Diagnostic Yield of Bronchoalveolar Lavage in Immunocompromised Children

Wong, Jeff Chin Pang; Hon, Kam Lun; Leung, Karen Ka Yan; Qian, Suyun; Leung, Alexander K. C.

doi:10.1093/tropej/fmaa131

Cited by 3 publications

(4 citation statements)

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“…Beyond diagnostic yield, the clinical impact of BAL on antimicrobial use has also been assessed, resulting in change in antimicrobial therapy of between 34% and 68% of episodes [9–11]. As outlined in Table 2, these data suggest that BAL has important implications for antimicrobial stewardship and may contribute to reducing unwarranted antibiotic exposure in this population.…”

Section: Standard Diagnosticsmentioning

confidence: 99%

“…Although some authors have debated the role of bronchoscopy and BAL in investigating post HSCT pulmonary disease, this remains commonly utilized [5] (Table 2). The diagnostic yield using standard investigations such as microscopy, culture and sensitivity (MC&S) and polymerase chain reaction (PCR) on BAL specimens in children has recently been reported to be between 30% and 67% [9][10][11]. A higher diagnostic yield has been reported when bronchoscopy is performed early in the presentation, specifically within the first 4 days after onset of symptoms or signs [9,10].…”

Section: Key Pointsmentioning

confidence: 99%

“…Of the two approaches, flexible bronchoscopic BAL was significantly more likely to have a diagnostic impact on multivariate analysis (odds ratio [OR] 6.10, (95% confidence interval [CI] 1.90-24.0)) [12]. Beyond diagnostic yield, the clinical impact of BAL on antimicrobial use has also been assessed, resulting in change in antimicrobial therapy of between 34% and 68% of episodes [9][10][11]. As outlined in Table 2, these data suggest that BAL has important implications for antimicrobial stewardship and may contribute to reducing unwarranted antibiotic exposure in this population.…”

Section: Key Pointsmentioning

confidence: 99%

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Novel approaches to the prediction and diagnosis of pulmonary complications in the paediatric haematopoietic stem cell transplant patient

Walker

Shanthikumar

Cole

et al. 2022

Current Opinion in Infectious Diseases

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Purpose of reviewHaematopoietic stem cell transplant (HSCT) remains the only curative treatment option for many children with relapsed leukaemia, primary immunodeficiencies and haemoglobinopathies. Unfortunately, infectious and noninfectious pulmonary complications following HSCT continue to cause significant morbidity and mortality. This review will focus on recent advances in the field that enhance clinically available diagnostic tools and the role of novel diagnostic techniques.Recent findingsResearch continues to highlight the role of standard diagnostic modalities, including imaging using computed topography chest and Fluorodeoxyglucose-positron emission tomography (FDG-PET) in the diagnosis of posttransplant pulmonary infections. Similarly, bronchoalveolar lavage using bronchoscopy to obtain samples for microbiological analysis remains an important tool in the clinical and diagnostic algorithm for these children. The application of more novel diagnostic techniques such as metagenomic next-generation sequencing and the use of specific biomarkers remain potential future tools in children in whom the aetiology of posttransplant lung disease is unknown. The impact of the pulmonary microbiome on infectious and noninfectious pulmonary disease post HSCT is a future research direction.SummaryPulmonary infectious complications post HSCT remain a devastating complication for children and their families. Despite improvements in standard and novel diagnostic modalities, the aetiology of pulmonary disease remains unknown for many patients. There is an urgent need for ongoing collaborative research to bridge this critical knowledge gap and lead to better patient outcomes.

