The Value of Bronchoalveolar Lavage in Diagnosis of Fungal Pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

JiaQin , PiWeifeng , WangYanmin , CaiRong , LiuQian , GuanWenbing ,  GuoXuejun

Department of Respiratory Medicine, Shanghai Xinhua Hospital, Jiaotong Medical University, Shanghai, 200092, China;

Corresponding author：

GuoXuejun, Email: snowgen@126.com

Keywords：

Fungal pneumonia; Bronchoalveolar lavage fluid; Infection; Colonization

DOI：

10.7507/1671-6205.2014139

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the value of bronchoscopy alveolar lavage cytology in diagnosis of pulmonary fungus infection and distinguishing colonization from true fungal infections. Methods A retrospective analysis was conducted on the patients with positive fungi results in bronchoalveolar lavage cytology admitted in Shanghai Xinhua Hospital between January 2009 and December 2013.Clinical,radiological,bronchoalveolar lavage and histopathology findings were recorded and analyzed. Results Fungi were found in alveolar lavage fluid in 60 cases.The most common fungal organism identified was Aspergillus,followed by Candida and Cryptococcosis.Twenty-seven cases (45.00%) by lung biopsy pathology were diagnosed as pulmonary fungal infection and 33 cases (55.00%) were diagnosed as lung bacteria colonization.Aspergillus was found in 35 cases (58.33%),as pathogenic bacteria in 12 cases (34.28%),and colonization bacteria in 23 cases (65.72%).Candida was found in 13 cases (21.67%),as pathogenic bacteria in 3 cases (23.08%),and colonization bacteria in 10 cases (76.92%).Ten cases of Cryptococcus and 2 cases of pulmonary sporozoan were all as pathogenic bacteria.Most cases of Aspergillus and Candida in cytological specimens presented as a pulmonary mass or endobrochial growth and were diagnosed as carcinomas in biopsy specimens,so bacteria colonization should be considered in these cases first of all.All cases of Pneumocystis with bilateral ground glass infiltrates and cryptococcosis with parenchymal mass lesion in radiology represented true infection.The coincidence rate of bronchoscopy alveolar lavage cytology and histopathology was 45%. Conclusion Aspergillus and Candida species are the most common fungal organisms in the bronchoscopy alveolar lavage.Fluid cytological examination is an important diagnostic modality for pulmonary mycoses,however it is important to correlate with clinical,bronchoscopy and biopsy findings for accurate diagnosis and appropriate management.

Citation： JiaQin, PiWeifeng, WangYanmin, CaiRong, LiuQian, GuanWenbing, GuoXuejun. The Value of Bronchoalveolar Lavage in Diagnosis of Fungal Pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(6): 569-573. doi: 10.7507/1671-6205.2014139 Copy

