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Cytomorphology of Alternaria in bronchoalveolar lavage specimens
Abstract:
Review of the bronchoalveolar lavage specimens from 326 patients resulted in the identification of Alternaria in 28 (8.6%) of the specimens. On Papanicolaou-stained Millipore filters, the most common finding was a yellow-brown-pigmented muriform conidium with characteristic transverse and longitudinal septations. Four of the patients had floccose branched and septated hyphae of Alternaria in addition to conidia. Budding yeast or yeast forms were also present in the lavage fluid of 14 of the patients with Alternaria. Two patients had concurrent Pneumocystis carinii pneumonia, and one patient had cytomegalovirus pneumonitis. No patient developed clinical features of systemic Alternaria infection, and autopsy of four patients did not reveal pneumonia. Alternaria conidia in a bronchoalveolar lavage fluid will usually represent laboratory contaminants or nonpathogenic saprophytes, and their significance lies in distinguishing them from other fungi. However, the expanded use of immunosuppressive therapy and the increasing prevalence of acquired immune deficiency syndrome may render such saprophytes clinically important.
Insights
Alternaria fungi were found in bronchoalveolar lavage fluid from 8.6% of patients. While often contaminants, these fungi may become clinically significant in immunocompromised individuals.
Area of Science:
- Medical Mycology
- Pulmonary Medicine
- Clinical Microbiology
Background:
- Bronchoalveolar lavage (BAL) is a diagnostic procedure for pulmonary infections.
- Alternaria species are common airborne fungi, typically considered non-pathogenic saprophytes.
- The clinical significance of fungal identification in BAL fluid requires careful interpretation.
Purpose of the Study:
- To determine the prevalence of Alternaria in BAL specimens.
- To characterize the morphological findings of Alternaria in Papanicolaou-stained BAL fluid.
- To assess the clinical relevance of Alternaria detection in BAL fluid.
Main Methods:
- Review of 326 bronchoalveolar lavage specimens.
- Microscopic examination of Papanicolaou-stained Millipore filters.
- Correlation of fungal findings with patient clinical data and outcomes.
Main Results:
- Alternaria was identified in 28 (8.6%) of 326 BAL specimens.
- Characteristic yellow-brown pigmented muriform conidia were the most common finding.
- No patients developed systemic Alternaria infection; autopsy did not reveal Alternaria pneumonia.
Conclusions:
- Alternaria conidia in BAL fluid are often laboratory contaminants or nonpathogenic saprophytes.
- Distinguishing Alternaria from pathogenic fungi is crucial for accurate diagnosis.
- Increased immunosuppression and acquired immune deficiency syndrome prevalence may elevate the clinical importance of saprophytic fungi like Alternaria.