Ewig S, Moter A, Nachtsheim K H, Seuffert H M, Marklein G, Schumacher R, Eis G, Leutner C, Bauer T, Reichel C
Medizinische Universitätsklinik und Poliklinik, Institut für Medizinische Mikrobiologie und Immunologie, Bonn.
Pneumologie. 1995 Oct;49(10):546-55.
The concept of the protected bronchoalveolar lavage (PBAL) is to improve the diagnostic yield in bacterial pneumonia by unifying the high sensitivity of bronchoalveolar lavage (BAL) and specificity of the protected specimen brush (PSB). HIV-infected patients have been shown to have a high incidence of bacterial pneumonia as well as bacterial colonisation of the tracheobronchial tree. We therefore studied the value of PBAL in this population.
During a period of twelve months 40 episodes in 36 patients with symptoms suggestive of pneumonia were investigated retrospectively. In all cases without infiltrates on chest radiograph a CT-scan of the chest was performed. Patients without infiltrates also in CT-scan served as controls. Bronchoscopic investigation included a PSB and a PBAL in the same lung segment most prominently affected. Microbiological workup was performed for bacterial agents, mycobacteria, fungi, viruses and parasites. Quantitative cultures for bacteria were considered significant in case of > or equal to 10(3) cfu/ml in PSB and > or equal to 10(4) cfu/ml in PBAL.
32 episodes in 28 patients were identified as pneumonia. A definite diagnosis could be established in 19/32 (59%) of cases. Bacteria accounted for 10/19 (53%). Pneumocystis carinii for 9/19 (47%) of cases including one case that revealed mixed infection with Streptococcus pneumoniae and Pneumocystis carinii. Another pneumonia was due to Aspergillus fumigatus. The sensitivity for bacterial pneumonia was 44% for PSB and 56% for PBAL, the specificity 100%. The overall diagnostic accuracy was 60% and 68%, respectively. The yield for Pneumocystis carinii was 8/9 (89%).
PBAL as compared to PSB had a superior diagnostic yield for bacterial pneumonia. As PBAL additionally conserved the yield of BAL reported for Pneumocystis carinii, it may represent a rational diagnostic technique for pneumonia in HIV-infected patients.
支气管肺泡灌洗保护毛刷（PBAL）的概念是通过结合支气管肺泡灌洗（BAL）的高敏感性和保护样本刷（PSB）的特异性，提高细菌性肺炎的诊断率。已证实，HIV感染患者细菌性肺炎以及气管支气管树细菌定植的发生率较高。因此，我们研究了PBAL在该人群中的价值。
回顾性研究了36例有肺炎症状的患者在12个月内发生的40次发作。所有胸部X线片无浸润影的病例均进行胸部CT扫描。胸部CT扫描也无浸润影的患者作为对照。支气管镜检查包括在最明显受累的同一肺段进行PSB和PBAL。对细菌、分枝杆菌、真菌、病毒和寄生虫进行微生物学检查。PSB中细菌定量培养≥10³cfu/ml且PBAL中≥10⁴cfu/ml时，细菌定量培养被视为有意义。
28例患者中的32次发作被诊断为肺炎。19/32（59%）的病例可明确诊断。细菌占10/19（53%）。卡氏肺孢子虫占9/19（47%）的病例，其中1例显示肺炎链球菌和卡氏肺孢子虫混合感染。另1例肺炎由烟曲霉引起。PSB对细菌性肺炎的敏感性为44%，PBAL为56%，特异性为100%。总体诊断准确率分别为60%和68%。卡氏肺孢子虫的检出率为8/9（89%）。
与PSB相比，PBAL对细菌性肺炎的诊断率更高。由于PBAL还保留了BAL对卡氏肺孢子虫的检出率，它可能是HIV感染患者肺炎的一种合理诊断技术。