1.	Ascioglu S,Rex JH,de Pauw B,et al.Invasive Fungal Infections Cooperative Group of the European Organization for Research and Treatment of Cancer; Mycoses Study Group of the National Institute of Allergy and Infectious Diseases:Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants:an international consensus.Clin Infect Dis,2002,34:7-14.
2.	Shahid M,Malik A,Bhargava R.Bronchogenic carcinoma and secondary aspergillosis common yet unexplored:evaluation of the role of bronchoalveolar lavage-polymerase chain reaction and some nonvalidated serologic methods to establish early diagnosis.Cancer,2008,113:547-558.
3.	Luo BL,Zhang LM,Hu CP,et al.Clinical analysis of 68 patients with pulmonary mycosis in China.Multidiscip Respir Med,2011,6:278-283.
4.	Smahi M,Serraj M,Ouadnouni Y,et al.Aspergilloma in combination with adenocarcinoma of the lung.World J Surg Oncol,2011,9:27.
5.	Schwarz J.The diagnosis of deep mycoses by morphologic methods.Hum Pathol,1982,13:519-533.
6.	Levy H,Horak DA,Tegtmeier BR,et al.The value of bronchoalveolar lavage and bronchial washings in the diagnosis of invasive pulmonary aspergillosis.Respir Med,1992,86:243-248.
7.	Knox KS,Meinke L.Role of bronchoalveolar lavage diagnostics in fungal infections.Clin Chest Med,2009,30:355-365.
8.	Huang L,Morris A,Limper AH,et al.ATS Pneumocystis Workshop Participants:An Official ATS Workshop Summary:recent advances and future directions in pneumocystis pneumonia (PCP).Proc Am Thorac Soc,2006,3:655-664.
9.	Hope WW,Walsh TJ,Denning DW.Laboratory diagnosis of invasive aspergillosis.Lancet Infect Dis,2005,5:609-622.
10.	Musher B,Fredricks D,Leisenring W,et al.Aspergillus galactomannan enzyme immunoassay and quantitative PCR for diagnosis of invasive aspergillosis with bronchoalveolar lavage fluid.J Clin Microbiol,2004,42:5517-5522.
11.	Hayden RT,Isotalo PA,Parrett T,et al.In situ hybridization for the differentiation of Aspergillus,Fusarium,and Pseudallescheria species in tissue section.Diagn Mol Pathol,2003,12:21-26.
12.	Franquet T,Muller NL,Gimenez A,et al.Spectrum of pulmonary aspergillosis:histologic,clinical,and radiologic findings.Radiographics,2001,21:825-837.
13.	Babbin BA,Greene JN,Vega R,et al.Pathologic manifestations of invasive pulmonary aspergillosis in cancer patients:the many faces of Aspergillus.Cancer Control,2000,7:566-571.
14.	Nilsson JR,Restrepo CS,Jagirdar J.Two cases of endobronchial carcinoid masked by superimposed aspergillosis:a review of the literature of primary lung cancers associated with Aspergillus.Ann Diagn Pathol,2013,17:131-136.
15.	Olobatoke AO,David D,Hafeez W,et al.Pulmonary carcinosarcoma initially presenting as invasive aspergillosis:a case report of previously unreported combination.Diagn Pathol,2010,5:11.
16.	Greaves TS,Strigle SM.The recognition of Pneumocystis carinii in routine Papanicolaou-stained smears.Acta Cytol,1985,29:714-720.
17.	Paradis IL,Ross C,Dekker A,et al.A comparison of modified methenamine silver and toluidine blue stains for the detection of Pneumocystis carinii in bronchoalveolar lavage specimens from immunosuppressed patients.Acta Cytol,1990,34:511-516.
18.	Johnston WW,Schlein B,Amatulli J.Cytopathologic diagnosis of fungus infections.1.A method for the preparation of simulated cytopathologic material for the teaching of fungus morphology in cytology specimens.2.The presence of fungus in clinical material.Acta Cytol,1969,13:488-495.
19.	Whitaker D,Sterrett GF.Cryptococcus neoformans diagnosed by fine needle aspiration cytology of the lung.Acta Cytol,1976,20:105-107.
20.	Powers CN.Diagnosis of infectious diseases:a cytopathologist's perspective.Clin Microbiol Rev,1998,11:341-365.
21.	Austin P,Dekker A,Kennerdall JS.Orbital aspergillosis:report of a case diagnosed by fine needle aspiration.Acta Cytol,1983,27:166-169.
22.	Ashton PR.Infectious organisms in cytologic material.Lab Med,1983,14:227-233.
23.	Neumann MP,Eng MH,Rholl KE,et al.Disseminated histoplasmosis diagnosed by percutaneous needle biopsy of a retroperitoneal lymph node:a case report.Acta Cytol,1992,36:527-528.
24.	Itano H,Andou A,Date H,et al.Nonsmall cell lung cancer coexisting with pulmonary aspergilloma.Jpn J Thorac Cardiovasc Surg,2005,53:513-516.
25.	Shimizu J,Watanabe Y,Oda M,et al.A case of lung cancer suspected to be pulmonary mycosis of the fungus ball type.Nihon Kyobu Shikkan Gakkai Zasshi,1990,28:1252-1256.
26.	Sangoi AR,Rogers WM,Longacre TA,et al.Challenges and pitfalls of morphologic identification of fungal infections in histologic and cytologic specimens:a ten-year retrospective review at a single institution.Am J Clin Pathol,2009,131:364-375.
27.	Crapanzano JP,Zakowski MF.Diagnostic dilemmas in pulmonary cytology.Cancer,2001,93:364-375.
28.	Limper AH.The changing spectrum of fungal infections in pulmonary and critical care practice:clinical approach to diagnosis.Proc Am Thorac Soc,2010,7:163-168.
29.	Greene RE,Schlamm HT,Oestmann JW,et al.Imaging findings in acute invasive pulmonary aspergillosis:clinical significance of the halo sign.Clin Infect Dis,2007,44:373-379.
30.	Jain D,Kumar Y,Vasishta RK,et al.Zygomycotic necrotizing fasciitis in immunocompetent patients:a series of 18 cases.Mod Pathol,2006,19:1221-1226.
31.	Lui G,Lee N,Lee N,et al.Cryptococcosis in apparently immunocompetent patients.QJM,2006,99:143-151.
32.	Chabé M,Dei-Cas E,Creusy C,et al.Immunocompetent hosts as a reservoir of pneumocystis organisms:histological and RT-PCR data demonstrate active replication.Eur J Clin Microbiol Infect Dis,2004,23:89-97.
33.	Rozenbaum R,Goncalves AJ.Clinical epidemiological study of 171 cases of cryptococcosis.Clin Infect Dis,1994,18:369-380.
34.	Feigin DS.Pulmonary cryptococcosis:radiologic-pathologic correlates of its three forms.AJR Am J Roentgenol,1983,141:1262-1272.
35.	Robinson TD,Barnes DJ,Watson GF.Coexistent cryptococcosis and carcinoma within a solitary pulmonary nodule.Aust NZ J Med,1999,29:561-562.
36.	Kawasaki H,Ishikawa K.Lung adenocarcinoma with coexisting pulmonary cryptococcoma.Jpn J Thorac Cardiovasc Surg,2004,52:21-25.
37.	Hayden RT,Qian X,Roberts GD,et al.In situ hybridization for the identification of yeastlike organisms in tissue section.Diagn Mol Pathol,2001,10:15-23.
38.	Velez L,Correa LT,Maya MA,et al.Diagnostic accuracy of bronchoalveolar lavage samples in immunosuppressed patients with suspected pneumonia:analysis of a protocol.Respir Med,2007,101:2160-2167.

