Article

Diagnostic yield of bronchoscopy in histologically proven invasive pulmonary aspergillosis.

Division of Pneumology, University Hospital, Basel, Switzerland.
Bone Marrow Transplantation (impact factor: 3.75). 01/2000; 24(11):1195-9. DOI:10.1038/sj.bmt.1702045 pp.1195-9
Source: PubMed

ABSTRACT Invasive pulmonary aspergillosis (IPA) is a life-threatening infectious complication in neutropenic patients after high-dose chemotherapy or hematopoietic stem cell transplantation. Its diagnosis is mainly based on clinical symptoms, and radiological signs on thoracic CT scan. The value of bronchoscopy is controversial. We analyzed the diagnostic yield of bronchoscopy in 23 consecutive patients with histologically proven invasive pulmonary aspergillosis. In seven patients (30%) bronchoscopically obtained specimens were diagnostic for pulmonary fungal infection. Typical hyphae were detected by cytology in six patients and fungal cultures were positive in four cases. Patients with a positive bronchoscopic result presented more often with multiple changes on thoracic CT scan (71%; 5/7), but had received a lower median cumulative dose of amphotericine B (300 mg; 168-3010 mg) compared to patients with non-diagnostic bronchoscopy (25% multiple lesions (4/16); amphotericine dose 1100 mg, 260-2860 mg). The diagnostic yield of bronchoscopy was not associated with clinical symptoms or duration of neutropenia. Bronchoscopy allows the diagnosis of IPA in about one third of patients. Fungal cultures and cytological examination of intrabronchial specimens obtained during bronchoscopy have a high specificity, but its sensitivity is low. It is advisable to perform diagnostic bronchoscopy before starting antifungal therapy. Better diagnostic tools are urgently needed.

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Keywords

23 consecutive patients
 
25% multiple lesions
 
amphotericine dose 1100 mg
 
antifungal therapy
 
cell transplantation
 
clinical symptoms
 
cytological examination
 
diagnostic yield
 
fungal cultures
 
intrabronchial specimens
 
invasive pulmonary aspergillosis
 
life-threatening infectious complication
 
lower median cumulative dose
 
multiple changes
 
neutropenic patients
 
non-diagnostic bronchoscopy
 
positive bronchoscopic result
 
pulmonary fungal infection
 
thoracic CT scan
 
Typical hyphae