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Bedside bronchoalveolar lavage for the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. 1986

G R Flick, and R G Barbers, and H Gong

We studied the utility of bronchoalveolar lavage (BAL) as the primary diagnostic procedure in 46 separate episodes of suspected Pneumocystis carinii pneumonia (PCP) in 42 patients with AIDS. 35 procedures were performed at the bedside. A separate group of 40 historical controls with AIDS and suspected PCP had transbronchial biopsy (TBB) as the primary procedure. At least 100 cc of saline in 50 cc aliquots was used for BAL. Specimens were processed using rapid silver methenamine, Papanicolau, and Ziehl Neelson stains with appropriate cultures. There were 29 positives and 17 true negatives for PCP with BAL, confirmed by biopsy in 11, and using clinical criteria in 6. Accuracy, sensitivity, and predictive value of a negative result were all 100%. There was no significant difference in yield between TBB and BAL (p greater than 0.10). BAL was useful to diagnose other opportunistic organisms including CMV, atypical mycobacteria, and fungi. The frequency of isolates in the TBB group were comparable. TBB was complicated by 4 episodes of major bleeding. The data indicate that bedside BAL is effective, and safer than TBB in patients with AIDS and suspected PCP. We advocate BAL as the primary diagnostic procedure which can be performed at the bedside in patients with suspected PCP and AIDS. The high accuracy and predictive value of a negative BAL for PCP suggests confirmatory procedures may not be necessary in many cases.

UI MeSH Term Description Entries
D007507 Therapeutic Irrigation The washing of a body cavity or surface by flowing water or solution for therapy or diagnosis. Douching,Lavage,Douchings,Irrigation, Therapeutic,Irrigations, Therapeutic,Lavages,Therapeutic Irrigations
D011020 Pneumonia, Pneumocystis A pulmonary disease in humans occurring in immunodeficient or malnourished patients or infants, characterized by DYSPNEA, tachypnea, and HYPOXEMIA. Pneumocystis pneumonia is a frequently seen opportunistic infection in AIDS. It is caused by the fungus PNEUMOCYSTIS JIROVECII. The disease is also found in other MAMMALS where it is caused by related species of Pneumocystis. P carinii Pneumonia,P. carinii Pneumonia,P. jirovecii Pneumonia,PCP Pneumonia,Pneumocystis Pneumonia,Pneumocystosis,Pneumonia, Interstitial Plasma Cell,PCP Infection,Pneumocystis carinii Pneumonia,Pneumocystis jirovecii Pneumonia,Pneumonia, Pneumocystis carinii,Infection, PCP,P carinii Pneumonias,P. carinii Pneumonias,P. jirovecii Pneumonias,PCP Infections,PCP Pneumonias,Pneumocystis Pneumonias,Pneumocystoses,Pneumonia, P carinii,Pneumonia, P. carinii,Pneumonia, P. jirovecii,Pneumonia, PCP,Pneumonia, Pneumocystis jirovecii,Pneumonias, PCP
D011650 Pulmonary Alveoli Small polyhedral outpouchings along the walls of the alveolar sacs, alveolar ducts and terminal bronchioles through the walls of which gas exchange between alveolar air and pulmonary capillary blood takes place. Alveoli, Pulmonary,Alveolus, Pulmonary,Pulmonary Alveolus
D001980 Bronchi The larger air passages of the lungs arising from the terminal bifurcation of the TRACHEA. They include the largest two primary bronchi which branch out into secondary bronchi, and tertiary bronchi which extend into BRONCHIOLES and PULMONARY ALVEOLI. Primary Bronchi,Primary Bronchus,Secondary Bronchi,Secondary Bronchus,Tertiary Bronchi,Tertiary Bronchus,Bronchi, Primary,Bronchi, Secondary,Bronchi, Tertiary,Bronchus,Bronchus, Primary,Bronchus, Secondary,Bronchus, Tertiary
D001999 Bronchoscopy Endoscopic examination, therapy or surgery of the bronchi. Bronchoscopic Surgical Procedures,Surgical Procedures, Bronchoscopic,Bronchoscopic Surgery,Surgery, Bronchoscopic,Bronchoscopic Surgeries,Bronchoscopic Surgical Procedure,Bronchoscopies,Surgeries, Bronchoscopic,Surgical Procedure, Bronchoscopic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000163 Acquired Immunodeficiency Syndrome An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive T-lymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. AIDS,Immunodeficiency Syndrome, Acquired,Immunologic Deficiency Syndrome, Acquired,Acquired Immune Deficiency Syndrome,Acquired Immuno-Deficiency Syndrome,Acquired Immuno Deficiency Syndrome,Acquired Immuno-Deficiency Syndromes,Acquired Immunodeficiency Syndromes,Immuno-Deficiency Syndrome, Acquired,Immuno-Deficiency Syndromes, Acquired,Immunodeficiency Syndromes, Acquired,Syndrome, Acquired Immuno-Deficiency,Syndrome, Acquired Immunodeficiency,Syndromes, Acquired Immuno-Deficiency,Syndromes, Acquired Immunodeficiency
D001706 Biopsy Removal and pathologic examination of specimens from the living body. Biopsies

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