Bronchoalveolar Lavage Fluid Findings Research Articles

Pulmonary superinfection diagnosed with bronchoalveolar lavage at intubation in COVID patients: A Swedish single-centre study.

Patients with severe coronavirus disease 2019 (COVID) pneumonia and acute respiratory distress syndrome (C-ARDS) on invasive mechanical ventilation (IMV) have been found to be prone to having other microbial findings than severe acute respiratory syndrome coronavirus 2 (SARS-2)-CoV-19 in the bronchoalveolar lavage (BAL) fluid at intubation causing a superinfection. These BAL results could guide empirical antibiotic treatment in complex clinical situations. However, there are limited data on the relationship between microbial findings in the initial BAL at intubation and later ventilator-associated pneumonia (VAP) diagnoses. To analyse the incidence of, and microorganisms responsible for, superinfections in C-ARDS patients at the time of first intubation through microbial findings in BAL fluid. To correlate these findings to markers of inflammation in plasma and later VAP development. Retrospective single-centre study. One COVID-19 intensive care unit (ICU) at a County Hospital in Sweden during the first year of the pandemic. All patients with C-ARDS who were intubated in the ICU. We analysed BAL fluid specimens from 112 patients at intubation, of whom 31 (28%) had superinfections. Blood levels of the C-reactive protein, procalcitonin, neutrophil granulocytes, and lymphocytes were indistinguishable between patients with and without a pulmonary superinfection. Ninety-eight (88%) of the patients were treated with IMV for more than 48 h and of these patients, 37% were diagnosed with VAP. The microorganisms identified in BAL at the time of intubation are normally found at the oral, pharyngeal, and airway sites. Only one patient had an indistinguishable bacterial strain responsible for both superinfection at intubation and in VAP. One fourth of the patients with C-ARDS had a pulmonary superinfection in the lungs that was caused by another microorganism identified at intubation. Routine serum inflammatory markers could not be used to identify this complication. Microorganisms located in BAL at intubation were rarely associated with later VAP development.

Exposure of Rats to Multi-Walled Carbon Nanotubes: Correlation of Inhalation Exposure to Lung Burden, Bronchoalveolar Lavage Fluid Findings, and Lung Morphology.

To evaluate lung toxicity due to inhalation of multi-walled carbon nanotubes (MWCNTs) in rats, we developed a unique MWCNT aerosol generator based on dry aerosolization using the aerodynamic cyclone principle. Rats were exposed to MWNT-7 (also known as Mutsui-7 and MWCNT-7) aerosolized using this device. We report here an analysis of previously published data and additional unpublished data obtained in 1-day, 2-week, 13-week, and 2-year inhalation exposure studies. In one-day studies, it was found that approximately 50% of the deposited MWNT-7 fibers were cleared the day after the end of exposure, but that clearance of the remaining fibers was markedly reduced. This is in agreement with the premise that the rapidly cleared fibers were deposited in the ciliated airways while the slowly cleared fibers were deposited beyond the ciliated airways in the respiratory zone. Macrophage clearance of MWNT-7 fibers from the alveoli was limited. Instead of macrophage clearance from the alveoli, containment of MWNT-7 fibers within induced granulomatous lesions was observed. The earliest changes indicative of pulmonary toxicity were seen in the bronchoalveolar lavage fluid. Macrophage-associated inflammation persisted from the one-day exposure to MWNT-7 to the end of the two-year exposure period. Correlation of lung tumor development with MWNT-7 lung burden required incorporating the concept of area under the curve for the duration of the study; the development of lung tumors induced by MWNT-7 correlated with lung burden and the duration of MWNT-7 residence in the lung.

Clinical role of bronchoalveolar lavage in dermatomyositis-associated interstitial lung disease.

