Utility of Bronchoalveolar Lavage in Immunocompromised Children: Diagnostic Yield and Complications

Vega-Briceño, L.E.; Holmgren, N.L.; Bertrand, P.; Rodríguez, J.I.; Barriga, F.; Contreras, I.; Sánchez, I.

doi:10.1016/S1579-2129(06)60377-7

Archivos de Bronconeumología

ISSN: 0300-2896

Archivos de Bronconeumologia is an international journal that publishes original studies whose content is based upon results of research initiatives dealing with several aspects of respiratory medicine including epidemiology, respiratory physiology, pathophysiology of respiratory diseases, clinical management, thoracic surgery, pediatric lung diseases, respiratory critical care, respiratory allergy and translational research. Other types of articles such as editorials, reviews, and different types of letters are also published in the journal. Additionally, the journal expresses the voice of the following scientific societies: the Spanish Respiratory Society of Pneumology and Thoracic Surgery (SEPAR; https://www.separ.es/), the Latin American Thoracic Society (ALAT; https://alatorax.org/), and the Iberian American Association of Thoracic Surgery (AIACT; http://www.aiatorax.com/).

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Vol. 40. Issue 12.

Pages 570-574 (December 2004)

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Pages 570-574 (December 2004)

Original Articles

DOI: 10.1016/S1579-2129(06)60377-7

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Utility of Bronchoalveolar Lavage in Immunocompromised Children: Diagnostic Yield and Complications

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L.E. Vega-Briceñoa,

Corresponding author

LEvega@puc.cl

Correspondence: Dr. L.E. Vega-Briceño. Sección de Respiratorio Pediátrico. Departamento de Pediatría. Pontificia Universidad Católica de Chile. Lira, 85, 5°piso. Laboratorio de Respiratorio. Santiago de Chile. Chile

, N.L. Holmgrena, P. Bertranda, J.I. Rodríguezb, F. Barrigac, I. Contrerasa, I. Sáncheza

a Sección de Respiratorio Pediátrico, Departamento de Pediatría, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile

b Unidad de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile

c Sección de Oncología Pediátrica, Departamento de Pediatría, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile

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Abstract

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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.

Results

Sixty-eight BAL were performed on 54 children (mean age: 7.5 years) receiving wide-spectrum antibiotic treatment. The most frequent respiratory signs and symptoms were fever (90%) and cough and respiratory distress (81%); 18% had neutropenia and 43% thrombocytopenia. A specific pathogen was identified in BAL samples for 25 patients (37%). The pathogens isolated were bacteria in 21 cases, viruses in 6, Pneumocystis carinii in 5, fungi in 4, and Mycobacterium tuberculosis in one. Fourteen (19%) of the children who underwent BAL were on mechanical ventilation. Outcome was satisfactory in all cases. Twenty-one complications were recorded, 17 of which were minor (mild hypoxemia or fever) and 4 major, requiring tracheal intubation. No deaths were recorded.

Conclusions

Evaluation by fiberoptic bronchoscopy together with BAL proved to be a safe procedure with an adequate diagnostic yield that made it possible to determine the etiology of the pulmonary infiltrates seen in chest x-rays. Both positive and negative results of BAL were useful for treating the patients.

Key Words:

Bronchoalveolar lavage

Fiberoptic bronchoscopy

Children

Immunodeficiency

Objetivo

LOS niños inmunodeprimidos presentan el ries-go de desarrollar neumonía por gérmenes oportunistas. El papel del lavado broncoalveolar (LBA) en la evaluación de estos pacientes es aún controvertido.

Material Y Método

Se revisaron las fichas de pacientes con inmunodepresión y síntomas respiratorios a los que se les había practicado un LBA en el Servicio de Pediatría del Hospital Clínico de la Pontificia Universidad Católica de Chile.

Resultados

Se practicaron 68 LBA en 54 niños inmunodeprimidos (edad media: 7,5 años). Los síntomas respiratorios más frecuentes fueron fiebre (90%) y tos y dificultad respiratoria (81%); el 18% tenía neutropenia y el 43%, trombocitopenia. Todos los pacientes estaban en tratamiento antibiótico de amplio espectro. Las muestras del LBA pro-porcionaron un germen específico en 25 pacientes (37%). Los patógenos aislados fueron: bacterias en 21 casos, virus en 6, Pneumocystis carinii en 5, hongos en 4 y Mycobacterium tuberculosis en uno. Catorce (19%) LBA se realizaron a niños que recibían ventilación mecánica. La evolución fue sa-tisfactoria en todos los casos. Se registraron 21 complicaciones, 17 menores (hipoxemia leve o fiebre) y 4 mayores que requirieron intubación traqueal. No se registraron muertes.

Conclusiones

La evaluación fibrobroncoscópica asocia-da a un LBA fue un método seguro, con un adecuado rendimiento, que permitió evaluar la etiología de los infiltrados pulmonares en la radiografía de tórax. Tanto los resultados positivos como los negativos del LBA contribuyeron al tratamiento de estos pacientes.

Palabras clave:

Lavado broncoalveolar

Fibrobroncoscopia

Niños

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