1. Ascioglu S,Rex JH,de Pauw B,et al.Invasive Fungal Infections Cooperative Group of the European Organization for Research and Treatment of Cancer; Mycoses Study Group of the National Institute of Allergy and Infectious Diseases:Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants:an international consensus.Clin Infect Dis,2002,34:7-14.
2. Shahid M,Malik A,Bhargava R.Bronchogenic carcinoma and secondary aspergillosis common yet unexplored:evaluation of the role of bronchoalveolar lavage-polymerase chain reaction and some nonvalidated serologic methods to establish early diagnosis.Cancer,2008,113:547-558.
3. Luo BL,Zhang LM,Hu CP,et al.Clinical analysis of 68 patients with pulmonary mycosis in China.Multidiscip Respir Med,2011,6:278-283.
4. Smahi M,Serraj M,Ouadnouni Y,et al.Aspergilloma in combination with adenocarcinoma of the lung.World J Surg Oncol,2011,9:27.
5. Schwarz J.The diagnosis of deep mycoses by morphologic methods.Hum Pathol,1982,13:519-533.
6. Levy H,Horak DA,Tegtmeier BR,et al.The value of bronchoalveolar lavage and bronchial washings in the diagnosis of invasive pulmonary aspergillosis.Respir Med,1992,86:243-248.
7. Knox KS,Meinke L.Role of bronchoalveolar lavage diagnostics in fungal infections.Clin Chest Med,2009,30:355-365.
8. Huang L,Morris A,Limper AH,et al.ATS Pneumocystis Workshop Participants:An Official ATS Workshop Summary:recent advances and future directions in pneumocystis pneumonia (PCP).Proc Am Thorac Soc,2006,3:655-664.
9. Hope WW,Walsh TJ,Denning DW.Laboratory diagnosis of invasive aspergillosis.Lancet Infect Dis,2005,5:609-622.
10. Musher B,Fredricks D,Leisenring W,et al.Aspergillus galactomannan enzyme immunoassay and quantitative PCR for diagnosis of invasive aspergillosis with bronchoalveolar lavage fluid.J Clin Microbiol,2004,42:5517-5522.
11. Hayden RT,Isotalo PA,Parrett T,et al.In situ hybridization for the differentiation of Aspergillus,Fusarium,and Pseudallescheria species in tissue section.Diagn Mol Pathol,2003,12:21-26.
12. Franquet T,Muller NL,Gimenez A,et al.Spectrum of pulmonary aspergillosis:histologic,clinical,and radiologic findings.Radiographics,2001,21:825-837.
13. Babbin BA,Greene JN,Vega R,et al.Pathologic manifestations of invasive pulmonary aspergillosis in cancer patients:the many faces of Aspergillus.Cancer Control,2000,7:566-571.
14. Nilsson JR,Restrepo CS,Jagirdar J.Two cases of endobronchial carcinoid masked by superimposed aspergillosis:a review of the literature of primary lung cancers associated with Aspergillus.Ann Diagn Pathol,2013,17:131-136.
15. Olobatoke AO,David D,Hafeez W,et al.Pulmonary carcinosarcoma initially presenting as invasive aspergillosis:a case report of previously unreported combination.Diagn Pathol,2010,5:11.
16. Greaves TS,Strigle SM.The recognition of Pneumocystis carinii in routine Papanicolaou-stained smears.Acta Cytol,1985,29:714-720.
17. Paradis IL,Ross C,Dekker A,et al.A comparison of modified methenamine silver and toluidine blue stains for the detection of Pneumocystis carinii in bronchoalveolar lavage specimens from immunosuppressed patients.Acta Cytol,1990,34:511-516.
18. Johnston WW,Schlein B,Amatulli J.Cytopathologic diagnosis of fungus infections.1.A method for the preparation of simulated cytopathologic material for the teaching of fungus morphology in cytology specimens.2.The presence of fungus in clinical material.Acta Cytol,1969,13:488-495.
