Bronchoalveolar Lavage (BAL) in the diagnosis of pulmonary infections in HIV-infected patients

Armando Puglisi, G. Chiesa, G. Melloni, A. Carretta, P. Ciriaco, C. Voci, P. Zannini, A. Grossi

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Purpose: Respiratory infectious disease still remains one of the main diagnostic and therapeutical problems in AIDS patients. The aim of this study was to analyze the microbiological results of BAL specimens of HIV-infected patients, with particular attention to the relationship between ethiology of the pulmonary involvement, radiological reports and endoscopical features. Methods: Between January 1994 and December 1995, 315 bronchoscopies have been performed in 256 consecutive HIV-infected patients at the Department of Thoracic Surgery, San Raffaele Hospital of Milan. Results: Overall diagnostic accuracy in the evaluation of pulmonary involvement was 75% (236 pts). In 231 cases (73.4%) an infectious disease was identified. In other 5 cases (1.6%) an endobronchial Kaposi's sarcoma without infection was observed. Pneumocystis carinii was detected in 126 out of 315 BAL specimens (40%). Cytomegalovirus (CMV) was observed in 111 out of 315 BAL specimens (35%) and in 93 cases it was associated with another pulmonary pathogen. Mycobacterial infections was observed in 49 out of 315 BAL specimens (15.5%); in 28 cases (57.1%) they have been identified as M. tuberculosis. A bacterial pulmonary involvement was observed in 71 out of 315 BAL specimens. Sixteen cases out of 315 BAL specimens demonstrated a fungal pulmonary involvement, among which 10 cases of Aspergillus fumigatus. Conclusions: The review of the microbiological data obtained from BAL specimens clearly demonstrate: 1) Pneumocystis carinii pneumonia, despite effective prophylaxis with Trimethoprim-Sulphametoxazole or aerosolized Pentamidine, still remains the most common cause of respiratory disease in HIV-infected patients; 2) a increasing incidence of polimicrobical infection of the lung; 3) an increasing incidence of bacterial pulmonary infections and in particular of Pseudomonas aeruginosa; 4) micronodular interstitial or an association between tipical interstitial and localized pulmonary involvement in the same patient is more frequently observed than in previous reports.

Original languageEnglish
Issue number4 SUPPL.
Publication statusPublished - Oct 1996

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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