Bronchoalveolar lavage (BAL) in miliary tuberculosis

Sharma, S.; Pande, J N; Verma, Khyati

doi:10.1016/0041-3879(88)90018-9

Cited by 18 publications

(7 citation statements)

References 9 publications

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“…Patients with TB had a significantly higher total cell count and increased proportion of lymphocytes and CD3 + and CD4 + T lymphocytes in the BAL fluid 101. In patients with miliary TB, BAL showed lymphocytic alveolitis 101,109. The finding of increased CD4 + lymphocytes in the BAL fluid and their depletion in the peripheral blood suggested compartmentalization of lymphocytes at the site of inflammation.…”

Section: Diagnosismentioning

confidence: 99%

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Diagnosis and management of miliary tuberculosis: current state and future perspectives

Ray¹,

Talukdar²,

Kundu³

et al. 2013

TCRM

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Tuberculosis (TB) remains one of the most important causes of death from an infectious disease, and it poses formidable challenges to global health at the public health, scientific, and political level. Miliary TB is a potentially fatal form of TB that results from massive lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli. The epidemiology of miliary TB has been altered by the emergence of the human immunodeficiency virus (HIV) infection and widespread use of immunosuppressive drugs. Diagnosis of miliary TB is a challenge that can perplex even the most experienced clinicians. There are nonspecific clinical symptoms, and the chest radiographs do not always reveal classical miliary changes. Atypical presentations like cryptic miliary TB and acute respiratory distress syndrome often lead to delayed diagnosis. High-resolution computed tomography (HRCT) is relatively more sensitive and shows randomly distributed miliary nodules. In extrapulmonary locations, ultrasonography, CT, and magnetic resonance imaging are useful in discerning the extent of organ involvement by lesions of miliary TB. Recently, positron-emission tomographic CT has been investigated as a promising tool for evaluation of suspected TB. Fundus examination for choroid tubercles, histopathological examination of tissue biopsy specimens, and rapid culture methods for isolation of M. tuberculosis in sputum, body fluids, and other body tissues aid in confirming the diagnosis. Several novel diagnostic tests have recently become available for detecting active TB disease, screening for latent M. tuberculosis infection, and identifying drug-resistant strains of M. tuberculosis. However, progress toward a robust point-of-care test has been limited, and novel biomarker discovery remains challenging. A high index of clinical suspicion and early diagnosis and timely institution of antituberculosis treatment can be lifesaving. Response to first-line antituberculosis drugs is good, but drug-induced hepatotoxicity and drug–drug interactions in HIV/TB coinfected patients create significant problems during treatment. Data available from randomized controlled trials are insufficient to define the optimum regimen and duration of treatment in patients with drug-sensitive as well as drug-resistant miliary TB, including those with HIV/AIDS, and the role of adjunctive corticosteroid treatment has not been properly studied. Research is going on worldwide in an attempt to provide a more effective vaccine than bacille Calmette–Guérin. This review highlights the epidemiology and clinical manifestation of miliary TB, challenges, recent advances, needs, and opportunities related to TB diagnostics and treatment.

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Section: Diagnosismentioning

confidence: 99%

“…A limited number of reports on the cellular characteristics of BAL in patients with miliary TB have been published, with conflicting results 100,101,109. Patients with TB had a significantly higher total cell count and increased proportion of lymphocytes and CD3 + and CD4 + T lymphocytes in the BAL fluid 101.…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and management of miliary tuberculosis: current state and future perspectives

Ray¹,

Talukdar²,

Kundu³

et al. 2013

TCRM

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“…The decrease in macrophage/monocyte frequencies in the TB cohort may reflect increased numbers and proportions of neutrophilic populations that predominate in TB patients and thus translate into decreased macrophage frequency expressed as a percentage. Alternatively, we could argue in favour of previously published data that supports the observed decreased frequency of alveolar macrophage frequencies in the BALF of TB-infected patients [25,31,32]. Another study proposed the ability of Mtb to hijack macrophages and promote translocation from the airway to the lung parenchyma, thus acting as supporting evidence to substantiate the reported pattern of decreased frequencies and cell number of airway macrophages within the BALF of TB-laden individuals, relative to the appropriate controls [33].…”

Section: Discussionmentioning

confidence: 57%

Performance and immune characteristics of bronchoalveolar lavage by research bronchoscopy in pulmonary tuberculosis and other lung diseases in the Western Cape, South Africa

Young¹,

Ahlers²,

Hiemstra³

et al. 2019

transl med commun

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Background: Tuberculosis (TB) remains a debilitating, deadly disease that warrants innovative research tools to fully understand the pathogenesis and host immune responses, particularly at the site of infection and disease. In this regard, bronchoscopies with bronchoalveolar lavage (BAL) serve as a valuable technique for site of disease sample retrieval for further clinical-and basic research. Here we investigate the feasibility of research bronchoscopies in a low/middle-income area, where TB remains rife, and assess the value of retrieved BAL cells (BALC) for downstream fluorescent-based cellular evaluations. Methods: Using quantitative and qualitative methods, we evaluate the outcomes, safety, tolerability, participant-perception and-experience, while also providing insight into participant recruitment and screening processes of our study. Using light microscopy differential counting for BALC analysis, we evaluate the cellular composition of BAL fluid (BALF) from TB patients, healthy community controls and patients with other lung diseases. We also use flow cytometry to describe the challenges associated with fluorescence-based phenotypic analysis of autofluorescent BALC. Results: Our findings suggest that research bronchoscopies are safe, acceptable procedures for research participants and are indeed a feasible technique for future study design. We also suggest that the majority of participants are receptive to the proposition of a second research bronchoscopy. This poses an important avenue for research entailing follow-up investigations of the same study participant. Furthermore, our results show that smoking is characterized by retrieval of BALC containing particulate matter, that interferes with fluorescence-based flow cytometry data analysis. Based on light microscopy differential cell counting, our findings suggest that there are differences in the cell yields and cellular composition of the BALF between TB patients, healthy community controls and patients with other lung diseases. We also report on subject characteristics and demographic factors, namely gender and age, that have the potential to affect cell yields and cellular data of BALF.

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“…A diagnosis of PCIP could be established in 24 patients, 19 of whom were HIV infected and 5 of whom were receiving immunosuppressive medications after transplantation. In 16 patients with AIDS, it was the first episode of P carinli infection, in 2 the second, and in 1 patient the third episode.…”

Section: Resultsmentioning

confidence: 99%

The Role of Two-Segment Bronchoalveolar Lavage in the Diagnosis of Pulmonary Infections

Grebski

Russi

Speich

et al. 1994

Chest

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Bronchoalveolar lavage (BAL) in miliary tuberculosis

Cited by 18 publications

References 9 publications

Diagnosis and management of miliary tuberculosis: current state and future perspectives

Diagnosis and management of miliary tuberculosis: current state and future perspectives

Performance and immune characteristics of bronchoalveolar lavage by research bronchoscopy in pulmonary tuberculosis and other lung diseases in the Western Cape, South Africa

The Role of Two-Segment Bronchoalveolar Lavage in the Diagnosis of Pulmonary Infections

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