To investigate the role of bronchoalveolar lavage (BAL) in DM-associated interstitial lung disease (ILD). We retrospectively reviewed the medical records of patients with DM-ILD who underwent bronchoscopy between October 2015 and September 2019. We then collated clinical features, laboratory data and bronchoscopy findings. The follow-up study was terminated on the 1 May 2020. A total of 113 DM-ILD patients were included in this study, including 27 patients with acute/subacute interstitial pneumonia (A/SIP) and 86 patients with chronic interstitial pneumonia (CIP). The A/SIP group had significantly lower proportions of lymphocytes and eosinophils in the bronchoalveolar lavage fluid (BALF) than the CIP group, but had a significantly higher proportion of neutrophils. Pathogens were discovered in BALF from 28 (24.8%) patients. Twenty-five (22.1%) patients commenced or changed antibiotic therapy on the basis of their bronchoscopy results. Lymphopenia and intensive care unit care were significantly associated with pathogen-positive BALF findings. Complications of bronchoscopy occurred in nine (8.0%) patients; fever (5.3%) was the most common complication. Twenty-five deaths (25/106, 23.6%) were observed during a mean follow-up of 22 months. Age, A/SIP and anti-MDA5 antibody were identified as independent predictors of a poor outcome, while mechanic's hands was an independent protective factor. However, cellular and pathogen findings in BALF had no significant influence on 30-day or overall mortality. Bronchoscopy is a relatively useful instrument to evaluate ILD in patients with DM, and BAL can improve the diagnosis of infection. However, cellular and pathogen findings from BALF had no significant influence on prognosis.

Bronchoalveolar lavage fluid characteristics and outcomes of invasively mechanically ventilated patients with COVID-19 pneumonia in Genoa, Italy

BackgroundThe primary objective of the study is to describe the cellular characteristics of bronchoalveolar lavage fluid (BALF) of COVID-19 patients requiring invasive mechanical ventilation; the secondary outcome is to describe BALF findings between survivors vs non-survivors.Materials and methodsPatients positive for SARS-CoV-2 RT PCR, admitted to ICU between March and April 2020 were enrolled. At ICU admission, BALF were analyzed by flow cytometry. Univariate, multivariate and Spearman correlation analyses were performed.ResultsSixty-four patients were enrolled, median age of 64 years (IQR 58–69). The majority cells in the BALF were neutrophils (70%, IQR 37.5–90.5) and macrophages (27%, IQR 7–49) while a minority were lymphocytes, 1%, TCD3+ 92% (IQR 82–95). The ICU mortality was 32.8%. Non-survivors had a significantly older age (p = 0.033) and peripheral lymphocytes (p = 0.012) were lower compared to the survivors. At multivariate analysis the percentage of macrophages in the BALF correlated with poor outcome (OR 1.336, CI95% 1.014–1.759, p = 0.039).ConclusionsIn critically ill patients, BALF cellularity is mainly composed of neutrophils and macrophages. The macrophages percentage in the BALF at ICU admittance correlated with higher ICU mortality. The lack of lymphocytes in BALF could partly explain a reduced anti-viral response.

Wandering pulmonary shadows coinciding with pericardial and pleural effusions

A 43-year-old man was referred to a nearby hospital because of exertional dyspnoea. Chest radiography revealed an enlarged heart and bilateral lower lung infiltrates (figure 1A). Chest CT revealed bilateral...

New procedure of bronchoalveolar lavage using a balloon catheter in diffuse lung diseases

Various procedures for bronchoalveolar lavage (BAL) have been developed. BAL needs a wedge between the bronchoscope and the inner surface of the bronchus. The feasibility of performing BAL at the targeted position cannot be determined until immediately before the procedure. We examined BAL performed using a balloon catheter to evaluate the stability of the procedure itself and quality of the specimen obtained. The main inclusion criteria were diffuse lung disease with a shadow in the B5a area. The tip of a disposable balloon catheter was passed through the orifice of the B5a bronchus, and the balloon was expanded at the B5a bronchus. A 50-mL syringe containing saline was instilled, and gentle hand suction was performed. This procedure was repeated two more times (total: 150mL). In all the 13 patients, the balloon of the catheter was inflated at the B5a bronchus. The median recovery rate was 34.92%±13.22%. These values were comparable to previously obtained BAL data (control group, N=56) from our facility. The BAL fluid findings and final diagnosis, with the exception of one undiagnosed case, were consistent. Overall, four patients suffered an adverse event during BAL (hypoxemia). All cases were managed by increasing the oxygen flow rate, and the adverse event did not affect the subsequent examinations. Using a balloon catheter enabled us to perform BAL at the intended bronchus. The quality of the obtained specimen was also acceptable.

