Diagnosis of pulmonary aspiration: A mouse model using a starch granule test in bronchoalveolar lavage

Pinto, Leonardo Araújo; Dias, Ana Christina O.; Jones, Marcus Herbert; Stein, Renato T.; Pitrez, Paulo Márcio

doi:10.1111/j.1440-1843.2008.01285.x

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…In a murine model, detection of starch granules in BAL was superior to LLAM index; the latter had a low specificity while the presence of starch granules in the BAL yielded 100% sensitivity and specificity for aspiration. The LLAM index was not different in mice that had starch aspiration versus those who had Pseudomonas aeruginosa instilled in their airways [60]. Similar conclusions came from human studies.…”

Section: Pathophysiologymentioning

confidence: 70%

Biomarkers in the diagnosis of aspiration syndromes

Jaoude

Knight

Ohtake

et al. 2010

Expert Review of Molecular Diagnostics

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Recognizing and managing the different types of aspiration events remain a challenging task due to the lack of distinguishing clinical or laboratory characteristics. Numerous biomarkers in serum, sputum and bronchoalveolar lavage have been studied, and their role in the recognition of aspiration remains controversial at this time. Recent animal investigations using an array of biomarkers based on distinct pathogenic features of each aspiration event have produced promising results; however, they have not been validated in humans. Newer markers are being introduced as diagnostic and prognostic tools in conditions such as community-acquired pneumonia and sepsis, but they have not been examined in aspiration. The present review summarizes the different biomarkers that have been studied in aspiration and those who might have a potential clinical use in the future. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript. NIH Public Access Author ManuscriptExpert Rev Mol Diagn. Author manuscript; available in PMC 2011 February 1. Published in final edited form as:Expert Rev Mol Diagn. 2010 April ; 10(3): 309-319. doi:10.1586/erm.10.7. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript with gastrointestinal (GI) and esophageal abnormalities [5], as well as patients with neuro logic and neuromuscular diseases [6]. The clinical manifestation of an aspiration event falls within a wide spectrum ranging from subclinical manifestations, such as dry cough or dysphonia to a fulminant life-threatening condition, such as the acute respiratory distress syndrome (ARDS). The pathogenic process can be further complicated by superimposed secondary infection, lung abscess, airway obstruction, exogenous lipoid pneumonia and progression into chronic interstitial fibrosis [7]. However, the most challenging task for medical practitioners is the ability to differentiate between the two most common presentations of the aspiration syndromes: the gastric aspiration pneumonitis and the bacterial aspiration pneumonia. The distinction between the two entities is important because while bacterial aspiration pneumonia needs to be treated with antibiotics, treatment of aspiration pneumonitis is supportive [8]. Routine use of anti biotics for aspiration-induced lung injury offers no benefits and promotes colonization with drug-resistant bacteria. There is overwhelming epidemiologic evidence to suggest that indiscriminate administration of antibiotics has immediate-and long-term consequences contributing to emergence of multiresistant pathogens and an increased risk of super-infection [9]. In addition, previous exposure to antibiotics is an independent risk factor for development of bacterial pneumonia in the intensive care unit (ICU) [10]. Furthermore, the us...

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Section: Pathophysiologymentioning

confidence: 70%

Biomarkers in the diagnosis of aspiration syndromes

Jaoude

Knight

Ohtake

et al. 2010

Expert Review of Molecular Diagnostics

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“…Pinto et al describe a mouse model of aspiration in a technical report to Respirology and found that the detection of starch granules in BAL is a simple and highly specific method for the diagnosis of aspiration. 53 In contrast, the better known 'lipid-laden macrophages' were found in all mice irrespective of aspiration. Clinical studies using the starch granule detection method in BAL should be considered to investigate if this approach allows better diagnostic of paediatric patients at risk for repeated and/or chronic aspiration.…”

Section: Technical Aspects In Lung Biology and Diseasementioning

confidence: 88%

“…Pinto et al. describe a mouse model of aspiration in a technical report to Respirology and found that the detection of starch granules in BAL is a simple and highly specific method for the diagnosis of aspiration 53 . In contrast, the better known ‘lipid‐laden macrophages’ were found in all mice irrespective of aspiration.…”

Section: Technical Aspects In Lung Biology and Diseasementioning

confidence: 99%

Respirology year‐in‐review 2008: Basic science

Kolb

Yang

2009

Respirology

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“…Additional markers of aspiration (e.g., pepsin, radioactive tracers such as Technetium-99m, or food additives might better provide evidence for recurrent aspiration and its role in chronic lung disease [9, 21, 22]).…”

Section: Discussionmentioning

confidence: 99%

Lipid-Laden Alveolar Macrophages and pH Monitoring in Gastroesophageal Reflux-Related Respiratory Symptoms

et al. 2012

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Lipid-laden alveolar macrophages and pH monitoring have been used in the diagnosis of chronic aspiration in children with gastroesophageal reflux (GER). This study was conducted to prove a correlation between the detection of alimentary pulmonary fat phagocytosis and an increasing amount of proximal gastroesophageal reflux. It was assumed that proximal gastroesophageal reflux better correlates with aspiration than distal GER. Patients from 6 months to 16 years with unexplained recurrent wheezy bronchitis and bronchial hyperreactivity, or recurrent pneumonia with chronic cough underwent 24-hour double-channel pH monitoring and bronchoscopy with bronchoalveolar lavage (BAL). Aspiration of gastric content was determined by counting lipid laden alveolar macrophages from BAL specimens. There were no correlations between any pH-monitoring parameters and counts of lipid-laden macrophages in the whole study population, even when restricting analysis to those with abnormal reflux index expressing clinically significant GER. Quantifying lipid-laden alveolar macrophages from BAL in children with gastroesophageal-related respiratory disorders does not have an acceptable specificity to prove chronic aspiration as an underlying etiology. Therefore, research for other markers of pulmonary aspiration is needed.

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Diagnosis of pulmonary aspiration: A mouse model using a starch granule test in bronchoalveolar lavage

Cited by 8 publications

References 22 publications

Biomarkers in the diagnosis of aspiration syndromes

Biomarkers in the diagnosis of aspiration syndromes

Respirology year‐in‐review 2008: Basic science

Lipid-Laden Alveolar Macrophages and pH Monitoring in Gastroesophageal Reflux-Related Respiratory Symptoms

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