Bronchoalveolar lavage during neutropenic episodes: diagnostic yield and cellular pattern

Cordonnier, C; Escudier, Estelle; Verra, F.; Brochard, Laurent; Bernaudin, J. F.; Fleury-Feith, J

doi:10.1183/09031936.94.07010114

Cited by 72 publications

(52 citation statements)

References 16 publications

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“…In these patients, reported diagnostic yields range from 35 to 60%. 8,9,11,12,15,17,[18][19][20][21][22][23][24] We found comparable results in our patients with lymphoid malignancies, with a diagnostic yield of 50%. The much lower diagnostic yield of FOB-BAL in our AML patients with ARF admitted in ICU raises several issues, dominated by the differences in studied populations between available reports.…”

Section: Overall Diagnostic Yield Of Fob-balsupporting

confidence: 72%

“…Accordingly, FOB-BAL yield was lower in our neutropenic than in nonneutropenic patients: 11 vs 36%. Conversely, no such difference was found in a large study by Cordonnier et al 18 However, it should be noticed that this study was not performed in ICU patients, although the number of patients who did not receive antibiotics was higher than in our study. Third, the prolonged neutropenia observed in AML patients leads to a higher incidence of pulmonary aspergillosis than in previous studies.…”

Section: Yield Of Fob-bal For the Diagnosis Of Infectious Pulmonary Ccontrasting

confidence: 52%

“…Comparable results varying from 16 to 25% were observed in previous studies. 9,18,20 Other authors found much higher therapeutic impact for FOB-BAL. 8,15 Several facts may explain these discrepancies.…”

Section: Fob-bal-related Therapeutic Changesmentioning

confidence: 98%

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Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

et al. 2008

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In patients with hematological malignancy (HM) developing acute respiratory failure (ARF) bronchoalveolar lavage (BAL) is considered as a major diagnostic tool. However, the benefit/risk ratio of this invasive procedure is probably lower in the subset of patients with acute myeloid leukemia (AML). The study was to analyze the yield of BAL performed in HM patients (n ¼ 175) with AML or lymphoid malignancies (LM) admitted in intensive care unit (ICU) for ARF and pulmonary infiltrates. BAL was performed in 121 patients (53/73 AML patients (73%) and 68/102 LM patients (67%)) without a definite diagnosis at admission or contraindication for fiberoptic bronchoscopy. Life-threatening complications were noticed in 12/121 patients (10%). The overall diagnostic yield of BAL was 47% (25/53) in AML patients and 50% (34/68) in LM patients. A microorganism was recovered from BAL in 23% (12/53) of AML patients and 41% (28/68) of LM patients (Po0.005). BAL results induced significant therapeutic changes in 17% (9/53) of AML patients vs 35% (24/68) of LM patients (P ¼ 0.039). This study underlines the rather low diagnostic yield of BAL for infectious diagnosis and the low rate of therapeutic changes induced by its results in AML patients with ARF admitted in ICU.

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Section: Overall Diagnostic Yield Of Fob-balsupporting

confidence: 72%

Section: Yield Of Fob-bal For the Diagnosis Of Infectious Pulmonary Ccontrasting

confidence: 52%

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Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

et al. 2008

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“…4,5 Bronchoscopy with bronchoalveolar lavage is an established method for the diagnosis of infectious pulmonary complications in neutropenic patients. 7 Respiratory tract cultures for IPA are regarded as highly specific, but rather low in sensitivity. 7,8 In this study, we report the diagnostic yield of bronchoscopy for IPA in neutropenic patients with histologically proven invasive fungal infection following high-dose chemotherapy or SCT.…”

mentioning

confidence: 99%

Diagnostic yield of bronchoscopy in histologically proven invasive pulmonary aspergillosis

