The value of bronchoalveolar lavage and bronchial washings in the diagnosis of invasive pulmonary aspergillosis

Levy, Howard; Hořák, David; Tegtmeier, Bernard; Yokota, Susan; Forman, Stephen J.

doi:10.1016/s0954-6111(06)80062-4

Cited by 145 publications

(95 citation statements)

References 13 publications

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“…Analysis of bronchoalveolar lavage fluid was performed frequently with 9/14 (64%) positive results, most of them on the account of microscopy, since fungal cultures were usually negative. Most of our patients were either on low-dose AB prophylaxis or already receiving full dose of antifungal therapy, which was probably the reason for negative cultures, as described before [23,24]. It would seem that IPA should be suspected in every febrile neutropenic patient not responding to broadspectrum antibiotics who develops pulmonary infiltrates, and high-dose AB treatment should be started immediately.…”

Section: Discussionmentioning

confidence: 90%

Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

et al. 2001

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during extensive hospital construction and indoor renovation, a nosocomial outbreak of invasive pulmonary aspergillosis occurred in acute leukemia patients treated in a regular ward that has only natural ventilation. The observed infection rate was 50%. Chemoprophylaxis with intravenous continuous low-dose amphotericin B was then instituted as a preventive measure. During the next 18 months invasive pulmonary aspergillosis developed in 43% of acute leukemia patients. After that period a new hematology ward was opened with an air filtration system through high-efficiency particulate air filtration (HEPA) filters, and a bone marrow transplantation program was started on the hematology service. During the following three years, none of the acute leukemia or bone marrow transplantation patients who were hospitalized exclusively in the hematology ward developed invasive pulmonary aspergillosis, although 29% of acute leukemia patients who were housed in a regular ward, because of shortage of space in the new facility, still contracted invasive pulmonary aspergillosis. Overall, 31 patients were diagnosed with invasive pulmonary aspergillosis during almost five years: 74% of patients recovered from invasive pulmonary aspergillosis, and 42% are long-term survivors; 26% of patients died of resistant leukemia with aspergillosis, but no one died of invasive pulmonary aspergillosis alone. In conclusion, during an on-going construction period, an extremely high incidence rate of invasive pulmonary aspergillosis in acute leukemia patients undergoing intensive chemotherapy was observed. Institution of low-dose intravenous amphotericin B prophylaxis marginally reduced the incidence rate of invasive pulmonary aspergillosis. Keeping patients in a special ward with air filtration through a HEPA system eliminated invasive pulmonary aspergillosis completely. Among patients who developed invasive pulmonary aspergillosis, early diagnosis and treatment are probably the explanation for the favorable outcome. Am. J. Hematol. 66:257-262, 2001.

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Section: Discussionmentioning

confidence: 90%

Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

et al. 2001

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“…3 The current approach in which clinical probability, fungal culture and cytology examination serve as guidelines for therapy is not satisfactory. 4,5 For this purpose, more rapid confirmation of aspergillus infection with non-culturebased testing may be more useful. Detection of ASP DNA in BAL fluid theoretically enables early diagnosis and early guided optimal therapy that is expected eventually to improve the outcome of IPA in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Early diagnosis of IPA and administration of antifungal treatment is expected to improve outcome, but this goal is difficult to achieve as cultivation of the causative agent Aspergillus species (ASP) from respiratory secretions has poor sensitivity. [3][4][5][6][7] Deep tissue biopsy specimens are difficult to obtain in this setup because many affected patients have poor respiratory status in addition to coagulation defects. PCR-based ASP DNA detection in bronchoalveolar lavage (BAL) fluid theoretically enables earlier and more frequent diagnosis of IPA.…”

Section: Introductionmentioning

confidence: 99%

Impact of PCR-based diagnosis of invasive pulmonary aspergillosis on clinical outcome

Hardak

Yigla

Avivi

et al. 2009

Bone Marrow Transplant

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“…18,19 The imaging appearances on HRCT of PCP, Kaposi's sarcoma and angioinvasive fungal infections has been well characterised in patients with HIV. [20][21][22] In the oncology setting, HRCT can show characteristic findings within 30 days of bone marrow transplantation (BMT) that are strongly suggestive of the diagnosis of angioinvasive aspergillosis. 19 This infection results in scattered foci of parenchymal inflammation, infarction and necrosis.…”

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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The value of bronchoalveolar lavage and bronchial washings in the diagnosis of invasive pulmonary aspergillosis

Cited by 145 publications

References 13 publications

Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

Impact of PCR-based diagnosis of invasive pulmonary aspergillosis on clinical outcome

Use of first line bronchoalveolar lavage in the immunosuppressed oncology patient

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