Cytological Findings in Bronchoalveolar Lavage Fluid of Foals With Pneumonia Caused by Rhodococcus equi and Other Bacteria

The distinction between lower respiratory tract infections caused by Rhodococcus equi and those caused by other pathogens is difficult. The aim of this retrospective study was to describe cytological findings in bronchoalveolar lavage fluid (BALF) of foals with pneumonia caused by R. equi or other bacteria. Nineteen foals aged from 3 weeks to 6 months with evidence of respiratory disease between 2015 and 2016 were selected from the database of the Veterinary Teaching Hospital “Mario Modenato” of the University of Pisa. Eight foals of 19 (42.1%) had R. equi pneumonia, whereas 11 of 19 (57.9%) had another bacterial pneumonia. R. equi–positive foals had statistically significant higher total nucleated cell count (P = .02) and neutrophils percentage (P = .002) than R. equi–negative ones. Macrophages proportion (P = .01) was lower in R. equi–positive than in R. equi–negative foals. Bronchoalveolar lavage is a quite easy procedure that can be performed in the field with minimal equipment required. Here we reported significant differences in the cellular composition of BALF that can be used to differentiate foals with R. equi bronchopneumonia from those with other bacterial pneumonias, whereas waiting for culture results.

Microbiological findings in bronchoalveolar lavage fluid from lung transplant patients in Sweden.

BackgroundLung transplant patients experience a high risk of airway infections and microbial colonization of the lung due to constant exposure to the environment through inhaled microorganisms, denervation, reduced ciliary transport, and decreased cough.MethodsIn this nationwide prospective study on Swedish lung transplant patients, we evaluated the microbiological panorama of bacteria, fungi, and virus found in bronchoalveolar lavage fluid (BALF) obtained the first year after lung transplantation (LTx). Differences in microbiological findings depending of concomitant signs of infection and background factors were assessed.ResultsA total of 470 bronchoscopies from 126 patients were evaluated. Sixty‐two percent (n = 293) of BALF samples had positive microbiological finding(s). Forty‐six percent (n = 217) had bacterial growth, 29% (n = 137) fungal growth, and 9% (n = 43) were positive in viral PCR. In 38% of BALF samples (n = 181), a single microbe was found, whereas a combination of bacteria, fungi or virus was found in 24% (n = 112) of bronchoscopies. The most common microbiological findings were Candida albicans, Pseudomonas aeruginosa and coagulase negative Staphylococcus (in 42 (33%), 36 (29%), and 25 (20%) patients, respectively). Microbiological findings were similar in BALF from patients with and without signs of lung infection and the frequency of multidrug resistant (MDR) bacteria was low. No significant association was found between background factors and time to first lung infection.ConclusionThis study gives important epidemiologic insights and reinforces that microbiological findings have to be evaluated in the light of clinical symptoms and endobronchial appearance in the assessment of lung infections in lung transplant patients.

Bacteria from bronchoalveolar lavage fluid from children with suspected chronic lower respiratory tract infection: results from a multi-center, cross-sectional study in Spain

