Diagnostic value of bronchoalveolar lavage in ventilator associated pneumonia of pediatric patients

The major difficulty facing microbial investigation in ventilator associated pneumonia [VAP] is to find a method of choice for distal airway sampling avoiding the contamination of upper respiratory colonizers. Since the inappropriate antibiotic treatment is associated with increased morbidity and mortality therefore the detection of the pathogen causing VAP remains the cornerstone in management. This study was conducted to evaluate the role of bronchoscopic bronchoalveolar lavage [BAL] in the etiologic diagnosis of VAP in Pediatric Intensive Care Unit of Ain Shams University Hospital. In addition, aimed to analyze the pulmonary and systemic inflammatory responses, reflected by levels of serum and BAL interleukin 6 [lL-6] and IL-8, and their association with morbidity and mortality. Thirty VAP patients and 10 mechanically ventilated patients without development of VAP [control group] were enrolled in the study. Endotracheal aspirate [ETA], BAL, and blood samples were collected from VAP patients for microbiological diagnosis. ETA and BAL samples were cultured quantitatively and the isolated organisms were identified by standard techniques. Antimicrobial susceptibility testing was done by disc diffusion method. Blood samples were collected from patients and controls for estimation of serum levels of IL-6 and IL-8. Also levels of these cytokines were estimated in BAL of VAP patients. Twenty four [80%] BAL cultures and 14 [46.7%] ETA cultures were considered positive [thresholds of >/= 10[4] and >/= 10[6] CFU/mL]. Blood cultures were positive in 8 [26.7%] patients. The concordance between BAL and ETA culture results was 66.7% with fair agreement [K= 0.359] while it was only 46.7% between blood and BAL culture results with poor agreement [K= 0.167]. Staphylococcus aureus isolates were recovered from patients with early-onset VAP. Pseudomonas aeruginosa and enteric Gram negative bacilli were the isolated pathogens in late-onset VAP and showed a wide range of antibiotic resistance. The rate of positive BAL culture was significantly higher in late-onset VAP patients [P<0.050]. Serum levels [ng/mL] of lL-6 and IL-8 were significantly higher in VAP patients than controls. VAP patients with sepsis had higher levels of serum and BAL IL-8 and IL-6 than VAP patients without sepsis [p < 0.0001]. BAL IL-6 had the greatest ability to discriminate between patients with and without lung injury. Serum and BAL lL-6 and IL-8 showed a statistically significant [P<0.001] increase in non-survivors among VAP patients and serum IL-8 had the greatest discriminating ability between survivors and non-survivors. Quantitative culture of BAL samples had the potential to be a useful tool for the etiological diagnosis of VAP among mechanically ventilated pediatric patients. However, lowering of the diagnostic threshold to discriminate infection from colonization in patients with prior antibiotic therapy has to be considered. BAL and serum levels of IL-8 and IL-6 might be promising markers for morbidity and poor prognosis in mechanically ventilated pediatric patients

Exudative pleural effusion: effectiveness of pleural fluid analysis and pleural biopsy

The study compared pleural fluid analysis and pleural biopsy in the diagnosis of 100 patients with exudative pleural effusion [PE] in Babol, Islamic Republic of Iran. Tuberculous pleurisy and malignant pleural effusion were confirmed by the identification of acid-fast bacilli from body fluids or tumour cells from tissue specimens. Malignant diseases and tuberculosis were the causes of exudative PE in 43% and 33% of patients respectively. The diagnostic sensitivity of pleural biopsy in patients with tuberculous PE and malignant PE was 70% and 54%, and the diagnostic sensitivity of pleural fluid analysis was 33% and 70% respectively. Combined pleural biopsy and pleural fluid analysis were positive in 97% of tuberculous PE cases and 91% of malignant PE

Hepatocyte growth factor in serum and bronchoalveolar lavage fluid versus exhaled nitric oxide in systemic lupus erythematosus

