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Bronchoalveolar Lavage of Murine Lungs to Analyze Inflammatory Cell Infiltration
Published on: May 4, 2017
Cytologic examination of bronchoalveolar lavage fluid from immunosuppressed patients
Ali Mohammed Al-Za'abi1, Scott MacDonald, William Geddie
1Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Insights
Cytologic examination of bronchoalveolar lavage samples can detect infections in immunocompromised patients. However, its sensitivity is limited, especially for Cytomegalovirus, and silver staining offers no added benefit.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Cytopathology
Background:
- Pulmonary infiltrates in immunocompromised patients often indicate infections.
- Early and accurate diagnosis is crucial for effective treatment.
Purpose of the Study:
- To evaluate the diagnostic value of cytologic examination of bronchoalveolar lavage (BAL) samples in immunocompromised patients.
- To assess the utility of different BAL sample preparations and silver staining techniques.
Main Methods:
- Cytologic and microbiologic analyses were performed on 336 BAL samples from 155 immunosuppressed patients over six months.
- Sensitivity of cytology for infection detection was calculated, with and without Cytomegalovirus (CMV).
Main Results:
- Infectious agents were identified in 27 samples by cytology, microbiology, or both. Neoplastic processes were found in four cases.
- Cytology sensitivity for infection detection was 34.6% (42.9% excluding CMV).
- Cytology detected 6/15 Aspergillus and 3/4 Pneumocystis cases, but no CMV cases. Preparation methods and silver staining did not improve detection rates.
Conclusions:
- Cytologic examination of BAL samples has a limited sensitivity for detecting pulmonary infections in immunocompromised individuals.
- Specific pathogens like Aspergillus and Pneumocystis can be identified, but CMV is often missed.
- Standard preparations and silver staining do not enhance the diagnostic yield of BAL cytology for these infections.
Abstract:
Pulmonary infiltrates in immunocompromised patients frequently represent infections. This study was undertaken to evaluate cytologic examination of bronchoalveolar lavage samples and the value of different preparations and silver staining. Over 6 mo, 336 samples were collected from 155 immunosuppressed patients in whom both cytologic and microbiologic studies were performed. In 27 samples, the cytology, microbiology or both demonstrated the presence of infectious agents. In four cases, cytology identified neoplastic process. Cytology had a sensitivity of 34.6% for detection of infection, which increased to 42.9% when Cytomegalovirus was excluded. Cytology detected 6 of 15 cases of Aspergillus, including three cases not detected by microbiology and 3 of 4 cases of Pneumocystis, but did not identify any of the Cytomegalovirus cases. The type of preparations did not affect detection of the organism when present in cytologic samples and silver staining did not appear to have added value in examination of these samples.
