Role of bronchoscopy in diagnosis of pulmonary infections in non-HIV immune compromised host

Palaniappan Chockalingam, Deepaselvi Meyyappan


Background: The occurrence of pulmonary infections is a common life threatening complication in immunocompromised patients, necessitating timely diagnosis and specific treatment. In our study bronchoscopic diagnostic techniques that include fiber optic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) were applied in non-HIV immunocompromised conditions to determine the aetiology infectious microorganisms and comparing the clinical characteristics with bronchoscopic yield and to assess the influence of these methods on therapeutic outcome in this population.

Methods: This prospective observational study was conducted at Rajiv Gandhi Government General Hospital, Park Town, Chennai, for a period of 8 months from January 2016 – August 2016.After meeting the requirements of eligibility criteria, the study included 65 immunocompromised patients consecutively who presented with pulmonary diseases. The primary outcome measure was the diagnostic yield of bronchoscopy among non-HIV immunocompromised patients. The secondary outcome measures were collecting the data including etiology of different microorganisms and non-infectious causes of pulmonary diseases among non- HIV immunocompromised patients, comparing the symptoms at the time of presentation, different radiological pattern with bronchoscopic yield and comparing the different subgroups of non-HIV immunocompromised patients with regards to presenting symptoms, radiological patterns, bronchoscopic yield, treatment modification, different spectrum of infections and complications.

Results: The mean age of the patients was 41.91 ranging from 15-74 years. Majority (n=36) patients showed chest symptoms alone. On bronchoscopy, 52 cases (80%) out of 65 showed positive results and negative result was noticed in 13 cases (20%). Among them bacterial infections were predominant with 24%. After BAL culture bacterial culture was positive in 23 (35%) patients and fungal culture was positive in 15 (23%) cases. After bronchoscopy, current treatment plan was changed in 37 patients and clinical improvement was seen in 26 cases i.e. yield of bronchoscopy was 71%. Minor complications were noticed in 16 cases after bronchoscopy.

Conclusion: Our study concludes, in clinically stable patients FOB was the preferred technique for finding the cause of lung infiltrates in non-HIV immunocompromised patients. Because our results signifies that the yield of bronchoscopy was high (80%) despite empirical antimicrobial therapy.


Bronchoscopy, Pulmonary infections, Non-HIV immune compromised patients

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Pizzo PA. Fever in Immunocompromised Patients. N Engl J Med. 1999;341:893-900.

Grippi MA, Elias JA, Fishman JA, Kotloff RM, Pack AI, Senior RM, et al. Fishmans textbook of pulmonary medicine. 5th edition. Mc Graw Hill Education; 2015: 4006.

Meyer KC, Raghu G, Baughman RP, Brown KK, Costabel U, du Bois RM, et al. American Thoracic Society Committee on BAL in Interstitial Lung Disease. An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. Am J Respir Crit Care Med. 2012;185:1004–14.

Efrati O, Sadeh-Gornik U, Modan-Moses D, Barak A, Szeinberg A, Vardi A, et al. Flexible bronchoscopy and bronchoalveolar lavage in pediatric patients with lung disease. Pediatr Crit Care Med. 2009;10(1):80-4.

Technical recommendations and guidelines for bronchoalveolar lavage (BAL). Report of the European Society of Pneumology Task Group. Eur Respir J. 1989;2:561–85.

Prasoon Jain, Sunder Sandur, Yvonne Meli, Alejandro C. Arroliga, James K. Stoller, Atul C. Mehta. Role of Flexible Bronchoscopy in Immunocompromised Patients With Lung Infiltrates. Chest. 2004;125(2):712-22.

Kyle R. Brownback Association of bronchoalveolar lavage with computer tomogram and symptoms in immunocompromised patients. Annuals Thoracic Medicine. 2013;8(3):153-9.

Danés C, González-Martín J, Pumarola T, Rañó A, Benito N. Pulmonary Infiltrates in Immunosuppressed Patients: Analysis of a Diagnostic Protocol. J Clin Microbiol. 2002;40(6):2134–40.

Kahn FW. Analysis of Bronchoalveolar Lavage Specimens from Immunocompromised Patients with a Protocol Applicable in the Microbiology Laboratory. J Clin Microbiol. 1988;26(6):1150-5.

Baughman RP. Use of bronchoscopy in the diagnosis of infection in the immune-compromised host. Thorax. 1994;49:3-7.

Vélez L, Correa LT, Maya MA, Mejía P, Ortega J, Bedoya V, et al. Diagnostic accuracy of bronchoalveolar lavage samples in immunosuppressed patients with suspected pneumonia: Analysis of a protocol. Respir Med. 2007;101:2160–7.

Menon LR, Divate S, Acharya VN, Mahashur AA, Natrajan G, Almeida AF. Utility of bronchoalveolar lavage in the diagnosis of pulmonary infections in immunosuppressed patients. J Assoc Physicians India. 2002;50:1110-4.

Shorr AF, Susla GM. Pulmonary Infiltrates in the Non-HIVInfected Immunocompromised Patient, Etiologies, Diagnostic Strategies, and Outcomes. Chest. 2004;125(1):260-71.

Rañó A, Agustí C, Benito N, Rovira M, Angrill J. Prognostic factors of non-HIV immunocompromised patients with pulmonary infiltrates. Chest. 2002;122(1):253-61.

Chan JC, So SY, Lam WK, Mary SM. High incidence of pulmonary tuberculosis in the non-HIV infected immunocompromised patients in Hong Kong. Chest. 1989;96(4):835-9.

Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults, 2013. Thorax 2013;68:1–i44.

Hsu AA, Allen DM, Yeo CT, Ang BS, Ong YY . Bronchoscopy in immunocompromised host with pulmonary infiltrates. Ann Acad Med Singapore. 1996;25(6):797-803.

Hummel M, Rudert S, Hof H, Hehlmann R, Buchheidt D. Diagnostic yield of bronchoscopy with bronchoalveolar lavage in febrile patients with hematologic malignancies and pulmonary infiltrates. Ann Hematol. 2008;87(4):291-7.