Reichenberger

Habicht

Matt

et al. 1999

Bone Marrow Transplant

133

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Summary:Invasive pulmonary aspergillosis (IPA) is a life-threatening infectious complication in neutropenic patients after high-dose chemotherapy or hematopoietic stem cell transplantation. Its diagnosis is mainly based on clinical symptoms, and radiological signs on thoracic CT scan. The value of bronchoscopy is controversial. We analyzed the diagnostic yield of bronchoscopy in 23 consecutive patients with histologically proven invasive pulmonary aspergillosis. In seven patients (30%) bronchoscopically obtained specimens were diagnostic for pulmonary fungal infection. Typical hyphae were detected by cytology in six patients and fungal cultures were positive in four cases. Patients with a positive bronchoscopic result presented more often with multiple changes on thoracic CT scan (71%; 5/7), but had received a lower median cumulative dose of amphotericine B (300 mg; 168-3010 mg) compared to patients with non-diagnostic bronchoscopy (25% multiple lesions (4/16); amphotericine dose 1100 mg, 260-2860 mg). The diagnostic yield of bronchoscopy was not associated with clinical symptoms or duration of neutropenia. Bronchoscopy allows the diagnosis of IPA in about one third of patients. Fungal cultures and cytological examination of intrabronchial specimens obtained during bronchoscopy have a high specificity, but its sensitivity is low. It is advisable to perform diagnostic bronchoscopy before starting antifungal therapy. Better diagnostic tools are urgently needed.

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“…21 Dirksen et al 13 protwo of whom had AML, with a striking reduction or absence of ␤c protein expression on the cell surface.…”

Section: Figurementioning

confidence: 99%

Haematopoietic transplantation in pulmonary alveolar proteinosis associated with chronic myelogenous leukaemia

Rodríguez-Luaces

Lafuente

Martin

et al. 1997

Bone Marrow Transplant

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Summary:generated by gene targeting: these mutant mice developed pulmonary disease characteristic of PAP. In these animal models haematopoietic development and function were not Pulmonary alveolar proteinosis (PAP) is a disease of unknown etiopathogenesis sometimes associated with disturbed. [4][5][6] When found in association with haematological dismalignant haematological disorders. The potential reversibility of the process in these cases seems to be orders, PAP has been considered a secondary form. 7 In a series of haematology patients with respiratory failure, the related to recovery from the underlying disease. GM-CSF has acquired an important, potentially pathogenic incidence of PAP was 5.3%. 8 It has been suggested that in such cases, PAP may be the result of a disease-related role and BMT presents one therapeutic option effective in certain forms of human PAP. We present the case of defect in the AM function 9 and/or due to treatment (chemotherapy, radiotherapy, steroids). 10 The most signifia 43-year-old female patient with Ph؉ CML. During pretransplantation evaluation, unexpected pulmonary cant complication in both primary and secondary cases is superinfection, particularly by opportunistic organisms. The infiltrates were noted in the chest X-ray, PAP being diagnosed on biopsy. In view of the progressive respirpreferred diagnostic method both in primary 11 and secondary 8 PAP is bronchoalveolar lavage (BAL). atory symptomatology and her CML being in accelerated phase, the patient underwent haematopoietic transSpontaneous remission of idiopathic primary PAP has occasionally been described. 12 The use of BAL as therapy plantation. She died on day ؉12 from invasive pulmonary aspergillosis before a response could be has improved the prognosis considerably. However, the potential reversibility of the process in secondary PAP is observed. Pathogenic implications in PAP and the role of haematopoietic transplantation in this disease are related to prior recovery from the haematological condition. 8 The possible part played by a deficiency of GMdiscussed. Keywords: pulmonary alveolar proteinosis; CML; PBSC CSF in the pathogenesis of human PAP opens up new therapeutic possibilities, such as BMT 13 or treatment with transplantation; aspergillosis GM-CSF. 14 We present a case of PAP diagnosed in a female with CML. The patient underwent allogeneic haematopoietic Pulmonary alveolar proteinosis (PAP) is a heterogenous transplantation with the objective of achieving recovery and group of congenital and acquired diseases. It is characsubsequent control of the respiratory symptomatology. terized by deposition of extracellular granular material consisting of a mixture of phospholipids and surfactant proteins within the alveoli and airways. In humans, a fatal form of Case report congenital PAP arises from a mutation resulting in surfactant protein-B (SP-B) deficiency. 1 Acquired forms may be A 43-year-old female was diagnosed with CML Phϩ in found in previously healthy patients, but the pathogenic chronic phase during ho...

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Bronchoalveolar lavage during neutropenic episodes: diagnostic yield and cellular pattern

Cited by 72 publications

References 16 publications

Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

Diagnostic yield of bronchoscopy in histologically proven invasive pulmonary aspergillosis

Haematopoietic transplantation in pulmonary alveolar proteinosis associated with chronic myelogenous leukaemia

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