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Transthoracic needle aspiration of the lung in respiratory infections
S Kohno1, K Watanabe, A Hamamoto
1Second Department of Internal Medicine, Nagasaki University School of Medicine.
Abstract:
Transthoracic needle aspiration of the lung in guinea pigs with experimental pseudomonas pneumonia was evaluated. The number of bacteria in aspirates correlated well with that of bacteria in the lungs which showed diffuse pneumonia (10(7) inoculum group). The number of deaths of experimental animals increased together with an increase of the times of aspiration. This procedure was also investigated in 16 patients of pneumonia and 17 patients of pulmonary abscess. The isolation rate of pathogen from pneumonia was 31.3% and that from pulmonary abscess 58.8%. A higher isolation rate was obtained with purulent aspirates. Predominantly anaerobic bacteria were isolated, and in pulmonary abscess usually in association with other bacteria. This method could be applied with success, for determining responsible pathogens. Even the normal oropharyngeal flora such as alpha-Streptococcus could be identified as pathogens. The complication rate was relatively low (6 out of 33 patients, 18.2%) including hemoptysis as a major one and pneumothorax or bloody sputum as minor ones. Transthoracic needle aspiration was reevaluated in experimental and clinical materials and was found to be an excellent and safe method for determining the responsible pathogen of respiratory infection.
Insights
Transthoracic needle aspiration is an effective method for identifying bacterial pathogens in lung infections. This study found it safe and accurate in both animal models and human patients with pneumonia and abscesses.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Microbiology
Background:
- Accurate pathogen identification is crucial for treating lung infections like pneumonia and pulmonary abscesses.
- Transthoracic needle aspiration (TNA) is a diagnostic procedure that involves collecting samples from the lung via a needle inserted through the chest wall.
- Previous evaluations of TNA's efficacy and safety in diagnosing respiratory infections are limited.
Purpose of the Study:
- To evaluate the efficacy and safety of transthoracic needle aspiration (TNA) for pathogen identification in experimental and clinical lung infections.
- To correlate bacterial load in aspirates with lung infection severity in a guinea pig model.
- To assess the diagnostic yield and complication rates of TNA in human patients with pneumonia and pulmonary abscesses.
Main Methods:
- Experimental evaluation of TNA in guinea pigs with experimentally induced Pseudomonas pneumonia.
- Clinical investigation of TNA in 16 patients with pneumonia and 17 patients with pulmonary abscess.
- Analysis of bacterial isolation rates, correlation with aspirate purulence, and identification of common pathogens, including anaerobes and oropharyngeal flora.
- Documentation and assessment of procedure-related complications.
Main Results:
- In experimental pneumonia, bacterial counts in TNA aspirates strongly correlated with lung bacterial burden.
- Animal mortality increased with repeated aspiration attempts.
- Pathogen isolation rates were 31.3% for pneumonia and 58.8% for pulmonary abscess, with higher rates for purulent samples.
- Anaerobic bacteria were frequently isolated, often in polymicrobial infections in pulmonary abscesses.
- The overall complication rate in patients was 18.2%, with hemoptysis being the most common major complication.
Conclusions:
- Transthoracic needle aspiration is a safe and effective method for identifying causative pathogens in lung infections.
- The procedure demonstrates good diagnostic yield, particularly for pulmonary abscesses and purulent infections.
- TNA aids in the etiological diagnosis of respiratory infections, even when normal flora are implicated as pathogens.