Cordani S, Manna A, Vignali M, Tascini C
Department of Pneumology and Microbiology Laboratory, S. Bartolomeo Hospital, Sarzana SP, Italy.
Infez Med. 2008 Dec;16(4):209-13.
We report our experience concerning bronchoalveolar lavage (BAL) in adult patients affected by haematological malignancies. BAL was performed in patients with documented pulmonary diseases not responding to empirical antibiotic and antifungal therapies. Overall, 25 bronchoscopies were performed in 24 patients. This technique led to pathogen identification in 11 out of 24 patients (45 percent). In particular, we identified four cases of tuberculosis, four of aspergillosis, two of pneumocystosis, two bacterial pneumonia and one pneumonia sustained by CMV (in two cases, pneumonia was polymicrobial). In three cases, where microbiological diagnosis had been obtained by means of other exams (blood culture, urinary antigens), BAL negativity allowed us to exclude alternative diagnoses. Pulmonary location of haematological disease was diagnosed in seven patients. BAL drove a switch therapy in 54 percent of patients. When performed by expert operators, BAL is useful and safe also in frail patients, such as those affected by onco-haematological malignancies.
我们报告了我们在患有血液系统恶性肿瘤的成年患者中进行支气管肺泡灌洗（BAL）的经验。BAL用于患有经证实的肺部疾病且对经验性抗生素和抗真菌治疗无反应的患者。总体而言，对24例患者进行了25次支气管镜检查。该技术在24例患者中的11例（45%）中鉴定出病原体。具体而言，我们鉴定出4例结核病、4例曲霉病、2例肺孢子菌病、2例细菌性肺炎和1例由巨细胞病毒引起的肺炎（2例为多微生物性肺炎）。在3例通过其他检查（血培养、尿抗原）获得微生物学诊断的病例中，BAL结果为阴性使我们能够排除其他诊断。7例患者被诊断为血液系统疾病的肺部定位。BAL促使54%的患者更换治疗方案。当由专业操作人员进行时，BAL对于体弱患者（如患有肿瘤血液系统恶性肿瘤的患者）也是有用且安全的。
