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Bronchoalveolar lavage for diagnosis of pneumonia in the immunocompromised child
L R Frankel1, D W Smith, N J Lewiston
1Department of Pediatrics, Stanford University Medical Center, CA 94305.
Insights
Pediatric flexible fiberoptic bronchoscopy with bronchoalveolar lavage aids in diagnosing pneumonia in immunocompromised children. This procedure identified infections like Pneumocystis carinii, Candida albicans, and cytomegalovirus without complications.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Immunocompromised Hosts
Background:
- Pneumonia in immunocompromised children presents diagnostic challenges.
- Early and accurate diagnosis is crucial for effective management.
- Identifying specific pathogens is key to targeted therapy.
Purpose of the Study:
- To evaluate the utility of flexible fiberoptic bronchoscopy with bronchoalveolar lavage in diagnosing pneumonia in immunocompromised children.
- To determine the spectrum of pathogens causing pneumonia in this patient population.
- To assess the safety and feasibility of the procedure.
Main Methods:
- Flexible fiberoptic bronchoscopy was performed on seven immunocompromised children with pneumonia.
- Bronchoalveolar lavage (BAL) was collected during the procedure.
- BAL samples were analyzed for microbial pathogens.
Main Results:
- A definitive diagnosis was achieved in six out of seven patients (85.7%).
- Identified pathogens included Pneumocystis carinii (3 cases), Candida albicans (2 cases), and cytomegalovirus (1 case).
- The procedure was well-tolerated with no reported complications.
Conclusions:
- Flexible fiberoptic bronchoscopy with bronchoalveolar lavage is a safe and effective diagnostic tool for pneumonia in immunocompromised children.
- The procedure facilitates early identification of diverse pathogens.
- Early consideration of bronchoscopy with BAL is recommended for evaluating pneumonia in this vulnerable group.
Abstract:
Seven children with immunocompromised states were referred to the pediatric bronchoscopy service for evaluation of pneumonia. Flexible fiberoptic bronchoscopy accompanied with bronchoalveolar lavage was performed in all seven of these children. A definitive diagnosis was made for six of these seven patients. The diagnosis included Pneumocystis carinii in three, Candida albicans in two, and cytomegalovirus in one. There were no complications associated with the procedure. Flexible fiberoptic bronchoscopy with bronchoalveolar lavage should be considered early in the evaluation of the immunocompromised child with pneumonia.