Clinical Utility of Bronchoalveolar Lavage in Immunocompromised Hosts

Pisani, Richard J.; Wright, Alan J.

doi:10.1016/s0025-6196(12)60096-2

Cited by 91 publications

(49 citation statements)

References 19 publications

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“…The result of six of these studies from 1984 to 1995 5,7,[11][12][13][14] are summarised in Table 3. BAL is less invasive than TBB, is well tolerated and is essentially devoid of direct complications. BAL appears to have an equivalent diagnostic yield to TBB when the underlying diagnosis is infection as in PCP (90%) and Aspergillus (40-50%).…”

Section: Discussionmentioning

confidence: 99%

Use of first line bronchoalveolar lavage in the immunosuppressed oncology patient

Murray

O’Brien

Padhani

et al. 2001

Bone Marrow Transplant

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Summary:Immunosuppressed oncology patients who develop pulmonary infiltrates during treatment have a mortality rate of the order of 55-90%. Early diagnosis and treatment is associated with increased survival. At present, diagnosis relies on invasive sampling of the respiratory tract using fibre-optic bronchoscopy. We have looked at a 30-month period, from June 1997 to December 1999, where 25 bronchoscopies were performed on patients from the Lymphoma and BMT units at The Royal Marsden Hospital for the further investigation of pulmonary infiltrates. Nine bronchoscopies (36%) yielded a positive result and seven (28%) led to a change in management. Analysis of the data showed that neither a positive result nor a change in management had any impact on overall survival. After reviewing the background literature on the investigation of pulmonary infiltrates in this group and discussion of the respective merits and limitations, we propose a management flowchart, with high-resolution computed tomography (HRCT) as the test arm in a future randomised trial of these patients. Bone Marrow Transplantation (2001) 27, 967-971. Keywords: oncology; HRCT; bronchoscopy The lung is a frequent site of infection in patients receiving treatment for malignancy. This occurs in up to 20% of cases and has a quoted mortality rate of 55-90%. 1,2 Although infection is the single most common cause of pulmonary infiltrates, a significant number are due to noninfective causes notably lung involvement with the primary malignancy, drug-related parenchymal disease, obliterative bronchiolitis, cryptogenic organising pneumonia (COP or BOOP), graft-versus-host disease and alveolar haemorrhage. The underlying pathogens are themselves dependent on the pattern of immunosuppression, as infections in patients with short bursts of neutropenia related to chemo-

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Section: Discussionmentioning

confidence: 99%

Use of first line bronchoalveolar lavage in the immunosuppressed oncology patient

Murray

O’Brien

Padhani

et al. 2001

Bone Marrow Transplant

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“…The di ag nos tic yield of BAL alone was 50%, with sheathed brushes con trib ut ing ad di tional in for ma tion in three cases, brush cy tology in one case and TBB in seven cases. A re view of other reports in the lit era ture in di cates a di ag nos tic yield for BAL in simi lar pa tient groups rang ing from 39 to 87% (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). This vari abil ity may in part be re lated to dif fer ences in pa tient popu la tions, as sug gested by Pi sani and Wright (2).…”

Section: Discussionmentioning

confidence: 63%

“…Clini cal and ra dio graphic fea tures are of ten non spe cific, and fi bre op tic bron cho scopy is fre quently used as a pri mary means of evalua tion. Pre vi ous stud ies have as sessed the util ity of bron cho scopy in the di agno sis of pul mo nary dis ease in the im mu no com pro mised host with var ied re sults de pend ing on the tech niques em ployed, popu la tion stud ied and di ag nos tic cri te ria used (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). The ob jec tive of this study was to de ter mine the di ag nos tic util ity of bron cho scopy in a popu la tion of im mu no com pro mised hosts in north ern Al berta by com par ing bron choal veo lar lavage (BAL) with pro tected double-sheathed brushes, cy tology brushes and trans bron chial lung bi opsy (TBB).…”

Section: B Oth In Fec Tious and Non In Fec Tious Eti Olo Gies Maymentioning

confidence: 99%

Fibreoptic Bronchoscopy in the Diagnosis of Pulmonary Disease in the Immunocompromised Host in Northern Alberta

