Joos Ladina, Chhajed Prashant N, Wallner Julia, Battegay Manuel, Steiger Juerg, Gratwohl Alois, Tamm Michael
Department of Pulmonary Medicine and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
Respir Med. 2007 Jan;101(1):93-7. doi: 10.1016/j.rmed.2006.04.006. Epub 2006 Jun 5.
Bronchoalveolar lavage (BAL) is a useful tool in the diagnosis of pulmonary infections in immunocompromised patients. We aimed to compare the spectrum of infectious pulmonary complications diagnosed using BAL in a large consecutive cohort of immunocompromised patients. The diagnostic yield of 1066 BAL specimens was analyzed in 4 different groups of immunocompromised patients (HIV; solid organ transplants; high-dose chemotherapy and/or stem cell transplants; other immunosuppressive therapy) suffering from fever, respiratory symptoms and/or infiltrates on chest X-ray. Specimens were analyzed for bacteria, mycobacteria, fungi, Pneumocystis jiroveci, cytomegalovirus (CMV) and other viruses. Two time periods were compared (1992-1996; 1997-2003). The overall diagnostic yield of BAL was 34% for bacteria, 22% for CMV, 15% for P. jiroveci, 6% for other viruses, 6% for mycobacteria and 2% for aspergillus. There were significant changes in the pattern of opportunistic infections between the 2 time periods. Mycobacterial infections decreased considerably in the HIV group (17.9 vs. 8.5%, P=0.02), while the incidence of P. jiroveci decreased mainly in the transplant group (32.6 vs. 7.9%, P<0.00001). This study demonstrates a changed pattern of pulmonary infections in immunocompromised patients diagnosed by BAL. The overall diagnostic yield of BAL remains high in immunocompromised patients with respiratory symptoms.
支气管肺泡灌洗（BAL）是诊断免疫功能低下患者肺部感染的一种有用工具。我们旨在比较在一大组连续的免疫功能低下患者中，使用BAL诊断出的感染性肺部并发症的范围。对1066份BAL标本的诊断结果进行了分析，这些标本来自4组不同的免疫功能低下患者（HIV感染者；实体器官移植患者；高剂量化疗和/或干细胞移植患者；其他免疫抑制治疗患者），他们均有发热、呼吸道症状和/或胸部X线浸润影。对标本进行了细菌、分枝杆菌、真菌、耶氏肺孢子菌、巨细胞病毒（CMV）和其他病毒的检测。比较了两个时间段（1992 - 1996年；1997 - 2003年）。BAL对细菌的总体诊断率为34%，对CMV为22%，对耶氏肺孢子菌为15%，对其他病毒为6%，对分枝杆菌为6%，对曲霉菌为2%。两个时间段之间机会性感染的模式有显著变化。HIV组的分枝杆菌感染显著减少（17.9%对8.5%，P = 0.02），而耶氏肺孢子菌的发病率主要在移植组下降（32.6%对7.9%，P < 0.00001）。这项研究表明，通过BAL诊断的免疫功能低下患者肺部感染模式发生了变化。对于有呼吸道症状的免疫功能低下患者，BAL的总体诊断率仍然很高。
