH) in bronchoalveolar lavage (BAL) fluid and serum in the prediction of VAP was determined. Methods: The study was conducted over a 28-month period (November 1999-June 2002 at the University Hospital Maastricht. BAL fluid samples were collected from patients admitted to the intensive care unit. Differential cell count and quantitative culture of BAL fluid were performed. C-reactive protein (CRP) and procalcitonin (PCT) on BAL fluid were determined by means of two high-sensitivity kits (CRPH and ProCa-S, respectively). Since both kits were designed for use on serum, validation for use on BAL fluid was performed. Results: A total of 117 patients were included. 43.6% (51/117) had microbiologically confirmed VAP. Both CRPH and ProCa-S showed good matrix effect, linearity and intra-and inter-assay variation. No significant differences in PCT and CRP concentrations in serum and BAL fluid were found between the VAP and the non-VAP group. Conclusions: Both the ProCa-S and the CRPH kits can be used for assessing the concentration of PCT and CRP in BAL fluid, respectively. PCT and CRP concentrations in BAL fluid appeared to be of no additional value in the diagnosis of VAP. 2008; 45: 293-298. DOI: 10.1258 45: 293-298. DOI: 10. /acb.2007 Introduction Ventilator-associated pneumonia (VAP) is a common complication in intensive care patients. The clinical diagnosis is difficult and a definite microbiological diagnosis is based on quantitative culture of bronchoalveolar lavage (BAL) fluid exceeding 10 4 colony forming units (cfu) per mL and/or the presence of !2% cells with phagocytized organisms (infected cells, IC). Ann Clin Biochem1,2 Routine application of BAL fluid analysis is limited by the fact that this procedure is expensive and time-consuming, and relies upon specialized technicians. In most hospitals, facilities for BAL fluid cytology are not available on a 24 h basis, therefore we were interested in a fast method, present in most hospitals, to predict VAP. Several markers to differentiate between inflammation and infection have been described in the literature.3,4 Determination of C-reactive protein (CRP) in serum is a valuable marker of infection in serum. 5,6 Procalcitonin (PCT) has shown great potential as a marker in serum in recent years. 7,8 The value of PCT in serious bacterial infection, mainly sepsis, has been shown, 9 -15 and it could also be useful in the diagnosis of other infections like yeast 16 and parasitic infection. 17 Few studies have investigated the value of PCT in patients with pneumonia. The studies that are available show discrepant results 15,18,19 and all focused on detection of parameters in serum from patients with a community-acquired pneumonia. One of the drawbacks of detecting any parameter in BAL fluid is the dilution (approximately 10-100 times) of the original fluid present in the alveoli....