Bronchoalveolar Lavage In Diagnosis Research Articles

Role of Bronchoalveolar Lavage in Diagnosis of Interstitial Lung Diseases

Role of Bronchoalveolar Lavage in Diagnosis of Interstitial Lung Diseases

Antimicrobial resistance of Pseudomonas aeruginosa isolated from patients with pneumonia during the COVID-19 pandemic and pre-pandemic periods in Northeast Brazil.

Healthcare-related infections caused by resistant microorganisms are a severe public health problem and are becoming increasingly prevalent in the hospital environment, especially Pseudomonas aeruginosa. This work aimed to evaluate the resistance profile of Pseudomonas aeruginosa to antimicrobials before the COVID-19 pandemic and during the pandemic period. Bacteria strains were obtained from tracheal aspiration, sputum, and bronchoalveolar lavage for diagnosis and phenotypic characterization. Matrix assisted laser-desorption ionization-time of flight mass spectrometry (MALD-TOF MS) was used to identify strains. Automated Phoenix and VITEK® 2 Compact system and the disc diffusion method were performed to determine the antimicrobial susceptibility profile. A total of 41,000 medical reports from adult patients with pneumonia were analyzed. Of these, 951 patients were positive for P. aeruginosa, of which 373 were related to the pre-pandemic period and 578 to the pandemic period. Older men (≥60 years) were more prevalent in both periods. P. aeruginosa strains were resistant to imipenem in both periods: 38.8 and 42.5%, respectively, followed by meropenem (34.2 and 39.2%), ciprofloxacin (33.6 and 36.7%), and levofloxacin (34.9 and 43.5%). Intensive care units had the highest percentage of affected patients (62 and 65%) compared with other sectors, with a prevalence of 71% in the public network before COVID-19 and 59% during the pandemic. Our data showed a prevalence of P. aeruginosa in elderly patients in both the pre-pandemic and pandemic periods. In addition, an increase in P. aeruginosa resistance to beta-lactams, quinolones, carbapenems, and cephalosporins was observed during the COVID-19 pandemic compared with the period before the pandemic, especially in ICUs.

Bronchoalveolar Lavage in Diagnostic Evaluation of Pulmonary Diseases- An Institutional Experience.

Bronchoalveolar lavage (BAL) is a widely accepted investigative tool for the diagnosis of pulmonary lesions. This study was done to find out the usefulness of BAL in diagnosis of pulmonary lesions from central Indian patient population. A cross-sectional prospective study was performed over a period of three years. All the BAL specimens of patients presenting to Department of Pulmonary Medicine and Tuberculosis during a period of January 2017 to December 2019 were included in the study. Cyto-histopathologic correlation was done, wherever available. Of total 277 cases, there were 178 (64.5%) males and 99 (35.5%) females. The age of patients ranged from 4 years to 82 years. In 92 (33%) cases, specific infective etiology could be identified on BAL cytology, the most common being tuberculosis (26%) followed by fungal infections (2%). Rarely, infections like nocardia, actinomycosis, and hydatidosis were also identified. Eight cases (3%) of malignancy were identified which included two cases of adenocarcinoma, one case of small cell carcinoma, three cases of poorly differentiated carcinoma, and two cases suspicious for malignancy. Some rare diagnoses like diffuse alveolar damage, pulmonary alveolar microlithiasis, and pulmonary alveolar proteinosis could be identified on BAL. BAL is useful in primary diagnosis of infections and malignancies of lower respiratory tract. BAL may aid in diagnostic workup of diffuse lung diseases. A combination of clinical information, high-resolution computed tomography, and BAL analysis may furnish an assured diagnosis to the clinician and obviate need for invasive procedures.

