Document 0818
 DOCN  M9650818
 TI    [Diagnostic value of protected bronchoalveolar lavage in HIV-associated
       pneumonia]
 DT    9605
 AU    Ewig S; Moter A; Nachtsheim KH; Seuffert HM; Marklein G; Schumacher R;
       Eis G; Leutner C; Bauer T; Reichel C; et al; Medizinische
       Universitatsklinik und Poliklinik, Institut fur; Medizinische
       Mikrobiologie und Immunologie, Bonn.
 SO    Pneumologie. 1995 Oct;49(10):546-55. Unique Identifier : AIDSLINE
       MED/96110071
 AB    OBJECTIVE: The concept of the protected bronchoalveolar lavage (PBAL) is
       to improve the diagnostic yield in bacterial pneumonia by unifying the
       high sensitivity of bronchoalveolar lavage (BAL) and specificity of the
       protected specimen brush (PSB). HIV-infected patients have been shown to
       have a high incidence of bacterial pneumonia as well as bacterial
       colonisation of the tracheobronchial tree. We therefore studied the
       value of PBAL in this population. METHODS: During a period of twelve
       months 40 episodes in 36 patients with symptoms suggestive of pneumonia
       were investigated retrospectively. In all cases without infiltrates on
       chest radiograph a CT-scan of the chest was performed. Patients without
       infiltrates also in CT-scan served as controls. Bronchoscopic
       investigation included a PSB and a PBAL in the same lung segment most
       prominently affected. Microbiological workup was performed for bacterial
       agents, mycobacteria, fungi, viruses and parasites. Quantitative
       cultures for bacteria were considered significant in case of > or equal
       to 10(3) cfu/ml in PSB and > or equal to 10(4) cfu/ml in PBAL. RESULTS:
       32 episodes in 28 patients were identified as pneumonia. A definite
       diagnosis could be established in 19/32 (59%) of cases. Bacteria
       accounted for 10/19 (53%). Pneumocystis carinii for 9/19 (47%) of cases
       including one case that revealed mixed infection with Streptococcus
       pneumoniae and Pneumocystis carinii. Another pneumonia was due to
       Aspergillus fumigatus. The sensitivity for bacterial pneumonia was 44%
       for PSB and 56% for PBAL, the specificity 100%. The overall diagnostic
       accuracy was 60% and 68%, respectively. The yield for Pneumocystis
       carinii was 8/9 (89%). CONCLUSIONS: PBAL as compared to PSB had a
       superior diagnostic yield for bacterial pneumonia. As PBAL additionally
       conserved the yield of BAL reported for Pneumocystis carinii, it may
       represent a rational diagnostic technique for pneumonia in HIV-infected
       patients.
 DE    Adult  AIDS-Related Opportunistic Infections/*DIAGNOSIS  Bacteriological
       Techniques  *Bronchoalveolar Lavage Fluid  Diagnosis, Differential
       English Abstract  Female  Human  Male  Middle Age  Pneumonia/*DIAGNOSIS
       Pneumonia, Bacterial/DIAGNOSIS  Pneumonia, Pneumocystis
       carinii/DIAGNOSIS  Pneumonia, Viral/DIAGNOSIS  Prospective 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).