Document 0254
 DOCN  M95A0254
 TI    The role of bronchoscopy in the diagnosis and treatment of pulmonary
       disease in HIV-infected patients.
 DT    9510
 AU    Lewin SR; Hoy J; Crowe SM; McDonald CF; Fairfield Hospital, Melbourne,
       Vic.
 SO    Aust N Z J Med. 1995 Apr;25(2):133-9. Unique Identifier : AIDSLINE
       MED/95329049
 AB    BACKGROUND: Pulmonary disease is the most common reason for presentation
       and the major cause of death in HIV-infected patients. There has been an
       evolution in the optimal approach to the investigation of a pulmonary
       infiltrate in HIV-infected patients since the introduction of induced
       sputum for the diagnosis of Pneumocystis carinii pneumonia (PCP). AIMS:
       To evaluate the usefulness of flexible fibreoptic bronchoscopy (FFB),
       bronchoalveolar lavage (BAL), transbronchial biopsy (TBB) and bronchial
       brushings (BB) in the diagnosis of pulmonary disease in HIV-infected
       patients and to examine the effect of FFB on changes in therapy and
       survival. METHODS: The histories of all HIV-infected patients referred
       to Fairfield Hospital for FFB between January 1990 and June 1993 were
       examined retrospectively. RESULTS: Forty-two FFB were performed on 41
       patients (40 male and one female). Definitive diagnoses made at FFB
       included Kaposi's sarcoma (KS) (n = 9), invasive aspergillosis (n = 5),
       PCP (n = 4), Mycobacterium avium complex (MAC) pneumonia (n = 2),
       cytomegalovirus (CMV) pneumonia (n = 1), Cryptococcus neoformans
       pneumonia (n = 1), microsporidium (n = 1) and Pseudomonas aeruginosa
       pneumonia (n = 1). TBB and BB did not provide a diagnosis for diseases
       not seen macroscopically at FFB or diagnosed by BAL. FFB findings
       altered diagnosis in 21/42 (50%) presentations and changed therapy in
       26/42 (62%) cases. CONCLUSIONS: FFB together with BAL altered the
       working diagnosis and changed therapy in a significant number of
       patients. TBB and BB should not be routinely performed in all patients
       as these procedures are of limited value in this setting.
 DE    Adult  AIDS-Related Opportunistic Infections/*DIAGNOSIS/PATHOLOGY
       Bacterial Infections/DIAGNOSIS  Biopsy  Bronchoscopy  Dimercaprol
       Evaluation Studies  Female  Fiber Optics  Human  Lung/PATHOLOGY  Lung
       Diseases, Fungal/DIAGNOSIS  Male  Middle Age  Respiratory Tract
       Infections/*DIAGNOSIS/PATHOLOGY  Retrospective Studies  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).