The role of bronchoalveolar lavage in diagnosis and prognosis of COVID-19 patients

The role of bronchoalveolar lavage in diagnosis and prognosis of COVID-19 patients

Diagnostic Accuracy of Bronchoalveolar Lavage in Diagnosis of Ple-ural Tuberculosis among Suspected Cases of Pleural TB

Aim: To determine the accuracy of bronchoalveolar lavage in diagnosis of pleural tuberculosis among suspected cases of pleural tuberculosis using biopsy. Study design: Descriptive, cross-sectional. Place and duration of study: Department of Chest Medicine, JPMC, Karachi from 1st August 2017 to 31st January 2018. Methodology: One hundred and thirty six patients with cases of pleural tuberculosis of age 18-55 years and both genders were included. Patients with anti-tuberculosis drugs, pneumonia, tonsillitis, pharyngitis, obstructive pulmonary disease and platelet function disorders, thrombocytopenia or coagulation factors disorder were excluded. 30-50 ml of bronchoalveolar fluid was carried out through fiberoptic bronchoscopy. Three milliliters of 4% lignocaine was used as pre-medication and 3 ml of 2% lignocaine was used during bronchoscopy. Results: In BAL positive patients, 73 (true positive) had pleural tuberculosis and 9 (false positive) had no pleural tuberculosis on biopsy. Among 54, BAL negative patients, 5 (false negative) had pleural tuberculosis on biopsy whereas 49 (true negative) had no pleural tuberculosis on biopsy. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of BAL in diagnosis of pleural tuberculosis among suspected cases of pleural tuberculosis using biopsy as gold standard was 93.59%, 84.48%, 89.02%, 90.74% and 89.71% respectively. Conclusion: The diagnostic accuracy of bronchoalveolar lavage in diagnosis of pleural tuberculosis among suspected cases of pleural tuberculosis is quite high. Keywords: Pleural tuberculosis, Bronchoalveolar lavage, Sensitivity

ROLE OF TRANSBRONCHIAL LUNG BIOPSY AND BRONCHOALVEOLAR LAVAGE IN DIAGNOSIS OF DIFFUSE PARENCHYMAL LUNG DISEASE

Background: Diffuse parenchymal lung diseases (DPLD) constitute a group of over 200 diverse etiologic entities which present with respiratory symptoms and diffuse lung infiltrates and account for 15% of patients seen by a pulmonary physician. Objective: To evaluate the role of transbronchial lung biopsy and bronchoalveolar lavage in diagnosis of diffuse parenchymal lung disease. Patients and Methods: This prospective cross-sectional study was carried out at the Department of Chest, Al-Hussein University Hospital, during the period from October 2019 to October 2020, and included sixty patients admitted in the inpatient wards with undiagnosed DPLD, after detailed history taking, physical examinations, routine labs, chest X-ray PA view, HRCT chest, pulmonary function tests (PFTs) as simple spirometry, ECG, echocardiography and Arterial blood gases evaluation. All of them were subjected to fibrooptic bronchoscope, transbronchial lung biopsy and bronchoalveolar lavage. Results: As regard comparison between bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) diagnostic yield there was a statistical significant difference between TBLB positive and negative patients, as regard BAL predominant cells and BAL microbiology. the comparison of histopathology as regard TBLB diagnostic yield showed a statistical significant difference between TBLB positive and TBLB negative patients. Conclusion: Bronchoalveolar lavage was a minimally invasive procedure performed during flexible bronchoscopy. BAL cellular analysis alone was insufficient to diagnose the specific type of DPLD, except in malignancies and some rare interstitial lung diseases (ILDs), and the yield of bronchoscopic lung biopsy was high in diseases where the lesions were peri bronchial in distribution such as in sarcoidosis, hypersensitivity pneumonitis and organizing pneumonias.

Role of bronchoalveolar lavage in diagnosing pulmonary infections and malignancies: Experience from a tertiary care center.

