Infectious pulmonary complications after stem cell transplantation or chemotherapy: diagnostic yield of bronchoalveolar lavage.
Hematologic patients are at high risk for infectious pulmonary complications after stem cell transplantation (SCT) or chemotherapy. The aim of this study was to detect the range of pulmonary pathogens in these patients, analyzing 95 bronchoalveolar lavage (BAL) samples with classic and molecular (polymerase chain reaction [PCR]) detection methods. Human cytomegalovirus (HCMV) was detected in 33, herpes simplex virus in 21, human herpesvirus 6 in 24, and other viruses in 16 samples. Aspergillus species were detected in 19, Candida species in 25, and Gram-positive bacteria in 29 samples. The additional use of PCR detection methods increased the diagnostic yield from 56% to 73%, especially concerning viral and fungal infections in BAL samples. No infectious agent was detected in 26 samples. Interestingly, a high incidence of polymicrobial infections (50/95) was detected, dominated by HCMV co-infections, especially after allogeneic SCT. Within 3 years of follow-up, a poor outcome of co-infections of Aspergillus species with HCMV in 9 of 10 cases could be documented, whereas only 7 of 20 patients died with noninfectious BAL results. Herpesviruses, fungi, and Gram-positive bacteria were detected most frequently, and in 53%, polymicrobial infections were diagnosed.
Bissinger
Alfred Lennart
AL
Medizinische Klinik II, Universitätsklinikum Tübingen, D-72076 Tübingen, Germany.
Einsele
Hermann
H
Hamprecht
Klaus
K
Schumacher
Ulricke
U
Kandolf
Reinhard
R
Loeffler
Juergen
J
Aepinus
Christian
C
Bock
Thomas
T
Jahn
Gerhard
G
Hebart
Holger
H
D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology* / Q000821:virology*; D005260:Female; D005658:Fungi / Q000235:genetics / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000382:microbiology; D006402:Hematologic Diseases / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology; D016133:Polymerase Chain Reaction / Q000379:methods; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014184:Transplantation, Homologous / Q000009:adverse effects*; D014777:Virus Diseases / Q000175:diagnosis / Q000821:virology; D014780:Viruses / Q000235:genetics / Q000302:isolation & purification