Value of open lung biopsy in immunocompromised children

Archivos De Bronconeumologia, 2004

OBJECTIVE: Immunocompromised children are at high risk for developing pneumonia due to opportunistic pathogens. The role of bronchoalveolar lavage (BAL) in the evaluation of such patients is still controversial. MATERIAL AND METHOD: We reviewed the hospital records of immunosuppressed patients with respiratory symptoms who had undergone BAL in the pediatric department of the Hospital Clínico de la Pontificia Universidad Católica of Chile.

Acta Haematologica, 2015

Background: Surgical lung biopsy is considered a gold standard for the evaluation of pulmonary disease in immunocompromised children. However, in the literature, its accuracy and the rate of complications vary. Objective: We aimed to evaluate the yield of surgical lung biopsies in the management of persistent pulmonary findings in immunocompromised children. Methods: We performed a retrospective review of clinical records of immunocompromised children who underwent surgical lung biopsies, and evaluated the impact that preoperative factors had on outcomes. Results: Twenty-five patients underwent 27 surgical lung biopsies. The underlying immunodeficiency included allogeneic stem cell transplantation (n = 12), chemotherapy for solid tumors (n = 6), hematologic malignancy (n = 4), primary immunodeficiency (n = 4) and chronic steroid use (n = 1). Biopsies provided a specific histopathologic or microbiologic diagnosis in 10 cases (37%). No preoperative factor predicted a diagnostic biopsy...

Thorax, 1987

The diagnostic value of 73 bronchoalveolar lavages was assessed in 67 immunocompromised children (aged 3 months to 16 years) with pulmonary infiltrates. Thirty one children had primary and 19 secondary immune deficiency, 14 acquired immunodeficiency syndrome (AIDS), and three AIDS related complex. Bronchoalveolar lavage was performed during fibreoptic bronchoscopy, under local anaesthesia in all but two. One or more infective agents was found in eight of 11 patients with severe acute pneumonia and in 26 of 62 patients with interstitial pneumonitis. In interstitial pneumonitis, the most frequently encountered agents were Pneumocystis carinii (12), cytomegalovirus (8), and Aspergillusfumigatus (3). The yield was related to the severity of interstitial pneumonitis. The mean cellular count and cytological profile in lavage returns from patients with varying infective agents or underlying pathological conditions showed no significant difference, except in those children with AIDS and AIDS related complex who had appreciable lymphocytosis (mean percentage of lymphocytes 28 (SD 17)). In children with AIDS and chronic interstitial pneumonitis lymphocytosis without pneumocystis infection was observed in eight of nine bronchoalveolar lavage returns and was suggestive of pulmonary lymphoid hyperplasia. Finally, bronchoalveolar lavage produced a specific diagnosis from the microbiological or cytological findings in 44 instances (60%). Transient exacerbation of tachypnoea was observed in the most severely ill children but there was no case of respiratory decompensation attributable to the bronchoscopy. Bronchoalveolar lavage is a safe and rapid examination for the investigation of pulmonary infiltrates in immunocompromised children. It should be performed as a first line investigation and should reduce the use of open lung biopsy techniques.

Jornal Brasileiro de Pneumologia

Background: The clinical evaluation of patients with postinfectious bronchiolitis obliterans (BO) is variable. Objective: Substantiate the clinical characteristics, the evolution and the complementary tests of 48 patients with postinfectious bronchiolitis obliterans (BO). Method: Observational and retrospective study. Diagnosis of BO was based upon clinical criteria, CT scan findings and exclusion of other diseases. History prior to diagnosis and complementary tests were evaluated as well as initial and final values of oxygen saturation. Results: Mean age of patients at the acute stage of the infectious disease was of 9.6. Thirty-two of the patients were male. All were hospitalized during the acute stage, 14 (29%) in the ICU. Four patients died two years after onset of acute bronchiolitis. During evolution, all patients required emergency care due to exacerbation of the pulmonary condition and 24 (50%) were hospitalized, 2 of them in the ICU. In the majority of cases, cough, wheezing, crackles and hyperinflation persisted, albeit to a lesser degree. The mean baseline arterial saturation was 89% and the final mean was 92%. The most common infectious agents identified in sputum samples were H. influenzae, S. pneumoniae and M. catarrhalis. Increased serum levels of IgC and IgM were found in 7 and 9 patients, respectively. The most frequent findings at thorax CT scan were mosaic perfusion, bronchiectasis, atelectasis and bronchial wall thickening. Conclusion: Postinfectious BO is a chronic and severe disease with persistent symptoms that usually affects infants. Positive serum cultures and increased serum immunoglobulins are suggestive of chronic infectious inflammation.