This cross-sectional study assessed the prevalence of bacteria isolated from Spanish children with suspected chronic lower respiratory tract infection (LRTI) for whom bronchoalveolar lavage (BAL) was indicated. BAL fluid (BALF) was collected from 191 children (aged ≥ 6 months to < 6 years, with persistent or recurrent respiratory symptoms, non-responders to usual treatment) and cultured. Nasopharyngeal swabs (NPSs) were also obtained and cultured to assess concordance of BALF and NPS findings in the same patient. Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis were identified from BALF with a bacterial load indicative of infection (> 104 colony-forming units/mL) in 10.5, 8.9, and 6.3% of children, respectively. Clinical characteristics were similar among participants, regardless of positivity status for any of the bacteria. Approximately 26% of pneumococcal isolates were PCV13 serotypes, and 96% of H. influenzae isolates were non-typeable (NTHi). Concordance between BALF and NPS isolates was 51.0% for S. pneumoniae, 52.1% for H. influenzae, and 22.0% for M. catarrhalis.Conclusion: S. pneumoniae, NTHi, and M. catarrhalis were the main bacteria detected in BALF and NPS. Children with suspected chronic LRTI may benefit from a vaccine protecting against NTHi.What is Known:• Chronic lower respiratory tract infection (LRTI) in children can cause high morbidity and is a major use of healthcare resources worldwide. Despite this, their etiology or potential preventive measures are poorly assessed.• Bronchoalveolar lavage can be used to determine bacterial etiology of chronic LRTI.What is New:• We used conventional and molecular techniques to show that Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis were present in the LRT of Spanish children with suspected chronic LRTI• Concordance between isolates from bronchoalveolar lavage fluid and nasopharyngeal swabs was low, suggesting that samples from the upper respiratory tract could not reliably predict the bacterial etiology of suspected chronic LRTI

The alpha-lipoic acid derivative DHLHZn: a new therapeutic agent for acute lung injury in vivo

An animal experiment was performed to demonstrate the anti-inflammatory effects of an alpha-lipoic acid (ALA) derivative, dihydrolipoyl histidinate zinc complex (DHLHZn) for acute lung injury (ALI) and to investigate the mechanism of action. Rats were randomly divided into three experimental groups: control group (n=17), DHLHZn(-) group (n=11, ALI model rats), and DHLHZn(+) group (n=12, ALI model rats treated by DHLHZn). Lipopolysaccharides (LPS, 10mg/kg) were administered intratracheally in the DHLHZn(-) group and the DHLHZn(+) group. For the DHLHZn(+) group, DHLHZn (100mg/kg) was administered intraperitoneally 2h prior to LPS administration. Four hours after LPS administration, bronchoalveolar lavage fluid (BALF) and lung tissue were collected. The findings were analyzed using the Mann-Whitney U test. Total number of cells, number of neutrophils and lymphocytes, levels of various inflammatory cytokines, and NF-kB p65 concentration of BALF were significantly lower in the DHLHZn(+) group than in the DHLHZn(-) group (p<0.05). ALI pathology scores were significantly lower in the DHLHZn(+) group than in the DHLHZn(-) group (p<0.001). Anti-inflammatory effects of DHLHZn for ALI were demonstrated by BALF and histopathological findings. The mechanism of action of DHLHZn was considered to be via inhibition of the NF-kB signaling pathway. DHLHZn is thus suggested to be a new prophylactic agent for ALI.

Evaluation of bronchoalveolar lavage for differentiating between Pneumocystis jiroveci pneumonia and drug-induced pulmonary parenchymal disease after chemotherapy for solid tumors

