title: Detection of non-infectious conditions mimicking pneumonia in the intensive care setting: usefulness of bronchoalveolar fluid cytology.
abstract: The present study investigated the usefulness of bronchoalveolar (BAL) fluid cytology in the identification of non-infectious pulmonary conditions in patients hospitalized in the intensive care unit (ICU) and suspected of pneumonia. A total of 182 BAL fluid samples obtained during a 27-month period from 130 ICU patients with suspected pneumonia were quantitatively cultured and investigated for opportunistic pathogens. Cytocentrifuged preparations stained with the May-Grünwald Giemsa and Perls's methods were reviewed. A non-infectious aetiology was considered when cultures yielded micro-organisms in quantities < 10(3) colony-forming units (CFU) per ml, in the absence of any other pathogen and in conjunction with one or more of the following cytological findings: > 20% haemosiderin macrophages, > 10% lymphocytes, the presence of activated lymphocytes, plasma cells, > 5% eosinophils, a preponderance of foamy macrophages, reactive type II pneumocytes or malignant cells. Patients' clinical records were reviewed to identify a clinical diagnosis for these episodes. In thirty-five (19.2%) BAL fluid samples from 26 patients, the cytological findings pointed to a non-infectious origin. An alternative diagnosis was ascertained in 20 of 26 patients. Diagnoses included: drug-induced pneumonitis (n = 7), aspiration of gastric contents (n = 2), pulmonary emboli (n = 3), adult respiratory distress syndrome (n = 4), lung contusion (n = 1), cardiogenic pulmonary oedema (n = 1), and carcinomatous lymphangitis (n = 2). The BAL fluid cytological findings were readily discernable and proved to be useful in the diagnostic work-up of samples obtained from ICU patients with suspected pneumonia.
authors.affiliation: Department of Medical Microbiology, University Hospital Maastricht, The Netherlands. jja@ms-azm-3.azm.nl
authors.forename: J A
authors.initials: JA
authors.lastname: Jacobs
authors.forename: E I
authors.initials: EI
authors.lastname: De Brauwer
authors.forename: G
authors.initials: G
authors.lastname: Ramsay
authors.forename: N A
authors.initials: NA
authors.lastname: Cobben
authors.forename: S S
authors.initials: SS
authors.lastname: Wagenaar
authors.forename: A J
authors.initials: AJ
authors.lastname: van der Ven
authors.forename: C A
authors.initials: CA
authors.lastname: Bruggeman
authors.forename: M
authors.initials: M
authors.lastname: Drent
mesh_terms: D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D003422:Critical Care; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis; D012189:Retrospective Studies