TABLE 3.
Description of patients with BAL GM levels of ≥1 but with no evidence of pulmonary aspergillosisa
| Age (yr) (sex) | Underlying disease(s) | Reason(s) for BAL | Antibiotic(s) prior to or at the time of BAL | Chest X-ray/chest CAT scan result | BAL GM level(s)b | Serum GM level(s)b | Microscopy result, TBBX result | Culture result | Diagnosis | Treatment (duration) | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 52 (M) | Healthy | Fever, respiratory symptoms | CTX, AZI | Micronod IF, air space disease, med LN | 1.04 | Not done | Hyphae, chronic inflammation | Aspergillus fumigatus, Aspergillus niger | CAP | No antifungal, antibiotics | Lived (F/u, 6 mo) |
| 48 (F) | COPD, pulmonary HTN | SOB | CTX, AZI | Multiple nodules, diffuse GGO, hilar LN | 1.33, 0.11c | 0.11 (+3 days), 0.05 (+2 m) | No hyphae, bronchiolitis (interstitial lung disease) | No fungus | Pulmonary HTN | No antifungal, antibiotics and steroid | Died (2 mo) |
| 22 (F) | Healthy with miliary TB | Respiratory symptoms | CTX, AZI | New cavitary lung lesion and tib | 0.32 (−12 days), 1.57 | 0.07 (−12 days), 0.11 | No hyphae, necrotizing granuloma | No fungus | Miliary TB | VORI, 5 days, TB medications | Died (19 days) (from disseminated tuberculosis) |
| 77 (M) | HTN | Fever, respiratory symptoms | CTX, AZI | Airspace disease, hilar and med LN | 1.58 | 0.06 (+3 days) | No hyphae, BOOP | Candida | BOOP | No antifungal, steroid | Lived (F/u, 1 yr) |
| 52 (M) | ICM | Respiratory symptoms | None | New cavitary lesion with surrounding infiltrate, hilar LN | 2.38, 0.15c | 0.15 (+10 days), 0.09 (+12 days), 0.07 (+13 days) | No hyphae, nondiagnostic | No fungus | Lung cancer (adenocarcinoma) | VORI, 3 mo (based on BAL GM), antibiotics | Died (4 mo) (lung cancer) |
| 57 (M) | CAD, HTN | Respiratory symptoms | CTX, AZI | New cavitary lesion, med LN | 2.67 | Not done | No hyphae, acute and organizing pneumonia | Aspergillus terreus | CAP, TB | No antifungal, antibiotics | Lived (F/u, 3 mo) |
| 2 (M) | Healthy | ARDS, fever | CTX, Vanc | Consolidation | 2.89, 0.98c | 0.09 (+3 days), 0.14 (+5 days) | No hyphae, not done | No fungus | MRSA pneumonia on viral pneumonia | No antifungal, antibiotics | Lived (alive at d/c; no F/u available) |
| 64 (M) | COPD | Chest pain, s/p falls | None | Mass with necrotic center | 4.98, 6.13c | 0.12 (+4 days) | Yeast, not done | Candida albicans | Disseminated community- acquired MRSA infection | No antifungal, antibiotics | Died (9 days) |
| 54 (F) | Hepatitis C virus with ESLD | Weakness, encephalopathy, respiratory failure | Tim, Vanc | Consolidation (focal), diffuse GGO | 1.26, 0.37c | Not done | Hyphal elements and yeasts, not done | No fungus | Diffuse alveolar hemorrhage | No antifungal | Died (8 days) (hepatorenal syndrome and sepsis) |
TBBX, transbronchial biopsy; M, male; F, female; Micronod IF, micronodular infiltrates; COPD, chronic obstructive pulmonary disease; SOB, shortness of breath; s/p, status post; HTN, hypertension; TB, tuberculosis; ICM, ischemic cardiomyopathy; CAD, coronary artery disease; ESLD, end-stage liver disease; BOOP, bronchiolitis obliterans with organizing pneumonia; LN, lymphadenopathy; GGO, ground glass opacity; med, mediastinal; CAP, community-acquired pneumonia; d/c, discharge; F/u, follow-up; CTX, ceftriaxone; AZI, azithromycin; Tim, timentin; Vanc, vancomycin; VORI, voriconazole.
Date given relative to the initial BAL (e.g., +1 day indicates 1 day after BAL, and −1 day indicates 1 day before BAL).
BAL was performed from several lung segments.