&lt;p align="left"&gt;Background: Differentiating between &lt;em&gt;Pneumocystis jiroveci &lt;/em&gt;pneumonia (PCP) and drug-induced pulmonary parenchymal disease (DIPPD) is difficult after chemotherapy for solid tumors. The aim of this study was to evaluate the utility of bronchoalveolar lavage fluid (BALF) analysis for the diagnosis of PCP and DIPPD.&lt;/p&gt;&lt;p align="left"&gt;Methods: We evaluated patients who underwent bronchoscopy at our institution from April 2012 to December 2014. Patients’ characteristics, comorbidity, previous treatment of solid tumor, and BALF findings were examined from the medical records.&lt;/p&gt;&lt;p align="left"&gt;Results: From a total of 2625 consecutive patients who underwent bronchoscopy, 89 underwent BALF examination; among these, 33 cases had prior chemotherapy for malignancy. PCP was diagnosed in 6 patients and DIPPD was diagnosed in 21 patients. Six patients were diagnosed to have other pathologies or were undiagnosed. The white blood cell count in BALF (PCP (median (%) (range), DIPPD (median (%) (range)) consisted of macrophages (24.7 (6.9-46.1), 26.5 (2.1-86.0)), lymphocytes (71.3 (49.6-84.8), 57.0 (4.3-96.4)), neutrophils (4.6 (1.0-14.0), 5.0 (0.5-69.8)), and eosinophils (0.3 (0-1.3), 2.5 (0-37.0)). Only the proportion of eosinophils in the BALF of DIPPD patients was significantly higher (p = 0.016) than that of PCP patients. BAL was performed without serious complications.&lt;/p&gt;Conclusions: BALF differential count, especially eosinophils, may be useful in distinguishing between PCP and DIPPD to avoid unnecessary treatment. Further prospective studies would be needed to confirm this benefit of BAL.

縦隔・肺門リンパ節結核の 1 例 : 治療前後での気管支肺胞洗浄所見の検討

縦隔・肺門リンパ節結核の 1 例 : 治療前後での気管支肺胞洗浄所見の検討

Architecture and Inflammatory Cell Composition of the Feline Lung with Special Consideration of Eosinophil Counts

An increase in the number of eosinophils in bronchoalveolar lavage fluid (BALF) is a hallmark of feline asthma; however, a wide range in the percentage of eosinophils in BALF has been documented in healthy cats. In this study, BALF and lung tissue were collected from 15 cats without respiratory disease, BALF was taken from 15 cats with asthma and lung tissue was collected from six different asthmatic cats. Total nucleated cell count (TNCC) and inflammatory cell percentages were measured in BALF and lung tissue was evaluated microscopically. Asthmatic cats had a significantly higher eosinophil count in lung tissue, but BALF TNCC did not differ significantly between groups. Cats without respiratory signs had significantly more numerous macrophages and lymphocytes in BALF than asthmatics, but significantly lower percentages of eosinophils (4.2 ± 7.8% versus 49.4 ± 20.6%, P <0.001). In healthy feline airways a BALF eosinophil percentage of <5% can be expected. Dominant microscopical findings in feline asthma include high eosinophil counts, airway remodelling and inflammation. There is good correlation between the findings in BALF and tissue in feline asthma.

An Official American Thoracic Society Clinical Practice Guideline: The Clinical Utility of Bronchoalveolar Lavage Cellular Analysis in Interstitial Lung Disease

The clinical utility of bronchoalveolar lavage fluid (BAL) cell analysis for the diagnosis and management of patients with interstitial lung disease (ILD) has been a subject of debate and controversy. The American Thoracic Society (ATS) sponsored a committee of international experts to examine all relevant literature on BAL in ILD and provide recommendations concerning the use of BAL in the diagnosis and management of patients with suspected ILD. To provide recommendations for (1) the performance and processing of BAL and (2) the interpretation of BAL nucleated immune cell patterns and other BAL characteristics in patients with suspected ILD. A pragmatic systematic review was performed to identify unique citations related to BAL in patients with ILD that were published between 1970 and 2006. The search was updated during the guideline development process to include published literature through March 2011. This is the evidence upon which the committee's conclusions and recommendations are based. Recommendations for the performance and processing of BAL, as well as the interpretation of BAL findings, were formulated by the committee. When used in conjunction with comprehensive clinical information and adequate thoracic imaging such as high-resolution computed tomography of the thorax, BAL cell patterns and other characteristics frequently provide useful information for the diagnostic evaluation of patients with suspected ILD.

