Bronchoalveolar lavage for pneumocystis pneumonia in HIV-infected children

Bronchoalveolar lavage (BAL) by flexible fiberoptic bronchoscopy is useful in the diagnosis of Pneumocystis carinii pneumonia (PCP) in adults with acquired immunodeficiency syndrome. To evaluate the safety and efficacy of this procedure in children with human immunodeficiency virus in whom PCP was considered, we reviewed the records of 15 consecutive procedures performed on eight patients by a pediatric pulmonologist during a 19-month period. Pneumocystis carinii pneumonia was identified after five of 15 BAL procedures. Other pathogens or multiple pathogens were found in some cases. A specific infectious diagnosis was obtained in ten of 15 procedures. No patient required subsequent open lung biopsy. Follow-up for a minimum of 6 weeks and response to therapy did not suggest PCP in any case where BAL failed to establish its diagnosis. No major complication was attributed to BAL. We conclude that BAL is safe and effective in the diagnosis of PCP in children with HIV infection. Guidelines are suggested to optimize its safety and utility.