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ctt-journal > Volkova 1 et al. (Abstract)

Volkova 1 et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract10
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation",
Saint Petersburg, Russia, September 18–20, 2010

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The utility of bronchoalveolar lavage in immunocompromised patients

Alisa G. Volkova, Vadim E. Karev, Maria U. Ibatulina

R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russia

Correspondence: Alisa G. Volkova, R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Saint-Petersburg Pavlov State Medical University, 6/8, Tolstoy str., Saint-Petersburg, 197022, Russia, E-mail: alisa-md@spam is badmail.ru

Abstract

Immunocompromised patients are at high risk for developing pneumonia due to opportunistic pathogens such as Pneumocystis carinii, Cytomegalovirus, Aspergillus fumigatus, and Candida albicans, among others. Pulmonary infections often present with atypical and nonspecific clinical and radiographic manifestations. As the antibody production is usually impaired, most diagnostic methods are aimed at revealing pathogens. Bronchoscopy with bronchoalveolar lavage (BAL) is generally used as a diagnostic tool in order to find the causative pathogen of the pulmonary infiltrates seen in chest x-rays. Nevertheless, a high probability of sample contamination may lead to false-positive results and unnecessary antibacterial therapy. These factors can be avoided by combining molecular biology and morphological methods.

Patients and methods: We have studied 150 BAL samples from adult and pediatric hemopoietic stem cell transplantation recipients with ALL (47.8%), AML (16.9%), CML, Ewing’s sarcoma, non-Hodgkin lymphoma, and MDS. The outcome was satisfactory in all cases. The samples obtained were sent immediately to the laboratory for virus culture, bacteriological study, specific testing for tuberculosis, direct inspection for fungal infection, and testing for P. carinii. Cytological samples were stained with hematoxylin-eosin, Ziehl-Neelsen method, or Shiff (PAS). In some cases immunocytochemistry methods were used. We evaluated cell composition, the state of the epithelial cell, degree of epithelial and non-epithelial cell macrophagal activity, exudative inflammation, and for specific infectious agents.

Results and conclusions: Signs of bacterial and viral infection were revealed in 26% and 16.9% of cases respectively. Changes caused by tumor involvement, fungal infection or pneumocystic infections were less frequent. Mycobacterial infection was diagnosed in one of the patients. In 32.3% of cases there were no pathological changes, in 8.4% of cases signs of pathological involution were observed. Complex investigation incorporating bacteriology, molecular biology and pathomorphology methods is a valid measure for early diagnosis of infectious complications. Practically all patients had thrombocytopenia at the moment of research, which raised the risk of complications occurrence.

Keywords: immunocompromised patients, infection, bronchoalveolar lavage

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