[The value of bronchoalveolar lavage in the clarifying of HIV-associated lung diseases].
OBJECTIVE
Examination of sputum is the first diagnostic step in the evaluation of HIV-infected patients with pulmonary complications. We were interested in the indications and the diagnostic value of subsequent bronchoscopy and bronchoalveolar lavage (BAL) and especially the importance of so-called atypical bacteria.


METHODS
We analysed 59 consecutive BALs performed in HIV positive patients with pulmonary symptoms (48 men, 11 women, age 22-70 years, 36 in stage C). Culture for Legionella pneumophila and PCR analysis for Mycoplasma pneumoniae and Chlamydia pneumoniae were done in all cases.


RESULTS
In 50 patients (85%) there was a clear indication for performing a BAL because either an infectious agent could no be detected on sputum examination (n = 36), or the patient's sputum production was insufficient (n = 14). In 30 (60%) of these cases bronchoscopy and BAL were able to establish a diagnosis. The most frequent agent was Pneumocystis carinii (n = 12). In contrast, BAL was able to establish coinfection in patients with positive sputum samples in one case only. So-called atypical bacteria were not found.


CONCLUSIONS
In patients with a clear indication, especially a non-diagnostic sputum examination, BAL plays an important role in the work-up of HIV-associated pulmonary disease. The search for so-called atypical bacteria yields unsatisfactory results.
Departement Innere Medizin, Universitätsspital Zürich.
J
J
Ersch
R
R
Speich
R
R
Weber
M
M
Altwegg
M
M
Hauser
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000382:microbiology; D000328:Adult; D000368:Aged; D018893:Bronchoalveolar Lavage / Q000706:statistics & numerical data; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy; D005069:Evaluation Studies as Topic; D005260:Female; D015497:HIV-1; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012189:Retrospective Studies