The present study tried to evaluate the clinical significance of hepatocyte growth factor [HGF] in the serum and bronchoalveolar lavage fluid [BALF] in systemic lupus erythematosus [SLE] patients and their relation to nitric oxide [NO] in exhaled air. Forty SLE patients were investigated along with ten apparently healthy individuals. The patients' group was divided into two groups: group [A] Inactive SLE patients without pulmonary affection [n=14] and group [B] SLE patients with pulmonary affection [n=26]. The last group was further classified into 4 sub groups: - B1= Active SLE patients without interstitial lung disease [ILD], B2= Active SLE patients with interstitial lung disease + Alveolitis [ILD +A], B3: Inactive SLE patients without ILD and B4= Inactive - SLE patients with ILD. All patient and control groups were evaluated for chest X-ray, pulmonary function tests and high-resolution computerized tomography [HRCT], along with systemic lupus erythematosus [SLE routine laboratory investigations. Measurement of HGF Levels in serum and BALF by Immunoassay and exhaled nitric oxide [NO] was measured by chemiluminescence. There were abnormal pulmonary function tests in 65% [26/40] of SLE patients and abnormal HRCT in the form of ILD in 32.5[13/40] of SLE patients. The exhaled NO showed a significant elevation in patients with activity especially those with evidence of active inflammation of the lung. There was no significant elevation of exhaled NO for patients with ILD without evidence of active inflammation. The level of HGF in serum and BALF showed a significant elevation in patients with activity especially with the presence of active lung inflammation. Also, there was a significant elevation of serum HGF and BALF-HGF for patients with ILD without evidence of inflammation. The level of HGF in serum and BALF showed significant elevation in patients as compared with control subjects. HGF levels in BALF of patients was more elevated than HGF levels in serum of patients groups. HGF in serum and BALF was increased in patients with pulmonary fibrosis and correlated with clinical parameters. Measurement of exhaled NO is a simple and non-invasive method to detect the presence of inflammatory lung disease

Efecto de la reexpansión pulmonar en la actividad de la gama glutamil transpeptidasa en el lavado broncoalveolar / Effect of lung reexpansion of gamma-glutamyl transpeptidase activity in broncho alveolar lavage

Se exploró la actividad de gama-glutamil transpeptidasa (GGT) en el lavado broncoalveolar (LBA) como posible indicador de daño tisular en la reexpansión pulmonar de un neumotórax experimental unilateral. Seis conejos adultos sedados con Ketamina y Acetilpromazina, se sometieron a neumotórax inyectando 20 ml de N2/kg en el espacio pleural derecho. Diariamente se repuso el N2 reabsorvido y al tercer día se reexpandió el pulmón aplicando -100 mm de Hg durante 2 h. Se extrajo y separó los pulmones y se practicó LBA con 9 ml de NaCl 0,9% /g x 5 veces a 4 grados Celcius. Previo recuento celular total el LBA se centrifugó 2 veces a 140 g por 10 minutos determinándose proteínas totales y actividad de GGT en el "pellet". Se encontró un aumento significativo tanto de células (p = 0,02) como de proteínas (p < 0,02) y de la actividad de GGT (p < 0,007) en el LBA del pulmón reexpandido comparado con el pulmón contralateral (prueba "t" de student para muestras pareadas). La actividad de GGT se correlacionó lineal r = 0,8 y significativamente p < 0,005; análisis de varianza) con el contenido de proteínas del LBA. Los resultados sugieren que el aumento de GGT en el LBA sería un indicador del daño pulmonar difuso provocado por la reexpansión

Increased levels of leukotriene c4 in bronchoalveolar lavage from patients with pigeon breede's disease

En este estudio se midió la concentración de Leucotriene C4 (LTC4) y de complejos inmunes en el líquido obtenido po lavado broncoalveolar en pacientes con neumonitis por hipersensibilidad inducida por antígeno aviario (n=14), fibrosis pulmonar idiopática (n=5), neumonitis secundaria a artritis reumatoide (n=5), y en sujetos normales (n=4). Se encontró que los pacientes con neumonitis por hipersensibilidad tenían valores de LTC4 maiores que los sujetos normales (mediana, 5 ng/ml y 2.25 ng/ml, respectivamente) con p < 0.05, mientras que los pacientes con fibrosis pulmonar y artritis reumatóide tenían intermedios. Además, de 5 pacientes con neumonitis por hipersensibilidad y LTC4 < 4 ng/ml sólo uno tenía complejos inmunes elevados, mientras que de 9 pacientes con esta enfermedad y LTC4 > 4 ng/ml, 8 tenían complejos inmunes elevados (p < 0.03). Estos resultados sugieren que probablemente el LTC4 constituye uno de los mediadores biológicos que participan en la inflamación pulmonar de la neumonitis por hipersensibilidad inducida por antígeno aviario