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Section: Standard Diagnosticsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

See 1 more Smart Citation

Novel approaches to the prediction and diagnosis of pulmonary complications in the paediatric haematopoietic stem cell transplant patient

Walker

Shanthikumar

Cole

et al. 2022

Current Opinion in Infectious Diseases

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“… 64 , 66 Diagnostic bronchopulmonary alveolar lavage (BAL) can be used to guide treatment, the diagnostic yield of BAL in immunocompromised children ranges from 28% to 68%. 67 The primary lung insult of ARDS includes lung injury following aspiration, toxicity from pneumotoxic drugs, radiation toxicity and post-thoracic surgical changes. Other aetiologies include reduced baseline lung function post-chemotherapy (e.g.…”

Section: Reviewmentioning

confidence: 99%

Therapeutics for paediatric oncological emergencies

Leung¹,

Hon²,

Hui³

et al. 2021

DIC

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Background With advancements in the field of oncology, cancer survival rates have improved dramatically but modern cancer treatments also come with an increasing number of disease and treatment-associated complications. This article provides an updated narrative review on the pathophysiology, clinical presentations and latest management strategies for common paediatric oncological emergencies. Methods An extensive PubMed ® search of all human studies in the English literature was performed in Clinical Queries for different oncology syndromes and conditions using the following Medical Subject Headings: “tumour lysis syndrome”, “hyperleukocytosis”, “disseminated intravascular coagulation”, “superior mediastinal syndrome”, “superior vena cava syndrome”, “sepsis”, “severe inflammatory response syndrome”, “acute respiratory distress syndrome”, “posterior reversible encephalopathy syndrome” and “reversible posterior leukoencephalopathy syndrome”. Categories were limited to clinical trials and reviews for ages from birth to 18 years. Results The general description, presentation and management of these oncologic emergencies are systematically described. Early recognition along with prompt and proactive treatment can reduce the chances of potential complications and improve the clinical outcomes, thereby improving not only survival rates in oncology patients but also their clinical outcomes and quality of life. Conclusions Oncologic emergencies are associated with significant mortality and morbidity. Healthcare professionals involved with the care of oncology patients must be vigilant of these emergencies.

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Acetylcysteine and budesonide for the treatment of refractory Mycoplasma pneumoniae pneumonia in children: a clinical observation

et al. 2023

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Background To examine the clinical impact of bronchoscope alveolar lavage (BAL) combination with budesonide, ambroxol + budesonide, or acetylcysteine + budesonide in the treatment of refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods Eighty-two RMPP patients admitted to Pediatrics at The First People’s Hospital of Zhengzhou were retrospectively evaluated between August 2016 and August 2019. All patients were administered BAL in addition to intravenous Azithromycin, expectoration, and nebulizer inhalation. The medications added to the BLA separated the patients into the Budesonide group, Ambroxol + budesonide group, and acetylcysteine + budesonide group. Analyzed were the variations in laboratory examination indices, improvement in lung imaging, overall effective rate, and adverse responses in the three groups. Results The laboratory test indices of patients in all three groups improved significantly relative to pre-treatment levels, and the results were statistically significant. After therapy, there were no significant differences between the three groups in terms of white blood cell (WBC), C-reactive protein (CRP), or erythrocyte sedimentation rate (ESR). Serum lactate dehydrogenase (LDH) and serum ferritin (SF) varied significantly across the three groups (P < 0.05). In the acetylcysteine + budesonide group, the absorption rate of lung imaging lesions and clinical efficacy were superior to those of the other two groups. There were no significant differences between the three groups in the occurrence of adverse events (P > 0.05). Conclusions BLA-coupled acetylcysteine + budesonide was superior to the other two groups in enhancing the effectiveness of RMPP in children, which might increase lung opacity absorption and minimize lung inflammation.

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Diagnostic Yield of Bronchoalveolar Lavage in Immunocompromised Children

Cited by 3 publications

References 10 publications

Novel approaches to the prediction and diagnosis of pulmonary complications in the paediatric haematopoietic stem cell transplant patient

Novel approaches to the prediction and diagnosis of pulmonary complications in the paediatric haematopoietic stem cell transplant patient

Therapeutics for paediatric oncological emergencies

Acetylcysteine and budesonide for the treatment of refractory Mycoplasma pneumoniae pneumonia in children: a clinical observation

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