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[Pneumonia diagnosed with bronchoscopy in HIV-positive patients]
M Cruz Villuendas1, M A Remacha, B Echávarri
1Servicios de Microbiología, Hospital Miguel Servet, Zaragoza.
Background:
The object of our research is to analyse the microbiological results of the samples which have been obtained by means of fibronchoscopy (FB) from HIV positive patients from 1991 until 1993.
Methods:
Sixty fibrobronchoscopies were carried out on fifty-seven HIV positive patients. In every case, samples of bronchoaspirate (BAS), bronchoalveolar lavage (BAL) and telescoping plugged catheter (TPC) were cultured; the last two in a quantitative way. Pneumocystis carinii was investigated in BAL by means of immunofluorescence with monoclonal antibodies.
Results:
Some microorganisms were isolated in forty-seven bronchoscopies. Thirteen episodes resulted negative. The most frequent etiologic agent was Pneumocystis carinii (seventeen cases). The etiology of fifteen episodes was polymicrobial. The intersticial radiological pattern was the predominant one. It was observed in twenty-seven cases. With regard to immunity, 91% of the patients showed CD4 < 200.
Conclusions:
In our research work, the samples that have been obtained by means of FB showed a high percentage of diagnoses; that is the reason why we regard this technique as very useful for the diagnosis of pneumonia in patients with AIDS. Due to the large number of bacterian pneumonia, we consider necessary not only the use of BAL, but also that of TPC in these processes.
Insights
Fibrobronchoscopy (FB) is highly effective for diagnosing pneumonia in HIV-positive patients, with Pneumocystis carinii being the most common cause. Combining bronchoalveolar lavage (BAL) and telescoping plugged catheter (TPC) samples improves bacterial pneumonia detection.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pulmonology
Context:
- Human Immunodeficiency Virus (HIV) positive patients often present with opportunistic infections, particularly pneumonia.
- Diagnosing pneumonia in immunocompromised individuals requires sensitive microbiological techniques.
Purpose:
- To analyze microbiological findings from bronchoalveolar samples in HIV-positive patients.
- To evaluate the diagnostic utility of fibrobronchoscopy (FB) and specific sampling methods (BAS, BAL, TPC) for pneumonia in this population.
Summary:
- Microbiological analysis of samples obtained via FB from 57 HIV-positive patients revealed pathogens in 47 cases.
- Pneumocystis carinii was the most frequent isolate (17 cases), followed by polymicrobial infections (15 cases).
- The interstitial radiological pattern was predominant (27 cases), and 91% of patients had CD4 counts < 200 cells/µL.
Impact:
- Fibrobronchoscopy (FB) demonstrates high diagnostic yield for pneumonia in patients with Acquired Immunodeficiency Syndrome (AIDS).
- The study advocates for the combined use of bronchoalveolar lavage (BAL) and telescoping plugged catheter (TPC) for improved bacterial pneumonia diagnosis.