Crocket¹,

Chaput²,

Lien³

1995

Canadian Journal of Infectious Diseases and Medical Microbiolog

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JA CROCKET, MR CHAPUT, DC LIEN. Fi bre op tic bron cho scopy in the di ag no sis of pul mo nary dis ease in the im mu no com pro mised host in north ern Al berta. Can J In fect Dis 1995;6(6):286-290. OB JEC TIVES:To de ter mine the di ag nos tic util ity of bron cho scopy in a popu la tion of im mu no com pro mised hosts in north ern Al berta. PA TIENTS AND METH ODS: Re sults from bron cho scopy in 86 im mu no com pro mised pa tients who un der went a to tal of 101 pro ce dures were ret ro spec tively re viewed. RE SULTS:The over all di ag nos tic yield was 57% with the high est yield in pa tients on im mu no sup pres sive drug ther apy (80%) and the low est yield in the group of bone mar row trans plant pa tients (27%). CON CLU SIONS: Bron cho scopy is a valu able tool for the evalua tion of pul mo nary dis ease in the im mu no com pro mised host. Over all di ag nos tic yield of 57% is com pa ra ble with that re ported in the lit era ture. Key Words: Bron choal veo lar lavage, Bron cho scopy, Im mu no com pro mised host, Pneu mo niaBronchoscopie au moyen de la fibre optique dans le diagnostic de la pneumopathie chez l'hôte immunodéficient dans le Nord de l'Alberta OB JEC TIFS : Dé ter mi ner l'u til ité di ag nos tique de la bron cho sco pie au près d'une popu la tion de su jets im mu nodéfi -cients, dans le Nord de l'Al berta. PA TIENTS ET MÉTH ODES : Les résul tats de la bron cho sco pie ef fec tuée chez 86 pa tients im mu nodéfi cients to tali sant 101 in ter ven tions ont été pas sés en re vue. RÉSUL TATS : Dans l'en sem ble, le ren de ment di ag nos tique à été de 57 %, le ren de ment étant le plus fort chez les patients sous traite ment médica men teux im mu no sup presseurs (80 %) et le plus fai ble, chez les pa tients ay ant subi une trans plan ta tion de moelle os seuse (27 %). CON CLU SIONS : La bron cho sco pie est utile pour éval uer la pneu mo pathie chez l'hôte im mu nodéfi cient. Le ren dement di ag nos tique global ob tenu (57 %) se com pare au ren de ment dont fait état la litté ra ture. 286CAN J IN FECT DIS VOL 6 NO 6 NO VEM BER/DE CEM BER 1995

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“…The commonest infections in lung transplant recipients, such as CMV, Candida and Aspergillus, are colonizers more often than invasive pathogens, and in one report eventually proved to be pathogens in only 24, 25 and 0% of cases, respectively [26], with a similarly poor specificity reported for viral pneumonia [27]. Similarly, BAL samples have not proved helpful for rejection; the most widely-used BAL assay has been that of lymphocyte subsets, which has a disappointing sensitivity of <30% [28].…”

Section: Discussionmentioning

confidence: 98%

Thallium-201 scintigraphy in the evaluation of graft dysfunction in lung transplantation. Newark Beth Israel Medical Center Lung Transplant Group

Rr²,

Ma³

1996

Eur Respir J

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T Th ha al ll li iu um m--2 20 01 1 s sc ci in nt ti ig gr ra ap ph hy y i in n t th he e e ev va al lu ua at ti io on n o of f g gr ra af ft t d dy ys sf fu un nc ct ti io on n i in n l lu un ng g t tr ra an ns sp pl la an nt ta at ti io on n ABSTRACT: The object of this study was to evaluate graft dysfunction utilizing thallium-201 scintigraphy in patients who had undergone lung transplantation.We studied 11 patients who had undergone single-lung transplantation and had 44 evaluations for suspected graft dysfunction. All evaluations included a lung thallium-201 scan and chest radiography. In addition, 42 transbronchial biopsies, 19 gallium-67 scans and 28 pulmonary function tests were obtained. Rejection was defined by histopathology and/or the response to an empirical pulse of methylprednisolone, while cultures of protected specimen brushes and blood with a positive chest radiograph were used to define infection.The sensitivity of thallium scintigraphy for diagnosing rejection and/or infection (94%) was higher than that for transbronchial biopsy (86%), gallium scintigraphy (47%), chest radiography (67%), or spirometry testing (30%). Specificity was 100% for thallium scintigraphy and transbronchial biopsy, as compared to chest radiography and spirometry, which were 75 and 80% respectively. This study indicated that thallium-201 scintigraphy is useful for screening lung transplant recipients for episodes of acute rejection and/or infection. A positive scan is confirmation of graft parenchymal dysfunction and may then be followed by empirical treatment or bronchoscopy with transbronchial biopsy and culture to differentiate rejection and infection.

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Clinical Utility of Bronchoalveolar Lavage in Immunocompromised Hosts

Cited by 91 publications

References 19 publications

Use of first line bronchoalveolar lavage in the immunosuppressed oncology patient

Use of first line bronchoalveolar lavage in the immunosuppressed oncology patient

Fibreoptic Bronchoscopy in the Diagnosis of Pulmonary Disease in the Immunocompromised Host in Northern Alberta

Thallium-201 scintigraphy in the evaluation of graft dysfunction in lung transplantation. Newark Beth Israel Medical Center Lung Transplant Group

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