Pulmonary infiltrates in immunocompromised patients. Diagnostic value of telescoping plugged catheter and bronchoalveolar lavage.
The usefulness of telescoping plugged catheter (TPC) together with bronchoalveolar lavage (BAL) in the same bronchoscopic act in the diagnosis of pulmonary infiltrates was studied in 113 fiberoptic bronchoscopic examinations performed on 96 immunocompromised patients. The TPC cultures detected pulmonary bacterial infections in 25 (22 percent) cases but showed a high frequency of false positive results (12 microorganisms, 27 percent). Bronchoalveolar lavage had an overall diagnostic yield of 49 percent (53 of 113 cases). Combining TPC and BAL diagnostic values, 78 of 113 pulmonary infiltrates (69 percent) were diagnosed. The results obtained by both techniques allowed us to modify the treatment in 35 (31 percent) cases. Combined, TPC and BAL show a good diagnostic yield in immunocompromised patients with pulmonary infiltrates. Both techniques should be performed as the first approach in the evaluation of these patients, and be done in the same bronchoscopic procedure.
Department of Medicine, (Servei de Pneumologia), Hospital Clinic, Facultat de Medicina, Universitat de Barcelona, Spain.
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A
Xaubet
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A
Torres
F
F
Marco
J
J
Puig-De la Bellacasa
R
R
Faus
A
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Agusti-Vidal
D001419:Bacteria / Q000302:isolation & purification; D001992:Bronchoalveolar Lavage Fluid / Q000032:analysis* / Q000382:microbiology; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods; D002404:Catheterization / Q000295:instrumentation*; D003951:Diagnostic Errors; D006470:Hemorrhage / Q000175:diagnosis; D006801:Humans; D007108:Immune Tolerance; D008171:Lung Diseases / Q000175:diagnosis*; D008172:Lung Diseases, Fungal / Q000175:diagnosis; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis; D011024:Pneumonia, Viral / Q000175:diagnosis; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis