Analysis of bronchoalveolar lavage specimens from immunocompromised patients with a protocol applicable in the microbiology laboratory.
Several studies have concluded that bronchoalveolar lavage (BAL) is a useful technique for diagnosing pulmonary disease in immunocompromised patients, but implementation of a protocol for obtaining, processing, and analyzing BAL specimens in a clinical microbiology laboratory has not been reported. We determined the utility of a laboratory protocol by analyzing 100 BAL specimens from 94 immunocompromised patients. Each BAL specimen was cultured quantitatively for bacteria. A concentrate of each specimen was cultured for fungi, viruses, mycobacteria, and Legionella sp. Slides of the BAL concentrate were prepared by cytocentrifugation and stained by a number of histochemical and fluorescence techniques. Overall diagnostic yields of 81% for infections, 90% for hemorrhage, and 13% for neoplasms were obtained with the patients studied. BAL analysis was incapable of diagnosing drug- or radiation-induced pneumonitis or idiopathic interstitial pneumonitis. After evaluation of the protocol was completed, it was successfully implemented in two university-based clinical microbiology laboratories as a routine diagnostic service.
Kahn
F W
FW
Research Service, Middleton Veterans Administration Hospital, Madison, Wisconsin.
Jones
J M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003587:Cytomegalovirus / Q000302:isolation & purification; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D007108:Immune Tolerance; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000175:diagnosis*