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Bacterial Tracheobronchitis and Bronchial Anastomotic Infections in Lung Transplant Recipients
Infection
Signs/symptoms
Radiology
Microbiology
Histopathologic evidence
Proven tracheobronchitis
At least one of the following:
• New-onset purulent sputum OR change in character/quantity of sputum OR increased respiratory secretions suctioned
• New-onset or worsening cough, dyspnea, tachypnea AND
• One or more endobronchial lesions (erythema, ulceration, necrosis and pseudomembrane formation, including at the site endobronchial stent) without an alternative diagnosis and without evidence of invasive parenchymal disease (Figure 1b)
Figure 1.
Presentations of tracheobronchitis (TrB) and bronchial anastomatic infection (BAI) in lung transplant recipients. (A) Normal bronchoscopy. (B) Bacterial tracheobronchitis. (C) Fungal tracheobronchitis. (D) Bronchial anastomotic infection.
Negative chest X-ray OR one CT scan without the following:
• New/progressive and persistent infiltrate
• Consolidation
• Cavitation
May be positive if concurrent pneumonia is present
Histology showing inflammation with organisms or positive culture from the sterile tissue ALONE
Probable tracheobronchitis
As for proven
As for proven
As for proven
Negative histology
Proven bronchial anastomotic infection
At least one of the following:
• New-onset purulent sputum OR change in character/quantity of sputum OR increased respiratory secretions suctioned
• New-onset or worsening cough, dyspnea, tachypnea
AND endobronchial lesions (erythema, ulceration, necrosis and pseudomembrane formation) restricted to the site of anastomosis without involvement of other parts of bronchial tree or lung parenchyma
As for proven tracheobronchitis; may be positive if concurrent pneumonia is present
