Utility of bronchoalveolar lavage in the diagnosis of pulmonary infections in immunosuppressed patients.
OBJECTIVE
To evaluate the utility of bronchoalveolar lavage (BAL) in immunocompromised patients.


METHODS
We studied BAL cytology and microbiological culture in 16 kidney transplant recipients (Group A), 14 dialysis patients (Group B) and eight HIV positive patients (Group C) suspected of having pulmonary infections. A group of 21 individuals without pulmonary diseases were studied as controls.


RESULTS
A comparison of the cytological profile in controls and study groups showed that percentages of lymphocytes and neutrophils were significantly increased in all three patient groups as compared to controls, BAL bacterial cultures were positive in 4, 3 and 4 cases of Group A, B and C, respectively. Direct examination of BAL cytosmears helped in detecting cytomegalovirus inclusions, acid fast bacilli and Pneumocystis carinii in 3, 2 and 5 cases of Group A, B and C, respectively though microbial cultures were negative. The sensitivity of BAL cytology was found to be 76.3%, whereas that of microbial culture was only 31.5%. The diagnostic yield of BAL was 68.75%, 71.42% and 100% in the Groups A, B and C, respectively, while it was 76% when all three groups were considered together. BAL cytology yielded the diagnosis in 47.36% of cases, a combination of BAL cytology and culture in 23.68% and culture alone in 5.3% of cases.


CONCLUSIONS
BAL is useful relatively non-invasive investigative tool in the rapid diagnosis of infections in immunocompromised patients. BAL cytology was found to be more useful than microbial cultures.
Menon
L R
LR
Department of Pathology, KEM Hospital, Seth GS Medical College, Parel, Mumbai 400 012.
Divate
S
S
Acharya
V N
VN
Mahashur
A A
AA
Natrajan
G
G
Almeida
A F
AF
D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology* / Q000276:immunology / Q000382:microbiology*; D015658:HIV Infections / Q000276:immunology* / Q000473:pathology*; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology*; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000276:immunology* / Q000473:pathology* / Q000628:therapy; D012141:Respiratory Tract Infections / Q000276:immunology / Q000382:microbiology* / Q000473:pathology*