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. 1989 Sep;64(9):1246–1250. doi: 10.1136/adc.64.9.1246

Bronchoalveolar lavage in HIV infected patients with interstitial pneumonitis.

J de Blic 1, S Blanche 1, C Danel 1, M Le Bourgeois 1, M Caniglia 1, P Scheinmann 1
PMCID: PMC1792727  PMID: 2817943

Abstract

The value of taking microbiological and cytological specimens by flexible bronchoscopy and bronchoalveolar lavage under local anaesthesia was assessed on 43 occasions in 35 HIV infected children, aged 3 months to 16 years, with interstitial pneumonitis. In acute interstitial pneumonitis (n = 22, 26 specimens from bronchoalveolar lavages) the microbiological yield was 73%, Pneumocystis carinii being the commonest infective agent (n = 14). P carinii pneumonia was found only in children with deficient antigen induced lymphocyte proliferative responses who had not been treated with long term prophylactic co-trimoxazole. In contrast, in 13 children with chronic interstitial pneumonitis that was consistent with a diagnosis of pulmonary lymphoid hyperplasia who underwent bronchoalveolar lavage on 17 occasions, there were two isolates of cytomegalovirus and one of adenovirus, but P carinii was not found. Ten of the 13 children had normal antigen induced lymphocyte proliferative responses. Useful cytological data were also gleaned from bronchoalveolar lavage specimens. Lymphocytosis was significantly higher in pulmonary lymphoid hyperplasia (36(SD 11)%) than in P carinii pneumonia (24(19)%) whereas the percentage of polymorphonuclear neutrophils was significantly lower (3(2)% compared with 12(13)%). Flexible bronchoscopy with bronchoalveolar lavage is safe even in young infants and should reduce the necessity for open lung biopsy in the management of HIV infected children with interstitial pneumonitis.

