Document 0536
 DOCN  M9590536
 TI    The role of two-segment bronchoalveolar lavage in the diagnosis of
       pulmonary infections.
 DT    9509
 AU    Grebski E; Russi EW; Speich R; Opravil M; Kuster H; Wust J; Department
       of Internal Medicine, University Hospital of Zurich,; Switzerland.
 SO    Chest. 1994 Aug;106(2):414-20. Unique Identifier : AIDSLINE MED/95292657
 AB    STUDY OBJECTIVE: To determine if performing bronchoalveolar lavage (BAL)
       from more than one lung segment augments the diagnostic yield in
       patients with pulmonary infection. PATIENTS AND STUDY DESIGN:
       Seventy-six patients who underwent bisegmental BAL for the diagnosis or
       exclusion of pulmonary infection were studied prospectively. MAIN
       RESULTS: In patients with AIDS, the concentration of Pneumocystis
       carinii was higher in the upper lobes than in the middle lobes,
       regardless of whether the patients had been receiving pentamidine
       prophylaxis. In patients without HIV infection, the number of P carinii
       clusters was much lower. In 2 of 5 HIV-negative patients, P carinii
       organisms were detectable but in one of two lavage specimens, whereas in
       only 1 of 19 AIDS patients, P carinii organisms were not found in both
       lavaged segments. In bacterial pneumonia, BAL fluid from a segment of
       the radiologically most involved area had a much higher cell
       concentration, percentage of neutrophils, and concentration of bacteria
       than from the segment that was not or less severely involved on chest
       radiograph. In two of nine patients with AIDS and cytomegalovirus (CMV)
       pneumonia, cytopathogenic CMV effects were not found in both lavaged
       segments. In one of eight patients, mycobacteria could be cultured only
       from one of two radiologically involved segments. CONCLUSION: An
       increase in the diagnostic sensitivity by performing BAL in two lung
       segments is limited to cases where P carinii pneumonia is a relevant
       consideration in immunocompromised patients without HIV infection. In
       bacterial pneumonia, BAL can be performed in a single radiographically
       involved lung segment without a loss in diagnostic sensitivity. Since
       our study population of patients with CMV pneumonitis, mycobacterial
       infections, and fungal infections was small, no reliable conclusions are
       possible and BAL of more than one lung segment seems justified until
       more information is available.
 DE    Adult  Aged  AIDS-Related Opportunistic Infections/DIAGNOSIS
       *Bronchoalveolar Lavage Fluid/IMMUNOLOGY  Cytomegalovirus
       Infections/DIAGNOSIS  Female  Human  Leukocytes  Lung Diseases,
       Fungal/DIAGNOSIS  Macrophages  Male  Methods  Middle Age
       Pneumonia/*DIAGNOSIS  Pneumonia, Bacterial/DIAGNOSIS  Pneumonia,
       Pneumocystis carinii/DIAGNOSIS  Prospective Studies  Sensitivity and
       Specificity  Support, Non-U.S. Gov't  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).