[Infectious pneumopathies in immunodepressed patients. Value of the study of bronchoalveolar lavage fluid]

During a period of 16 months 26 fluid specimens obtained by broncho-alveolar lavage (BAL) in 24 immunocompromised patients were examined. This material included 13 HIV positive patients and 11 patients presenting malignant hemopathies (MH), of whom 7 had had a blood marrow transplantation. The BAL fluid was divided into two equal parts, one of which was sent to the Institute of Pathology and the other to the Laboratory of Bacteriology of Geneva University Hospital. In some cases a transbronchial biopsy was also studied. Eight out of 13 HIV positive patients presented a Pneumocystis carinii infection and one a cytomegalovirus (CMV) infection (associated with atypical mycobacteria infection). In another case streptococcal pneumonia was observed. In 3 patients, analysis of the BAL fluid failed to yield a diagnosis. In the 11 patients with MH, 2 cases of CMV, 2 infections with Candida albicans and one with Aspergillus fumigatus were found. In 2 patients the pneumopathy was due to bacterial infection. Four BAL fluids failed to yield a diagnosis; however, in one of these transbronchial biopsy revealed interstitial pneumonia of unknown origin. On the basis of our material and comparison with clinica, radiological and serological data, it appears that BAL fluid analysis is a helpful and rapid diagnostic aid in infectious pneumopathies of immunocompromised patients. This is especially true of AIDS patients in whom the most common pulmonary complication is Pneumocystis carinii pneumonia. However, success of the analysis requires close cooperation between clinician, bacteriologist and pathologist.