19. Whitaker D,Sterrett GF.Cryptococcus neoformans diagnosed by fine needle aspiration cytology of the lung.Acta Cytol,1976,20:105-107.
20. Powers CN.Diagnosis of infectious diseases:a cytopathologist's perspective.Clin Microbiol Rev,1998,11:341-365.
21. Austin P,Dekker A,Kennerdall JS.Orbital aspergillosis:report of a case diagnosed by fine needle aspiration.Acta Cytol,1983,27:166-169.
22. Ashton PR.Infectious organisms in cytologic material.Lab Med,1983,14:227-233.
23. Neumann MP,Eng MH,Rholl KE,et al.Disseminated histoplasmosis diagnosed by percutaneous needle biopsy of a retroperitoneal lymph node:a case report.Acta Cytol,1992,36:527-528.
24. Itano H,Andou A,Date H,et al.Nonsmall cell lung cancer coexisting with pulmonary aspergilloma.Jpn J Thorac Cardiovasc Surg,2005,53:513-516.
25. Shimizu J,Watanabe Y,Oda M,et al.A case of lung cancer suspected to be pulmonary mycosis of the fungus ball type.Nihon Kyobu Shikkan Gakkai Zasshi,1990,28:1252-1256.
26. Sangoi AR,Rogers WM,Longacre TA,et al.Challenges and pitfalls of morphologic identification of fungal infections in histologic and cytologic specimens:a ten-year retrospective review at a single institution.Am J Clin Pathol,2009,131:364-375.
27. Crapanzano JP,Zakowski MF.Diagnostic dilemmas in pulmonary cytology.Cancer,2001,93:364-375.
28. Limper AH.The changing spectrum of fungal infections in pulmonary and critical care practice:clinical approach to diagnosis.Proc Am Thorac Soc,2010,7:163-168.
29. Greene RE,Schlamm HT,Oestmann JW,et al.Imaging findings in acute invasive pulmonary aspergillosis:clinical significance of the halo sign.Clin Infect Dis,2007,44:373-379.
30. Jain D,Kumar Y,Vasishta RK,et al.Zygomycotic necrotizing fasciitis in immunocompetent patients:a series of 18 cases.Mod Pathol,2006,19:1221-1226.
31. Lui G,Lee N,Lee N,et al.Cryptococcosis in apparently immunocompetent patients.QJM,2006,99:143-151.
32. Chabé M,Dei-Cas E,Creusy C,et al.Immunocompetent hosts as a reservoir of pneumocystis organisms:histological and RT-PCR data demonstrate active replication.Eur J Clin Microbiol Infect Dis,2004,23:89-97.
33. Rozenbaum R,Goncalves AJ.Clinical epidemiological study of 171 cases of cryptococcosis.Clin Infect Dis,1994,18:369-380.
34. Feigin DS.Pulmonary cryptococcosis:radiologic-pathologic correlates of its three forms.AJR Am J Roentgenol,1983,141:1262-1272.
35. Robinson TD,Barnes DJ,Watson GF.Coexistent cryptococcosis and carcinoma within a solitary pulmonary nodule.Aust NZ J Med,1999,29:561-562.
36. Kawasaki H,Ishikawa K.Lung adenocarcinoma with coexisting pulmonary cryptococcoma.Jpn J Thorac Cardiovasc Surg,2004,52:21-25.
37. Hayden RT,Qian X,Roberts GD,et al.In situ hybridization for the identification of yeastlike organisms in tissue section.Diagn Mol Pathol,2001,10:15-23.
38. Velez L,Correa LT,Maya MA,et al.Diagnostic accuracy of bronchoalveolar lavage samples in immunosuppressed patients with suspected pneumonia:analysis of a protocol.Respir Med,2007,101:2160-2167.

Chinese Journal of Respiratory and Critical Care Medicine

The Value of Bronchoalveolar Lavage in Diagnosis of Fungal Pneumonia

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content