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Selected References

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  1. Barbour S. D. Acquired immunodeficiency syndrome of childhood. Pediatr Clin North Am. 1987 Feb;34(1):247–268. doi: 10.1016/s0031-3955(16)36192-2. [DOI] [PubMed] [Google Scholar]
  2. Blanche S., Le Deist F., Fischer A., Veber F., Debre M., Chamaret S., Montagnier L., Griscelli C. Longitudinal study of 18 children with perinatal LAV/HTLV III infection: attempt at prognostic evaluation. J Pediatr. 1986 Dec;109(6):965–970. doi: 10.1016/s0022-3476(86)80277-3. [DOI] [PubMed] [Google Scholar]
  3. Bye M. R., Bernstein L., Shah K., Ellaurie M., Rubinstein A. Diagnostic bronchoalveolar lavage in children with AIDS. Pediatr Pulmonol. 1987 Nov-Dec;3(6):425–428. doi: 10.1002/ppul.1950030609. [DOI] [PubMed] [Google Scholar]
  4. Couderc L. J., Hervé P., Solal-Celigny P., Herman D., D'Agay M. F., Morinet F., Matheron S., Rabian C., Caubarrere I., Clauvel J. P. Pneumonie lymphoïde interstitielle et polyadénopathies chez des sujets infectés par le virus LAV/HTLV III. Presse Med. 1986 Jun 14;15(24):1127–1130. [PubMed] [Google Scholar]
  5. Durandy A., Wioland M., Sabolovic D., Griscelli C. Electrophoretic characteristics and membrane receptors of lymphocytes in primary immunodeficiency diseases. Clin Immunol Immunopathol. 1975 Sep;4(3):440–448. doi: 10.1016/0090-1229(75)90012-4. [DOI] [PubMed] [Google Scholar]
  6. Fitzpatrick S. B., Stokes D. C., Marsh B., Wang K. P. Transbronchial lung biopsy in pediatric and adolescent patients. Am J Dis Child. 1985 Jan;139(1):46–49. doi: 10.1001/archpedi.1985.02140030048027. [DOI] [PubMed] [Google Scholar]
  7. Fouret P., Touboul J. L., Picard F., Mayaud C., Roland J. Apport de l'examen cytologique du liquide de lavage bronchoalvéolaire chez les patients atteints de syndrome d'immunodéficience acquise et de syndrome associé. Ann Pathol. 1986;6(1):45–52. [PubMed] [Google Scholar]
  8. Frankel L. R., Smith D. W., Lewiston N. J. Bronchoalveolar lavage for diagnosis of pneumonia in the immunocompromised child. Pediatrics. 1988 Jun;81(6):785–788. [PubMed] [Google Scholar]
  9. Ho D. D., Pomerantz R. J., Kaplan J. C. Pathogenesis of infection with human immunodeficiency virus. N Engl J Med. 1987 Jul 30;317(5):278–286. doi: 10.1056/NEJM198707303170505. [DOI] [PubMed] [Google Scholar]
  10. Leigh M. W., Henshaw N. G., Wood R. E. Diagnosis of Pneumocystis carinii pneumonia in pediatric patients using bronchoscopic bronchoalveolar lavage. Pediatr Infect Dis. 1985 Jul-Aug;4(4):408–410. doi: 10.1097/00006454-198507000-00017. [DOI] [PubMed] [Google Scholar]
  11. Murray J. F., Garay S. M., Hopewell P. C., Mills J., Snider G. L., Stover D. E. NHLBI workshop summary. Pulmonary complications of the acquired immunodeficiency syndrome: an update. Report of the second National Heart, Lung and Blood Institute workshop. Am Rev Respir Dis. 1987 Feb;135(2):504–509. doi: 10.1164/arrd.1987.135.2.504. [DOI] [PubMed] [Google Scholar]
  12. Novick B. E., Rubinstein A. AIDS--the paediatric perspective. AIDS. 1987 May;1(1):3–7. [PubMed] [Google Scholar]
  13. Orenstein M., Webber C. A., Cash M., Heurich A. E. Value of bronchoalveolar lavage in the diagnosis of pulmonary infection in acquired immune deficiency syndrome. Thorax. 1986 May;41(5):345–349. doi: 10.1136/thx.41.5.345. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Pattishall E. N., Noyes B. E., Orenstein D. M. Use of bronchoalveolar lavage in immunocompromised children with pneumonia. Pediatr Pulmonol. 1988;5(1):1–5. doi: 10.1002/ppul.1950050102. [DOI] [PubMed] [Google Scholar]
  15. Plata F., Autran B., Martins L. P., Wain-Hobson S., Raphaël M., Mayaud C., Denis M., Guillon J. M., Debré P. AIDS virus-specific cytotoxic T lymphocytes in lung disorders. Nature. 1987 Jul 23;328(6128):348–351. doi: 10.1038/328348a0. [DOI] [PubMed] [Google Scholar]
  16. Rosen M. J., Tow T. W., Teirstein A. S., Chuang M. T., Marchevsky A., Bottone E. J. Diagnosis of pulmonary complications of the acquired immune deficiency syndrome. Thorax. 1985 Aug;40(8):571–575. doi: 10.1136/thx.40.8.571. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Rubinstein A., Morecki R., Silverman B., Charytan M., Krieger B. Z., Andiman W., Ziprkowski M. N., Goldman H. Pulmonary disease in children with acquired immune deficiency syndrome and AIDS-related complex. J Pediatr. 1986 Apr;108(4):498–503. doi: 10.1016/s0022-3476(86)80822-8. [DOI] [PubMed] [Google Scholar]
  18. Scott G. B., Buck B. E., Leterman J. G., Bloom F. L., Parks W. P. Acquired immunodeficiency syndrome in infants. N Engl J Med. 1984 Jan 12;310(2):76–81. doi: 10.1056/NEJM198401123100202. [DOI] [PubMed] [Google Scholar]
  19. Shannon K. M., Ammann A. J. Acquired immune deficiency syndrome in childhood. J Pediatr. 1985 Feb;106(2):332–342. doi: 10.1016/s0022-3476(85)80320-6. [DOI] [PubMed] [Google Scholar]
  20. Smith R. L., el-Sadr W. M., Lewis M. L. Correlation of bronchoalveolar lavage cell populations with clinical severity of Pneumocystis carinii pneumonia. Chest. 1988 Jan;93(1):60–64. doi: 10.1378/chest.93.1.60. [DOI] [PubMed] [Google Scholar]
  21. Suffredini A. F., Ognibene F. P., Lack E. E., Simmons J. T., Brenner M., Gill V. J., Lane H. C., Fauci A. S., Parrillo J. E., Masur H. Nonspecific interstitial pneumonitis: a common cause of pulmonary disease in the acquired immunodeficiency syndrome. Ann Intern Med. 1987 Jul;107(1):7–13. doi: 10.7326/0003-4819-107-1-7. [DOI] [PubMed] [Google Scholar]
  22. Venet A., Dennewald G., Sandron D., Stern M., Jaubert F., Leibowitch J. Bronchoalveolar lavage in acquired immunodeficiency syndrome. Lancet. 1983 Jul 2;2(8340):53–53. doi: 10.1016/s0140-6736(83)90041-7. [DOI] [PubMed] [Google Scholar]
  23. Wallace J. M., Barbers R. G., Oishi J. S., Prince H. Cellular and T-lymphocyte subpopulation profiles in bronchoalveolar lavage fluid from patients with acquired immunodeficiency syndrome and pneumonitis. Am Rev Respir Dis. 1984 Nov;130(5):786–790. doi: 10.1164/arrd.1984.130.5.786. [DOI] [PubMed] [Google Scholar]
  24. Young K. R., Jr, Rankin J. A., Naegel G. P., Paul E. S., Reynolds H. Y. Bronchoalveolar lavage cells and proteins in patients with the acquired immunodeficiency syndrome. An immunologic analysis. Ann Intern Med. 1985 Oct;103(4):522–533. doi: 10.7326/0003-4819-103-4-522. [DOI] [PubMed] [Google Scholar]
  25. de Blic J., McKelvie P., Le Bourgeois M., Blanche S., Benoist M. R., Scheinmann P. Value of bronchoalveolar lavage in the management of severe acute pneumonia and interstitial pneumonitis in the immunocompromised child. Thorax. 1987 Oct;42(10):759–765. doi: 10.1136/thx.42.10.759. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. de Blic J., Scheinmann P., Paupe J. Successful treatment of persistent neonatal interstitial emphysema by flexible bronchoscopy. Lancet. 1984 Dec 15;2(8416):1389–1390. doi: 10.1016/s0140-6736(84)92076-2. [DOI] [PubMed] [Google Scholar]

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