Bronchoalveolar lavage (BAL), is a safe, minimally invasive procedure to sample the terminal airways and the lung parenchyma. Although frequently used, there is lack of contemporary literature regarding the diagnostic utility of BAL for various pulmonary diseases. This study was conducted to evaluate the utility of BAL in diagnosis of various pulmonary pathologies, both infectious and neoplastic. This was a retrospective study performed over a period of 2 years. All the BAL samples reported on cytology were studied, their clinical details were retrieved, and the corresponding smears were reviewed. Cyto-histopathologic correlation was done, wherever possible. There were a total of 1835 cases (1153 men, 682 women; age, 8 months to 78 years). Of these, 19 (1%) cases were assessed as inadequate for opinion. In 348 (19%) cases, specific infective cause could be identified on BAL cytology alone. Tuberculosis and fungal infections could be diagnosed in 165 (9%) and 178 (9.7%) cases respectively. There were 46 (2.5%) neoplasms, including adenocarcinoma (n = 20), squamous cell carcinoma (n = 5), small cell carcinoma (n = 2), Langerhans cell histiocytosis (n = 1), suspicious for malignancy (n = 15) and metastatic carcinoma (n = 3). Some rare diagnoses were also reported on BAL cytology, including sarcoidosis, actinomycosis, leishmaniasis, pulmonary alveolar proteinosis and metastatic papillary carcinoma of the thyroid. BAL is a safe and useful procedure for primary diagnosis of infections such as tuberculosis and fungal infections, which has special significance in developing nations where prevalence of such infections is high. In addition, BAL has the potential to diagnose both primary as well as secondary malignant lung lesions.

Yields of Bronchoscopy and Bronchoalveolar Lavage in Diagnosis of Undefined Persistent Wheezy Chest Among Children

Background: Wheezing in infants and children is a common problem presented to primary care offices. Approximately 25 to 30 percent of infants will have at least one episode of wheezing. By three years of age, an episode of wheezing will have occurred in 40 percent of children, and by six years of age, almost one half of children will have at least one episode of wheezing. Most infants and children with recurrent wheezing have asthma, but other causes should be considered in the differential diagnosis. The most common diagnoses in children with persistent wheezing are asthma, allergies, gastroesophageal reflux, infections, foreign body aspiration and bronchopulmonary dysplasia. Objective: the present study was designed to evaluate the clinical role of different types of bronchoscope and bronchoalveolar lavage in diagnosis of undefined persistent wheezy chest among the age group from 6 months to 14 years, at Al-Azhar University Hospitals in Cairo. Patients and Methods: This a prospective study was conducted on 50 children complaining from different respiratory problems who had enrolled consecutively from the Outpatient Clinic and the Inpatient Pediatric Department of Al-Azhar Faculty of Medicine University Hospitals (AL-Hussein and Bab-Elshareya), from January 2017 to December 2018. Patients ages ranged between 6 months and 14 years. Results: as regard distribution of patients according to post bronchoscopy diagnosis, the study showed that foreign body inhalation n16 (32%), Chronic aspiration n9 (18%), tracheobronchomalacia n2 (4%), bronchial mass n1 (2%), streptococcus pneumonia n7 (14%), hemophilus influenza n2 (4%), staphylococcus aureus n3 (6%) and pseudomonas aeuroginosa n2 (4%), candida albicans n1 (2%), Mycobacterium TB n1 (2%). Conclusion: It could be concluded that if radiography is normal and the child continues to wheeze, bronchoscopy should be the next step, the bronchoscope is a valuable tool in the diagnosis and treatment of airway disorders in children. It has a good safety profile with rarely reported life threatening or long-standing complications.

Yields of Bronchoscopy and Bronchoalveolar Lavage in Diagnosis of Undefined Persistent Wheezy Chest Among Children

Yields of Bronchoscopy and Bronchoalveolar Lavage in Diagnosis of Undefined Persistent Wheezy Chest Among Children

Value of Broncho-Alveolar Lavage in Diagnosis of Newly Developed Lung Infiltrates in Mechanically Ventilated Patients

Background and Objectives: in a developing country, cost effectiveness is an important consideration. The aim of this study was to investigate the efficiency and safety of mini broncho-alveolar lavage (mini BAL) samples in the diagnosis of newly developed lung infiltrates in mechanically ventilated patients. Methods: fifty mechanically ventilated patients with newly developed lung infiltrates were assessed by mini-BAL and subsequent microbiological examination. An infant Ryle catheter FG-10 was used as the inner catheter, a Nelaton catheter size 18 FG was used as the outer protective catheter and was blocked by sterile K-Y gel instead of the pre-packaged catheters. Results: eighty six percent of samples collected by Mini-BAL technique from mechanically ventilated patients showed positive growth for culture and sensitivity. Thirty percent of patients had bi microbial infection while fourteen had polymicrobial infection. Fungal infection (Candida) was the most frequent isolated pathogen (32%) followed by Gram-negative bacteria (Klebsiella) (30%). Legionella was the commonest isolated atypical bacteria. Conclusion: this study highlighted the mini-BAL technique as a simple, safe, cheap, available and non-invasive bedside procedure for acquiring uncontaminated lower respiratory secretions in patients with newly developed pulmonary infiltrates.

