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. 1989 Jul;44(7):554–558. doi: 10.1136/thx.44.7.554

Diagnosis of pulmonary disease in human immunodeficiency virus infection: role of transbronchial biopsy and bronchoalveolar lavage.

M H Griffiths 1, G Kocjan 1, R F Miller 1, P Godfrey-Faussett 1
PMCID: PMC461947  PMID: 2549653

Abstract

The value of transbronchial biopsy and bronchoalveolar lavage was assessed in the diagnosis of pulmonary disease in patients infected with the human immunodeficiency virus (HIV). Seventy four transbronchial biopsy and 66 bronchoalveolar lavage specimens (60 paired specimens) from 80 examinations in 64 patients were reviewed. Pneumocystis carinii was the most common pathogen isolated (43 patients). Bronchoalveolar lavage was superior to transbronchial biopsy for the diagnosis of this pathogen, the sensitivities being 90% and 56%. Cytomegalovirus was identified three times by lavage and once by transbronchial biopsy. Neither method detected Kaposi's sarcoma in the one patient shown to have it by open lung biopsy. The complication rate in a concurrent study of bronchoscopy with transbronchial biopsy in 74 consecutive HIV positive patients was 22%. This study does not support the use of transbronchial biopsy in these patients.

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Selected References

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  1. Blumenfeld W., Wagar E., Hadley W. K. Use of the transbronchial biopsy for diagnosis of opportunistic pulmonary infections in acquired immunodeficiency syndrome (AIDS). Am J Clin Pathol. 1984 Jan;81(1):1–5. doi: 10.1093/ajcp/81.1.1. [DOI] [PubMed] [Google Scholar]
  2. Broaddus C., Dake M. D., Stulbarg M. S., Blumenfeld W., Hadley W. K., Golden J. A., Hopewell P. C. Bronchoalveolar lavage and transbronchial biopsy for the diagnosis of pulmonary infections in the acquired immunodeficiency syndrome. Ann Intern Med. 1985 Jun;102(6):747–752. doi: 10.7326/0003-4819-102-6-747. [DOI] [PubMed] [Google Scholar]
  3. Cunningham J. H., Zavala D. C., Corry R. J., Keim L. W. Trephine air drill, bronchial brush, and fiberoptic transbronchial lung biopsies in immunosuppressed patients. Am Rev Respir Dis. 1977 Feb;115(2):213–220. doi: 10.1164/arrd.1977.115.2.213. [DOI] [PubMed] [Google Scholar]
  4. Feldman N. T., Penningtonp J. E., Ehrie M. G. Transbronchial lung biopsy in the compromised host. JAMA. 1977 Sep 26;238(13):1377–1379. [PubMed] [Google Scholar]
  5. Fouret P. J., Touboul J. L., Mayaud C. M., Akoun G. M., Roland J. Pulmonary Kaposi's sarcoma in patients with acquired immune deficiency syndrome: a clinicopathological study. Thorax. 1987 Apr;42(4):262–268. doi: 10.1136/thx.42.4.262. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Francis N. D., Goldin R. D., Forster S. M., Cook H. T., Coleman D. V., Shaw R., Pinching A. J., Boylston A. W. Diagnosis of lung disease in acquired immune deficiency syndrome: biopsy or cytology and implications for management. J Clin Pathol. 1987 Nov;40(11):1269–1273. doi: 10.1136/jcp.40.11.1269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gal A. A., Klatt E. C., Koss M. N., Strigle S. M., Boylen C. T. The effectiveness of bronchoscopy in the diagnosis of Pneumocystis carinii and cytomegalovirus pulmonary infections in acquired immunodeficiency syndrome. Arch Pathol Lab Med. 1987 Mar;111(3):238–241. [PubMed] [Google Scholar]
  8. Golden J. A., Hollander H., Stulbarg M. S., Gamsu G. Bronchoalveolar lavage as the exclusive diagnostic modality for Pneumocystis carinii pneumonia. A prospective study among patients with acquired immunodeficiency syndrome. Chest. 1986 Jul;90(1):18–22. doi: 10.1378/chest.90.1.18. [DOI] [PubMed] [Google Scholar]
  9. Hanson P. J., Harcourt-Webster J. N., Gazzard B. G., Collins J. V. Fibreoptic bronchoscopy in diagnosis of bronchopulmonary Kaposi's sarcoma. Thorax. 1987 Apr;42(4):269–271. doi: 10.1136/thx.42.4.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hui A. N., Koss M. N., Meyer P. R. Necropsy findings in acquired immunodeficiency syndrome: a comparison of premortem diagnoses with postmortem findings. Hum Pathol. 1984 Jul;15(7):670–676. doi: 10.1016/s0046-8177(84)80293-2. [DOI] [PubMed] [Google Scholar]
