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1996-03-30
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Document 1083
DOCN M9651083
TI [Diagnostic value of protected bronchoalveolar lavage in HIV-associated
pneumonia]
DT 9505
AU Ewig S; Moter A; Nachtsheim KH; Seuffert HM; Marklein G; Schumacher R;
Eis G; Leutner C; Bauer T; Reichel C; et al; Medizinische
Universitatsklinik und Poliklinik, Institut fur; Medizinische
Mikrobiologie und Immunologie, Bonn.
SO Pneumologie. 1995 Oct;49(10):546-55. Unique Identifier : AIDSLINE
MED/96110071
AB OBJECTIVE: The concept of the protected bronchoalveolar lavage (PBAL) is
to improve the diagnostic yield in bacterial pneumonia by unifying the
high sensitivity of bronchoalveolar lavage (BAL) and specificity of the
protected specimen brush (PSB). HIV-infected patients have been shown to
have a high incidence of bacterial pneumonia as well as bacterial
colonisation of the tracheobronchial tree. We therefore studied the
value of PBAL in this population. METHODS: During a period of twelve
months 40 episodes in 36 patients with symptoms suggestive of pneumonia
were investigated retrospectively. In all cases without infiltrates on
chest radiograph a CT-scan of the chest was performed. Patients without
infiltrates also in CT-scan served as controls. Bronchoscopic
investigation included a PSB and a PBAL in the same lung segment most
prominently affected. Microbiological workup was performed for bacterial
agents, mycobacteria, fungi, viruses and parasites. Quantitative
cultures for bacteria were considered significant in case of > or equal
to 10(3) cfu/ml in PSB and > or equal to 10(4) cfu/ml in PBAL. RESULTS:
32 episodes in 28 patients were identified as pneumonia. A definite
diagnosis could be established in 19/32 (59%) of cases. Bacteria
accounted for 10/19 (53%). Pneumocystis carinii for 9/19 (47%) of cases
including one case that revealed mixed infection with Streptococcus
pneumoniae and Pneumocystis carinii. Another pneumonia was due to
Aspergillus fumigatus. The sensitivity for bacterial pneumonia was 44%
for PSB and 56% for PBAL, the specificity 100%. The overall diagnostic
accuracy was 60% and 68%, respectively. The yield for Pneumocystis
carinii was 8/9 (89%). CONCLUSIONS: PBAL as compared to PSB had a
superior diagnostic yield for bacterial pneumonia. As PBAL additionally
conserved the yield of BAL reported for Pneumocystis carinii, it may
represent a rational diagnostic technique for pneumonia in HIV-infected
patients.
DE Adult AIDS-Related Opportunistic Infections/*DIAGNOSIS Bacteriological
Techniques *Bronchoalveolar Lavage Fluid Diagnosis, Differential
English Abstract Female Human Male Middle Age Pneumonia/*DIAGNOSIS
Pneumonia, Bacterial/DIAGNOSIS Pneumonia, Pneumocystis
carinii/DIAGNOSIS Pneumonia, Viral/DIAGNOSIS Prospective Studies
Support, Non-U.S. Gov't JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).