Value of Broncho-Alveolar Lavage in Diagnosis of Newly Developed Lung Infiltrates in Mechanically Ventilated Patients

Value of Broncho-Alveolar Lavage in Diagnosis of Newly Developed Lung Infiltrates in Mechanically Ventilated Patients

Comparison of Bronchoalveolar Lavage and Protected Mini- Bronchoalveolar Lavage in Diagnosis of Pneumonia in Intensive Care Unit

Aim The aim is to compare microbiological examination of samples which were taken by fiberoptic BAL and protected mini BAL methods from patients with diagnosis of pneumonia in the intensive care unit Methods Study population included all adult critically ill mechanically ventilated patients who were admitted to Intensive Care Units of Cerrahpa a Medical School between July and November and diagnosed as pneumonia either on admission or during their stay Patients were assessed by APACHE II SOFA and CPIS The patients were randomly allocated in to two groups using computer generated random numbers In the first group FOB and BAL was applied first followed by protected mini BAL in the second group protected mini BAL was the first sampling method The samples were then transferred to the microbiology laboratory for microbiologic examination The materials were evaluated by gram staining and quantitative cultures The compability of fiberoptic BAL and protected mini BAL results for all cases was evaluated with kappa statistics A two tailed p value of lt was considered statistically significant Results Sixty six patients were included in to the study Fiberoptic BAL followed by protected mini BAL was performed in patients protected mini BAL followed by fiberoptic BAL in patients No significant difference was found between two groups about demographic features severity scores laboratory values use of antibiotics comorbidities and prognosis When the types of pathogens were compared between two groups no significant differences were found When the results of samples were evaluated for compatibility all together the Kappa coefficient was found as p which is not high value and this kappa coefficient is considered to be moderate value Conclusion Protected mini BAL procedure is effective less invasive and easier to apply compared to FOB But it cannot be used as an alternative to fiberoptic BAL to determine the causative organism of pneumonia in ICU patients according to this study results

Role of fiberoptic bronchoscopy and BAL in assessment of the patients with non-responding pneumonia

BackgroundNon-responding pneumonia is usually a topic of interest for pulmonologists. Fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) may be an important tool in assessment of non-responding pneumonia. There is paucity of recent studies in this area. AimThis study aimed to assess the impact of early bronchoscopy and BAL in etiological diagnosis of the patients with non-responding pneumonia with special emphasis on efficacy of FOB and BAL in diagnosis. Settings and designA prospective, observational study was conducted in chest and medical microbiology and immunology departments, Zagazig University Hospitals. Patients and methodsThere were total 135 patients included in our study after fulfilling the criteria of non-responding pneumonia by clinical and laboratory parameters, patients were subjected to FOB and BALF microbiological, cytological, histopathological investigations. ResultsThe patients were 90 males and 45 females with a mean age of 47.6±12.2years. Unilateral lung involvement was seen in 108 (80%) patients, whereas bilateral involvement in 27 (20%) patients. Right upper lobe was the most commonly involved site (25.9%). In this study, bacterial pneumonia 83.71% was found to be the commonest etiology of non-resolving pneumonia, followed by bronchogenic carcinoma 13.3% and tuberculosis 2.96%. FOB was done for all patients. BAL fluid results were 88 positive, gram stain samples (65.1%), 4 BAL ZN stain and mycobacterial culture positive cases (2.96%), pyogenic organisms were isolated in 113 patients 83.71% by BAL fluid culture. Bronchoscopic biopsies were also performed in 18 cases. BAL fluid cytology was positive in 6 cases (33.3%), transbronchial forceps biopsy positive results were found in 10 cases (55.55%) and bronchial brushing showed positive results in 3 cases (16.66%). ConclusionsNRP is common and represents a difficult clinical problem as the cause may vary from a benign delay in recovery to life-threatening progressive pneumonia. A systematic approach to investigation and management is recommended with consideration of both infectious and non-infectious causes.