  11. McCormick A., Tillett H., Bannister B., Emslie J. Surveillance of AIDS in the United Kingdom. Br Med J (Clin Res Ed) 1987 Dec 5;295(6611):1466–1469. doi: 10.1136/bmj.295.6611.1466. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. McKenna R. J., Jr, Campbell A., McMurtrey M. J., Mountain C. F. Diagnosis for interstitial lung disease in patients with acquired immunodeficiency syndrome (AIDS): a prospective comparison of bronchial washing, alveolar lavage, transbronchial lung biopsy, and open-lung biopsy. Ann Thorac Surg. 1986 Mar;41(3):318–321. doi: 10.1016/s0003-4975(10)62778-6. [DOI] [PubMed] [Google Scholar]
  13. Meduri G. U., Stover D. E., Lee M., Myskowski P. L., Caravelli J. F., Zaman M. B. Pulmonary Kaposi's sarcoma in the acquired immune deficiency syndrome. Clinical, radiographic, and pathologic manifestations. Am J Med. 1986 Jul;81(1):11–18. doi: 10.1016/0002-9343(86)90175-0. [DOI] [PubMed] [Google Scholar]
  14. Milligan S. A., Luce J. M., Golden J., Stulbarg M., Hopewell P. C. Transbronchial biopsy without fluoroscopy in patients with diffuse roentgenographic infiltrates and the acquired immunodeficiency syndrome. Am Rev Respir Dis. 1988 Feb;137(2):486–488. doi: 10.1164/ajrccm/137.2.486. [DOI] [PubMed] [Google Scholar]
  15. Nash G., Fligiel S. Kaposi's sarcoma presenting as pulmonary disease in the acquired immunodeficiency syndrome: diagnosis by lung biopsy. Hum Pathol. 1984 Oct;15(10):999–1001. doi: 10.1016/s0046-8177(84)80130-6. [DOI] [PubMed] [Google Scholar]
  16. Nash G., Fligiel S. Pathologic features of the lung in the acquired immune deficiency syndrome (AIDS): an autopsy study of seventeen homosexual males. Am J Clin Pathol. 1984 Jan;81(1):6–12. doi: 10.1093/ajcp/81.1.6. [DOI] [PubMed] [Google Scholar]
  17. Ognibene F. P., Steis R. G., Macher A. M., Liotta L., Gelmann E., Pass H. I., Lane H. C., Fauci A. S., Parrillo J. E., Masur H. Kaposi's sarcoma causing pulmonary infiltrates and respiratory failure in the acquired immunodeficiency syndrome. Ann Intern Med. 1985 Apr;102(4):471–475. doi: 10.7326/0003-4819-102-4-471. [DOI] [PubMed] [Google Scholar]
  18. 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]
  19. Pass H. I., Potter D., Shelhammer J., Macher A., Ognibene F. P., Longo D. L., Gelmann E., Masur H., Roth J. A. Indications for and diagnostic efficacy of open-lung biopsy in the patient with acquired immunodeficiency syndrome (AIDS). Ann Thorac Surg. 1986 Mar;41(3):307–312. doi: 10.1016/s0003-4975(10)62776-2. [DOI] [PubMed] [Google Scholar]
  20. Pitchenik A. E., Cole C., Russell B. W., Fischl M. A., Spira T. J., Snider D. E., Jr Tuberculosis, atypical mycobacteriosis, and the acquired immunodeficiency syndrome among Haitian and non-Haitian patients in south Florida. Ann Intern Med. 1984 Nov;101(5):641–645. doi: 10.7326/0003-4819-101-5-641. [DOI] [PubMed] [Google Scholar]
  21. Polsky B., Gold J. W., Whimbey E., Dryjanski J., Brown A. E., Schiffman G., Armstrong D. Bacterial pneumonia in patients with the acquired immunodeficiency syndrome. Ann Intern Med. 1986 Jan;104(1):38–41. doi: 10.7326/0003-4819-104-1-38. [DOI] [PubMed] [Google Scholar]
  22. Puksa S., Hutcheon M. A., Hyland R. H. Usefulness of transbronchial biopsy in immunosuppressed patients with pulmonary infiltrates. Thorax. 1983 Feb;38(2):146–150. doi: 10.1136/thx.38.2.146. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Simpson F. G., Arnold A. G., Purvis A., Belfield P. W., Muers M. F., Cooke N. J. Postal survey of bronchoscopic practice by physicians in the United Kingdom. Thorax. 1986 Apr;41(4):311–317. doi: 10.1136/thx.41.4.311. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Stover D. E., White D. A., Romano P. A., Gellene R. A., Robeson W. A. Spectrum of pulmonary diseases associated with the acquired immune deficiency syndrome. Am J Med. 1985 Mar;78(3):429–437. doi: 10.1016/0002-9343(85)90334-1. [DOI] [PubMed] [Google Scholar]
  25. 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]
  26. Sunderam G., McDonald R. J., Maniatis T., Oleske J., Kapila R., Reichman L. B. Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS). JAMA. 1986 Jul 18;256(3):362–366. [PubMed] [Google Scholar]
  27. White S., Tsou E., Waldhorn R. E., Katz P. Life-threatening bacterial pneumonia in male homosexuals with laboratory features of the acquired immunodeficiency syndrome. Chest. 1985 Apr;87(4):486–488. doi: 10.1378/chest.87.4.486. [DOI] [PubMed] [Google Scholar]
  28. Witt D. J., Craven D. E., McCabe W. R. Bacterial infections in adult patients with the acquired immune deficiency syndrome (AIDS) and AIDS-related complex. Am J Med. 1987 May;82(5):900–906. doi: 10.1016/0002-9343(87)90150-1. [DOI] [PubMed] [Google Scholar]

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