Comparison between cryptogenic organizing pneumonia and connective tissue disease-related organizing pneumonia

Although the overall prognosis of CTD-related interstitial pneumonia is better than that of idiopathic interstitial pneumonia, the prognosis of CTD-related organizing pneumonia (CTD-OP) was suggested to be worse than that of cryptogenic organizing pneumonia (COP). The aim of this study was to compare the clinical features and outcome of the two conditions. A retrospective review of 100 patients diagnosed by lung biopsy as having organizing pneumonia patterns (CTD, 24; COP, 76) at three tertiary referral centres. Underlying CTDs were mostly RA, SS and PM/DM. The median follow-up period was 43.6 months. There were no differences in initial symptoms, lung function or bronchoalveolar lavage fluid findings except significantly more females (83.3 vs. 59.2%, P = 0.048) in the CTD-OP than in the COP group. Over 80% of the patients in both the groups improved. However, complete recovery rate was lower in CTD-OP (20.8%) than in COP (46.1%; P = 0.028) with a tendency towards higher recurrence rate in CTD-OP (40.0 vs 20.3%; P = 0.072). There was no significant difference in the frequency of rapid progression or overall survival between the two groups. The clinical features and prognosis of CTD-OP are similar to COP. However, lower complete recovery rate with a tendency towards higher recurrence rate in CTD-OP compared with COP suggest the need for closer follow-up in patients with CTD-OP.

Clinicopathologic study of various lung diseases with bronchiolitis obliterans organizing pneumonia (BOOP) pattern in open lung biopsy

The histologic findings of BOOP are nonspecific, and the diagnosis of idiopathic BOOP is one of exclusion. We studied the clinicopathologic features of various lung diseases with histopathological appearance of bronchiolitis obliterans organizing pneumonia (BOOP) pattern in open lung biopsy specimens. The 17 patients with BOOP pattern studied included idiopathic BOOP (n = 7), unclassified interstitial pneumonia (n = 1), collagen vascular disease (n = 3, RA 1, PM/DM 2), hypersensitivity pneumonitis (HP, n = 2), eosinophilic pneumonia (EP, n = 1), multiple lung abscesses (n = 1), limited form of Wegener's granulomatosis (n = 1), and pneumocystis carinii pneumonia associated with adult T cell leukemia (n = 1). There were no differences in clinical symptoms, laboratory data, respiratory function, and cytological findings in bronchoalveolar lavage fluid (BALF) between cases of idiopathic BOOP and other lung diseases. The duration of clinical symptoms was less than one year in 16 patients (one case had no symptoms). Chest X-rays showed bilateral patchy, nodular, or reticular shadows in all cases. Multiple patchy migratory shadows were only observed in cases of idiopathic BOOP or EP. Organizing pneumonia was recognized in the transbronchial lung biopsy specimens of all patients with idiopathic BOOP, HP or EP. Regarding prognosis, relapses occurred in idiopathic BOOP (n = 5), polymyositis, EP, limited form of Wegener's granulomatosis, and Pneumocystis carinii pneumonia. Four patients with idiopathic BOOP relapsed when steroid therapy was decreased or stopped. These findings indicate that idiopathic BOOP should be differentiated from other lung diseases, and these patients should be followed for a long period of time.

Tumor associated carbohydrate antigens in bronchoalveolar lavage fluid in patients with diffuse panbronchiolitis

It is known that tumor associated carbohydrate antigens are significantly increased in the serum of patients with diffuse panbronchiolitis (DPB). We investigated carbohydrate antigens (SLX, CA19-9) in bronchoalveolar lavage fluid (BALF) obtained from 24 patients with DPB. The concentrations of SLX and CA19-9 were significantly higher in BALF from patients with DPB than those from healthy subjects (7 cases) and patients with pulmonary sarcoidosis (16 cases). No significant correlation was observed between either SLX or CA19-9 concentrations in the serum and BALF, and no significant correlation was observed between the concentrations of these carbohydrate antigens in BALF and clinical findings. Immunohistochemical study of SLX and CA19-9 in open lung biopsy specimens obtained from patients with DPB showed expression of SLX and CA19-9 on the bronchiolar surface epithelial cells and mucinous exudates in air spances. These results indicate that carbohydrate antigens are presumably increased in the pulmonary lesions of patients with DPB, and this increase causes high levels of these antigens in the serum. Furthermore, we investigated the change of concentrations of SLX and CA19-9 in BALF obtained from patients with DPB after erythromycin (EM) treatment. The concentrations of these two antigens were decreased after EM treatment.