Evaluation of Bronchoalveolar Lavage Cytology (B.A.L) in the Diagnosis of Lung Cancer among Sudanese Patients in Khartoum State Hospitals

Introduction: Lung cancer is the most common cause of cancer mortality worldwide, causing approximately 1.2 million deaths per year. Bronchoalveolar Lavage (BAL) is a minimally invasive procedure that has gained acceptance and steady popularity as a tool for diagnosing lung cancer. The aim of this study was to compare the diagnostic efficacy of BAL in diagnosing lung cancer, taking bronchial biopsy as the ‘Gold Standard’ diagnostic test. Material and Methods: During the period from 2010 to 2012, 179 BAL cytology samples were prepared for cytology examination and smears were stained with Diff Quick stain. Bronchial biopsy histological sections were stained with H&E stain. Histo/Cytology correlation was performed in 83 cases to determine the sensitivity and specificity of BAL in diagnosis of lung carcinoma. Results: Out of the 179 cases, 118 (65.9%) were males and 61 (34.1%) were females. The ages ranged from 18 to 86 years old. BAL cytology cases reported with diagnoses of negative for malignant cells (nZ152, 84.9%), suspicious (nZ12, 6.7%), and carcinoma (nZ15, 8.4%). Bronchial biopsy specimens showed benign and malignant conditions in 69 (76.6%), and 21 (23.4%) respectively. Of the 21 malignant conditions, 11 were squamous cell carcinoma, 9 were adenocarcinoma, and one case was small cell carcinoma. The correlation between BAL cytology and histology results were performed in 83 cases. BAL sensitivity and specificity was 55%, and 95% respectively. Conclusion: Bronchoalveolar Lavage (BAL) is an easily performed, noninvasive, and well tolerated procedure that is useful in routine assessment of patients for lung carcinoma. The low sensitivity of BAL in our study stresses the importance of optimum sampling as well as cytopreperatory techniques using cyto-centrifugation. BAL combined to bronchial biopsy increases the accuracy of lung carcinoma diagnosis.

Role of bronchoalveolar lavage in diagnosis and treatment of children with respiratory disorders

Bronchoalveolar lavage is a lung interventional technique,it has a good prospect in the diagnosis and treatment of childhood respiratory diseases,especially in severe and difficult cases.This article focused on the role of bronchoalveolar lavage in the diagnosis and treatment of respiratory diseases in children,described the impact of pulmonary surfactant. Key words: Bronchoalveolar lavage; Diagnosis; Treatment; Pulmonary surfactant; Children

Bronchoalveolar Lavage for Diagnosis of Miliary Lung Metastases From Papillary Thyroid Carcinoma

Bronchoalveolar Lavage for Diagnosis of Miliary Lung Metastases From Papillary Thyroid Carcinoma

Bronchoalveolar Lavage in Diagnosis of Ventilator-Associated Pneumonia in Patients with Burns

Ventilator-associated pneumonia (VAP) remains a major cause of morbidity and mortality for patients with burns. In nonburn populations, bronchoalveolar lavage (BAL) excludes other pathology such as systemic inflammatory response syndrome. We hypothesized that BAL would decrease our false-positive VAP rate. All ventilated patients with burn injury who were admitted to our institution from July 2000 through June 2003 were included. After June 2001, BAL was used to make the diagnosis of VAP, with > or =10(4) organisms considered a positive result. Fifty patients met criteria for VAP, 21 in the pre-BAL period and 29 in the BAL period. Six patients (21%) in the BAL group had quantitative cultures <10(4) and were not treated. The outcomes for these patients were not different than those treated for VAP. There were no differences in age, TBSA size, antibiotic use, or ventilator days for the pre-BAL or BAL groups, although the pneumonia rate was lower for the BAL time period. The use of BAL eliminated the unnecessary antibiotic treatment of 21% of patients in the BAL time period and was associated with a lower rate of VAP.