The Journal of Pediatrics, 1997

Objectives: To evaluate the diagnostic value of transbronchial biopsy (TBB), videoassisted thoracoscopy (VAT), and open lung biopsy (OLB) in immunocompetent children with chronic, d~fuse infiltrates; to identify factors that may predict diagnosis in children requiring biopsy; to determine whether age, number of biopsies, or type of procedure are associated with diagnostic yield in children undergoing transthoraeic biopsy; and to compare morbidity of VAT with that of OLB.

Cancer, 1985

The Annals of Thoracic Surgery, 2001

Methods. This is a retrospective review of 64 open-lung biopsies (58 patients) from 1976 to 1996. Open-lung biopsies were used to grade vasculopathy in 8 patients (12% of 64) with pulmonary hypertension and in 10 patients (16% of 64) with combined pulmonary hypertension and lung parenchymal disease. Forty-six biopsies (72%) were obtained to diagnose parenchymal disease. Comparisons were made between biopsies performed from 1976 to 1989 and from 1990 to 1996.

2020

Objective: This study aims to evaluate clinical and radiological findings and treatment outcomes of the patients with PIBO. Methods: One hundred fourteen children were enrolled. Initial demographic and clinical findings were evaluated. Pre- and post-treatment symptoms, radiological findings and scores, the number of admissions to the hospital and PICU were compared. Results: Seventy-three patients were male. The median age of the patients at initial pulmonary injury was 7.2 months, the median age at diagnosis was 17.5 months and the median interval from initial injury to diagnosis was 8.5 months. Thirty-five patients had mechanical ventilation history. Persistent wheezing was the most common complaints. The most common radiological findings were peribronchial thickening and air-trapping. Sixty-eight patients were treated with inhaled corticosteroid (IC), systemic corticosteroid (SC) and azithromycin (AZT) combination. 25 patients were treated with only IC, 14 with IC and AZT, and 7 ...

Respiratory Medicine, 2007

Bronchoalveolar lavage (BAL) is a useful tool in the diagnosis of pulmonary infections in immunocompromised patients. We aimed to compare the spectrum of infectious pulmonary complications diagnosed using BAL in a large consecutive cohort of immunocompromised patients. The diagnostic yield of 1066 BAL specimens was analyzed in 4 different groups of immunocompromised patients (HIV; solid organ transplants; high-dose chemotherapy and/or stem cell transplants; other immunosuppressive therapy) suffering from fever, respiratory symptoms and/or infiltrates on chest X-ray. Specimens were analyzed for bacteria, mycobacteria, fungi, Pneumocystis jiroveci, cytomegalovirus (CMV) and other viruses. Two time periods were compared (1992-1996; 1997-2003). The overall diagnostic yield of BAL was 34% for bacteria, 22% for CMV, 15% for P. jiroveci, 6% for other viruses, 6% for mycobacteria and 2% for aspergillus. There were significant changes in the pattern of opportunistic infections between the 2 time periods. Mycobacterial infections decreased considerably in the HIV group (17.9 vs. 8.5%, P ¼ 0:02), while the incidence of P. jiroveci decreased mainly in the transplant group (32.6 vs. 7.9%, Po0:00001). This study demonstrates a changed pattern of pulmonary infections in immunocompromised patients diagnosed by BAL. The overall diagnostic yield of BAL remains high in immunocompromised patients with respiratory symptoms.

Chest, 1995

Bronchoalveolar lavage (BAL) and transbronchial bi¬ opsy (TBB) frequently are performed in the investiga¬ tion of immunocompromised patients with lung disor¬ ders. The risk-benefit ratio of TBB currently is debated, since several authors have found that the less invasive BAL may provide as much information as TBB, with the avoidance of some biopsy-related side effects. We retrospectively evaluated 157 instances of bronchoscopy carried out on 142 immunocompromised patients, with both BAL and TBB performed in every case. Immuno¬ suppressant conditions were HIV infection (79), hema¬ tologic malignancies (36), and antirejection therapy in renal transplant recipients (27). Transbronchial biopsy provided a diagnostic yield significantly higher than that obtained by BAL in all categories investigated; di¬ agnostic rates were 77.3% for TBB and 47.6% for BAL (p <0.001) in patients with HIV infection, 55 and 20% (p <0.001) in patients with hematologic malignancies, and 57.5 and 27.2% (p <0.001) in renal transplant recipients. Looking at the whole series, the diagnostic rates of TBB and BAL were 67.5 and 36.3%, respectively (p <0.001), with a total additional yield of 33% provided by TBB, while in only 2% of cases BAL gave rise to di¬ agnostic information not achieved by TBB. Considering that side effects followed TBB at a negligible rate (2.5%), we believe that TBB should be routinely carried out in these patients once the diagnostic strategy has been oriented to bronchoscopy. (Chest 1995; 107:101-06) BAL=bronchoalveolar lavage; CMV=cytomegalovirus; KS=Kaposi's sarcoma; ¥CJ>=Pneumocystis carinii pneu¬ monia; TBB=transbronchial biopsy