Site-directed bronchoalveolar lavage and transbronchial biopsy in HIV-infected patients with pneumonia.
We have assessed the diagnostic value of site-directed bronchoalveolar lavage (BAL) and combined transbronchial biopsy (TBB) in 29 HIV-infected patients with localized pneumonia, in whom a previous BAL was nondiagnostic and in whom improvement did not occur with empiric antibiotic therapy. All patients but three had a CD4 cell count < 100/microliters. A definite diagnosis could be reached in 26 of 29 (90%) individuals, including 24 pathogens. Neither the radiologic pattern nor the type of Pneumocystis carinii (PC) prophylaxis could predict the positivity of either one of these two diagnostic procedures. Site-directed BAL alone allowed a diagnosis in infection in eight (28%) cases. TBB alone led to diagnosis in eight (28%) cases, including three PC and two toxoplasma gondii, undiagnosed by the site-directed BAL. Both techniques were positive and in agreement in 10 (34%) cases. The majority of the diagnosis led to a specific treatment. Therefore, the patients' survival was positively altered by the procedure. In conclusion, the performance of site-directed BAL and combined TBB markedly optimizes the diagnostic yield of each of these procedures performed separately in HIV-infected patients with localized pneumonia.
Cadranel
J
J
Service de Pneumologie, Hôpital Tenon, Paris, France.
Gillet-Juvin
K
K
Antoine
M
M
Carnot
F
F
Reynaud
P
P
Parrot
A
A
Carette
M F
MF
Mayaud
C
C
Israël-Biet
D
D
D000328:Adult; D001706:Biopsy; D001980:Bronchi / Q000473:pathology*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D015658:HIV Infections / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications* / Q000473:pathology*; D011020:Pneumonia, Pneumocystis / Q000473:pathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D007507:Therapeutic Irrigation / Q000379:methods