Pneumocystis Pneumonia

In Brief Major controversies persist regarding the diagnosis and management of Pneumocystis pneumonia (PCP). Of considerable significance is the fact that much of the available evidence relates to human immunodeficiency virus (HIV)–infected subjects and may not be applicable to other immunocompromised groups. Induced sputum (IS) remains an important diagnostic test with a high specificity and good patient acceptability. Immunofluorescence improves the sensitivity of IS when compared with standard cytochemical staining. Nucleic acid amplification techniques may also increase sensitivity, although they remain predominantly a research tool. Bronchoscopy with bronchoalveolar lavage (BAL) is the optimum diagnostic test, with bilobar washing including an upper lobe reaching sensitivities of 95%. BAL, rather than IS, should be performed as the initial diagnostic investigation in non–HIV-infected subjects where the Pneumocystis pathogen load is low. Transbronchial biopsy is no more sensitive than bilobar lavage and is associated with considerable morbidity. Nonbronchoscopic lavage is an underused diagnostic resource offering a cheap alternative to fiberoptic bronchoscopy. Early diagnostic evaluation with BAL rather than empirical treatment is encouraged since the chance of detecting Pneumocystis after several days of anti-Pneumocystis treatment is reduced. In addition, multiple respiratory pathogens are common in patients with low CD4 counts. This strategy of early BAL is particularly important in non–HIV-infected immunocompromised patients where there is greater uncertainty regarding the clinical diagnosis of PCP. Pneumocystis pneumonia remains a serious infection in both human immunodeficiency virus (HIV)–infected and noninfected immunocompromised populations. This review explores controversies in both the diagnosis and management of Pneumocystis pneumonia (PCP); notably the advantages and disadvantages of induced sputum and bronchoalveolar lavage for diagnosis, the optimum methods for identifying Pneumocystis in specimens, and the timing of the introduction of highly active antiretroviral therapy following HIV-PCP coinfection.

Giant cell interstitial pneumonia in two hard metal workers: The role of bronchoalveolar lavage in diagnosis

Two cases of hard metal lung disease and pathological findings of giant cell interstitial pneumonia are reported. The cases worked in different factories manufacturing hard metal parts from tungsten carbide and cobalt. Pathological specimens were obtained by percutaneous thoracoscopy and transbronchial lung biopsy. X-ray microanalysis detected only tungsten carbide in the lung specimen of one case. Bronchoalveolar lavage showed diagnostic bizarre macrophages in the lavage fluid.

Bronchoalveolar Lavage in the Diagnosis of Peripheral, Primary Lung Cancer

Numerous case reports have shown the advantage of using bronchoalveolar lavage (BAL) in cytologic diagnosis of primary and secondary malignant neoplasms of the respiratory system. The aim of this study was to determine the usefulness of BAL in the diagnosis of peripheral, primary lung cancer. Of 1,864 patients referred to the Bronchological Department for endoscopic examination, 145 patients were studied: six with large cell lung cancer, 22 with adenocarcinoma, 15 with alveolar cell lung cancer, 40 with small cell lung cancer, and 62 with squamous cell lung cancer. In 94 patients (64.8 percent), BAL was diagnostic, revealing malignant cells. In 52 (35.9 percent) of these patients, the cytologic diagnosis agreed with the final pathologic diagnosis of the resected tumor. The result of BAL was affected by the type of cancer and size of the tumor. Highest yields were seen in adenocarcinoma (59.2 percent) and alveolar cell lung cancer (80 percent). The average size of the tumor in the group with correct cell typing was 4.9 +/- 1.8 cm; in patients with nondiagnostic BAL, the average size was 2.6 +/- 1.2 cm. BAL provided the highest (statistically significant, p less than 0.05) diagnostic yield (64.8 percent) in comparison with other sampling techniques: brush biopsy (29.8 percent), catheter biopsy (26.8 percent), and forceps biopsy (32.7 percent). The diagnostic yield of BAL and transbronchial fine needle aspiration biopsy (58.3 percent) did not significantly differ. BAL proved to be a valuable diagnostic tool in detecting peripheral, primary, pulmonary malignant neoplasms.