Bronchoalveolar lavage specimen

Cysts and trophozoites of Pneumocystis jirovecii can be detected in bronchoalveolar lavage specimens using monoclonal antibodies that yield results that are slightly more sensitive than GMS, Giemsa, or Papanicolaou staining (Fig. 3.19).1 4,216,217 Antibodies are most helpful in cases of extrapulmonary pneumocystosis or... 

Ng VL, Geaghan SM, Leoung G, Shiboski S, Fahy J, Sehnapp LY, Yajko DH, Hopenell PC, Hadley WK. Lack of effect of prophylactic aerosolised pentamidine on detection oiPneumocystis carinii in induced sputum or bronchoalveolar lavage specimens. Arch Pathol Lab Med 1993 117 493-496. 

Uses quantitative culture of endotracheal aspirates, bronchoalveolar lavage (BAL), or protected specimen brush (PSB). 

Usually it requires a wedge biopsy of the lung to identify the histologic features and perform the necessary special studies for diagnosis. Occasionally, a transbronchial biopsy is sufficient to confirm recurrent disease, particularly when supported by immunohistochemistry or flow cytometry on cells studied from the bronchoalveolar lavage. In these cases, small specimens (transbronchial biopsy. 

Figure 1 Algorithm for the management of patients with nosocomial pneumonia. Abbreviations CXR, chest X ray CPIS, clinical pulmonary infection score TEAS, tracheobronchial aspirate BAL, bronchoalveolar lavage PSB, protected specimen bmsh PaOa, oxygen arterial pressure Fi02, inspired fraction of oxygen MODS, multiple organ dysfunction syndrome.

Lung tissue Protected specimen brush Bronchoalveolar lavage... 

Kirkpatrick MB, Bass JB. Quantitative bacterial cultures of bronchoalveolar lavage fluids and protected brush catheter specimens from normal subjects. Am Rev Respir Dis 1989 139 546-548. 

Chastre J, Fagon JY, Soler P, et al. Diagnosis of nosocomial bacterial pneumonia in intubated patients undergoing ventilation comparison of the usefulness of bronchoalveolar lavage and the protected specimen brush. Am J Med 1988 85 499-506. 

Torres A, Martos J, Puig de la Bellacasa, et al. Specificity of endotracheal aspiration, protected specimen brush and bronchoalveolar lavage cultures in mechanically ventilated patients without pneumonia. Am Rev Respir Dis 1993 147 952-957. 

Meduri GU, Beals DH, Maijub AG, Baselski V. Protected bronchoalveolar lavage. A new bronchoscopic technique to retrieve uncontaminated specimens in ICU patients A review. Crit Care Med 1994 22 1683-1691. 

Souweine B, Veber B, Bedos IP, et al. Diagnostic accuracy of protected specimen brush and bronchoalveolar lavage in nosocomial pneumonia impact of previous antimicrobial treatments. Crit Care Med 1998 26 236-244. 

Because of these problems, a group of investigators recently formulated recommendations for standardization of methods used to diagnose ventilator-associated pneumonia. These methods involve bronchoscopic techniques (e.g., quantitative culture of protected-specimen brushings, bronchoalveolar lavage, and protected bronchoalveolar lavage). The reported sensitivities and specificities of these methods have ranged from 70% to 100% and 60% to 100%, respectively (7). 

---