2-color analysis of lymphocyte subpopulation of bronchoalveolar lavage fluid and peripheral blood in patients with sarcoidosis

By means of 2-color analysis, we investigated the lymphocyte subpopulation of bronchoalveolar lavage fluid (BALF) and peripheral blood (PB) of 13 patients with pulmonary sarcoidosis. The BALF-CD4+ T cells of normal subjects and patients with sarcoidosis consisted almost completely of CD4+4B4+ cells (helper inducer T cells) and BALF-CD8+ T cells were almost completely composed of CD8+CD11- cells (cytotoxic T cells). The BALF findings of sarcoidosis were characterized by increased percentages of CD4+4B4+ cells (54.9 +/- 15.7%), decreased percentage of CD8+CD11- cells (12.0 +/- 8.4%) and increased percentage of CD4+HLA-DR+ cells (27.8 +/- 13.1%). These findings suggest that activated CD4+4B4+ cells (helper inducer T cells) may primarily contribute to the pathogenesis of pulmonary sarcoidosis. The in vivo or in vitro functions of CD4+4B4+ cells in sarcoidosis need further investigation.

Acute Lung Injury with Alveolar Hemorrhage Due to a Novel Swine-Origin Influenza A (H1N1) Virus

A 40-year-old woman with no major medical illness except for morbid obesity (BMI 40.7) was admitted to our hospital because of bilateral pneumonia due to a novel swine-origin influenza A (H1N1) virus (S-OIV). Non-invasive ventilation was introduced because of the hypoxemia. The description of bronchoalveolar lavage fluid findings showed an alveolar hemorrhage and neutrophilic inflammation. No evidence of bacterial infection was found. She was treated with oseltamivir and sivelestat sodium, neutrophil elastase inhibitor and thereafter was successfully discharged from the hospital. This case is the first report of a patient with acute lung injury with an alveolar hemorrhage caused by the S-OIV.

Bronchoalveolar lavage cytology from captive badgers

Bronchoalveolar lavage (BAL) fluid is evaluated for the diagnosis and study of lung disease and airway inflammation. Cytologic profiles for BAL fluid have not been reported for badgers and may be useful in understanding the pathogenesis of pulmonary diseases such as Mycobacterium bovis. The aim of this study was to evaluate cytologic and microbial findings in BAL fluid from captive European badgers (Meles meles) and identify correlates with the results of concurrently collected blood and fecal samples. BAL fluid (by a nonbronchoscopic method) and jugular venous blood samples (for routine CBC) were obtained from 23 captive tuberculosis-free anesthetized badgers on 2 occasions 4 weeks apart. Fecal samples were collected for routine parasitology. Morphologic evaluation and 100-cell differentials were done on cytocentrifuged BAL specimens. Pellets from centrifuged BAL were aerobically cultured for bacteria. With the 2 BAL samples from each of the 23 badgers combined, the median (range) cell percentages were 73.0% (5-95%) neutrophils, 7.5% (2-16%) macrophages, 8.0% (0-27%) lymphocytes, and 9.5% (0-92%) eosinophils. Macrophages frequently contained silica-like crystals. Other findings included ciliated epithelial cells, goblet cells, mucus, and Aelurostrongylus sp. larvae. A light growth of Streptococcus, Pasteurella, or Escherichia coli was cultured in 6 badgers. Trypanosoma pestanai were identified in blood from 10 badgers and fecal parasites (mainly coccidia) were found in 20 badgers. No correlation was found between BAL and CBC results and the presence of parasites. The predominance of neutrophils in BAL fluid from badgers differs from the predominance of macrophages found in BAL from other species. This difference may reflect the burrowing lifestyle or the unique immune response of badgers.