[Microbiologic diagnosis of diseases of the lung, bronchi and pleura]

Microbiological examination of sputum specimens is of limited value and may give misleading results. On the other side, knowledge of aetiologic agents and corresponding antibiograms may be life-saving in nosocomial pneumonias, for instance. Bronchoalveolar lavages and invasive diagnostic procedures are necessary to obtain microbiological materials without contamination by oral germs. Blood cultures and pleural effusions are useful too. Further informations are given by CF, immunofluorescence (antibody or antigen), ELISA, CIE, latex-agglutination and other modern techniques. Bacterial bronchitis should be treated on the base of calculated chemotherapy. Microbiological procedures are indicated only in the case of repeated therapeutic failure. Invasive diagnostic measures should be avoided in the case of bronchitis. Calculated chemotherapy is sufficient in most cases of community-acquired pneumonias too. Nosocomial pneumonias have a high mortality which only can be reduced by rapid aetiologic diagnosis. All efforts in this direction are of considerable value. Special problems are connected with aspiration pneumonia, atypical and viral pneumonias and pleural empyema. Besides pleural exudate pleural biopsies are useful to demonstrate some special microbes.