Bronchoscopy with bronchoalveolar lavage in tuberculosis and fungal infections.
OBJECTIVE
To determine the utility of bronchoscopy with bronchoalveolar lavage for diagnosing M tuberculosis and fungal infections.


METHODS
Retrospective review of patients over a six-year period.


METHODS
In- and outpatients of one University hospital and affiliated Veterans Administration Medical Center.


METHODS
Those who were subsequently found to have either M tuberculosis or fungal infections.


METHODS
Bronchoscopy with bronchoalveolar lavage specimens were compared to prebronchoscopy sputum, when available. Specimens were sent for smear and culture for both acid-fast bacilli and fungi. In the case of lavage, an aliquot also was studied for cellular differential.


RESULTS
For TB, sputum was smear-positive in 6/47 (34 percent) and culture positive in 24/47 (51 percent), while bronchoscopy was smear positive in 34/50 (68 percent) and culture positive in 46/50 (92 percent). For fungal infections, no sputum was smear-positive and only 1/22 (5 percent) was sputum culture-positive, while bronchoscopy was smear-positive in 14/41 (34 percent) and culture positive in 35/41 (85 percent). Bronchoscopy washings and BAL provided complementary specimens. Eighty-three patients had adequate lavages and the cellularity was significantly different from controls (lymphocytes: TB 18 +/- 11.2 percent [mean +/- SD]; fungal: 13 +/- 11.1 percent; controls 6 +/- 3.1 percent; p less than 0.001; neutrophils: TB 9 +/- 11.5 percent; fungal: 6 +/- 9.1 percent controls: 2 +/- 1.5 percent, p less than 0.01); however, there was overlap and no pattern was characteristic for TB or fungal infections.


CONCLUSIONS
Bronchoscopy with BAL is useful in diagnosing tuberculosis and fungal infections.
Baughman
R P
RP
University of Cincinnati Medical Center.
Dohn
M N
MN
Loudon
R G
RG
Frame
P T
PT
D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000382:microbiology*; D001999:Bronchoscopy; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis*; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*