title: Pulmonary infections diagnosed by BAL: a 12-year experience in 1066 immunocompromised patients.
abstract: Bronchoalveolar lavage (BAL) is a useful tool in the diagnosis of pulmonary infections in immunocompromised patients. We aimed to compare the spectrum of infectious pulmonary complications diagnosed using BAL in a large consecutive cohort of immunocompromised patients. The diagnostic yield of 1066 BAL specimens was analyzed in 4 different groups of immunocompromised patients (HIV; solid organ transplants; high-dose chemotherapy and/or stem cell transplants; other immunosuppressive therapy) suffering from fever, respiratory symptoms and/or infiltrates on chest X-ray. Specimens were analyzed for bacteria, mycobacteria, fungi, Pneumocystis jiroveci, cytomegalovirus (CMV) and other viruses. Two time periods were compared (1992-1996; 1997-2003). The overall diagnostic yield of BAL was 34% for bacteria, 22% for CMV, 15% for P. jiroveci, 6% for other viruses, 6% for mycobacteria and 2% for aspergillus. There were significant changes in the pattern of opportunistic infections between the 2 time periods. Mycobacterial infections decreased considerably in the HIV group (17.9 vs. 8.5%, P=0.02), while the incidence of P. jiroveci decreased mainly in the transplant group (32.6 vs. 7.9%, P<0.00001). This study demonstrates a changed pattern of pulmonary infections in immunocompromised patients diagnosed by BAL. The overall diagnostic yield of BAL remains high in immunocompromised patients with respiratory symptoms.
authors.affiliation: Department of Pulmonary Medicine and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. ljoos@uhbs.ch
authors.forename: Ladina
authors.initials: L
authors.lastname: Joos
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Chhajed
authors.forename: Julia
authors.initials: J
authors.lastname: Wallner
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Juerg
authors.initials: J
authors.lastname: Steiger
authors.forename: Alois
authors.initials: A
authors.lastname: Gratwohl
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
mesh_terms: D001424:Bacterial Infections / Q000175:diagnosis; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D016009:Chi-Square Distribution; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000175:diagnosis; D006801:Humans; D016867:Immunocompromised Host; D009164:Mycobacterium Infections / Q000175:diagnosis; D009894:Opportunistic Infections / Q000175:diagnosis*; D016377:Organ Transplantation; D011024:Pneumonia, Viral / Q000175:diagnosis; D012141:Respiratory Tract Infections / Q000175:diagnosis*; D012189:Retrospective Studies; D033581:Stem Cell Transplantation